Life After Laminitis
Your laminitis survivor’s true prognosis depends on how you manage him after the worst is over
One of the hardest things to accept after a horse survives a nasty bout of laminitis is that the battle isn’t over yet. This condition, characterized by painful separation of the laminae that connect the coffin bone to the hoof wall, can leave an indelible mark on the equine victim’s physiology. And in some cases, especially with endocrine (hormone) related laminitis, the battle is never really over. But keeping a level head, remaining patient, and working with your veterinarian can go a long way toward ensuring your horse recovers to lead as normal a life as possible.
To help you get through the post-laminitic period successfully (and sanely!), we’ve worked with veterinarians studying the disease to come up with a list of management do’s and don’ts.
DO: Know what caused the laminitic episode
Not all laminitis episodes are created equal, and the type your horse experiences can significantly affect the way you care for him as he recovers, says Catherine McGowan, BVSc, MACVSc, DEIM, Dipl. ECEIM, PhD, FHEA, MRCVS, head of the Department of Equine Clinical Science at the University of Liverpool, in Leahurst, U.K.
The key piece of information is whether the laminitis resulted from a metabolic or endocrine problem (equine metabolic syndrome or Cushing’s disease being the two primary culprits), an acute insult such as carbohydrate overload, a mechanical failure such as supporting-limb laminitis, or a toxic response such as what happens with a retained placenta. With the latter cases, in contrast to endocrinopathic laminitis, the disease has occurred due to an isolated incident probably unrelated to the horse’s genetic makeup. And the chances of it happening again, says McGowan, are extremely unlikely. The goal during recovery is to keep the horse as pain-free as possible and get him back to where he was before, athletically speaking.
However, if the horse developed laminitis due to metabolic/endocrine disorders, you’re looking at lifelong follow-up and management. The goal now is to not only relieve pain and restore athleticism but also prevent a new episode, she says.
DO: Keep horses confined during recovery
Lock them up? Unfortunately yes, says Andrew van Eps, BVSc, PhD, MACVSc, Dipl. ACVIM, associate professor of equine musculoskeletal research at the University of Pennsylvania’s School of Veterinary Medicine, in Kennett Square. He recommends strict stall rest (with occasional hand-walking and grazing), specifically one week for every day the horse was lame from laminitis.
“Confinement is key (in acute cases),” he says, “because the biggest thing that seems to affect outcome in horses is how they’re treated in the initial period once lameness resolves, as the strength of the lamellar (also called laminar) interface is not restored yet.
“The lamellar structure is really intricate, made up of hundreds of primary and secondary leaflike projections—the lamellae—which provide a meter-squared of surface area of attachment between bone and hoof for each foot, providing massive strength to support all the forces it’s subjected to.”
Laminitis disturbs this attachment, weakening the connection between bone and hoof. While it will never fully regain its original strength, it can come pretty close, depending on the severity of the disease and its management, says van Eps.
“During recovery, the hoof is actually growing down, remodeling that tissue, and that takes time—about a year for the whole hoof to regrow completely from top to bottom,” he says. Exercise, even alone in a paddock, can wreak havoc on the laminae during the repair phase.
DO: Seek special farriery
That foot has sustained some serious trauma, coupled with resulting pain and structural changes. The farrier’s goal with these horses will be to unload the front part of the sole.
“That’s where the bone can push down on the sole and cause them pain, if they’ve had any loss of the normal suspensory function of the lamellae as a result of their laminitic episode,” says van Eps.
Applying corrective shoes, heart-bar shoes, and even resin inserts that cover the back third of the hoof’s ground surface can help make the horse more comfortable, especially once he can be ridden, says McGowan.
But our sources agree that shoes aren’t a requirement post-laminitis. Barefoot trimming is a realistic possibility with a qualified farrier, especially if the horse was barefoot before and particularly in the very early post-laminitis stages when the horse is still lame. The important thing, they say, is to ensure the horse is getting the optimum farriery for his condition while that foot is still growing out.
“That’ll be at least a few shoeing or trimming cycles,” van Eps says.
And be patient with your farrier, McGowan adds. “It’s not an exact process, as each horse is different, and you need to let your farrier have a bit of trial and error before finding the ideal solution for your horse’s specific needs,” she says.
DO: Pay special attention to surfaces
Footing is critical to a horse’s comfort and healing after laminitis. Avoid hard surfaces, as they can cause significant pain in a horse with weakened laminae.
“The damage in laminitis is at the connection between hoof and bone,” says van Eps. “If you’re on a hard, nonslippery surface, when that horse pivots, the hoof is going to stay stuck to that concrete or asphalt, and it’s the bone inside that’s likely to pivot instead.”
The ideal footing for horses post-laminitis? Sand. “Sand gives under the foot, supporting the sole and frog and unloading the wall,” says van Eps. “It eases breakover when walking and allows them to turn easily. And it allows the horse to find a comfortable standing position.”
Owners should even consider putting sand in the stall, van Eps adds. “It’s hard to take care of, but it’s really ideal,” he says. “If necessary, use shavings or straw in half the stall, but keep sand where horses like to stand, like near the windows and under feed areas.”
If sand isn’t available, you might equip recovering horses with hoof boots with custom impression material inserts that conform to the frog/sole or generic soft inserts (e.g., Soft-Ride boots), says van Eps.
DO: Remain optimistic
We hear so many horror stories about laminitis that the immediate response to the diagnosis is often despair. But van Eps and McGowan say there’s hope for post-laminitic horses. Many do get healthy and back to work.
“You can see a practically full recovery in many horses, provided you get the underlying condition under control,” McGowan says. “Even if the coffin bone rotates, the prognosis can still be good.” That infamous rotating bone won’t rotate back, she adds. But the hoof can grow back with a more correct placement of that bone. It might just take a year (and some good trimming) to do so.
DON’T: Ride yet!
It might be tempting, especially if your horse “seems” okay, but riding a post-laminitic horse is definitely ill-advised in the early months. If you want that laminar interface to reconstruct as it should, you’ve got to keep the weight off—specifically, your weight.
“The pain may have resolved, but the hoof might not have the structural integrity to support more weight,” says McGowan. Above all, make sure the horse is off painkillers and you have your veterinarian’s approval before that first ride.
This might seem obvious, but it’s very important. Avoiding overfeeding requires some basic nutritional knowledge of grasses and hays as well as concentrate feeds and even treats, says Sarah Ralston, VMD, PhD, Dipl. ACVN, who recently retired from her long-held post as a professor in the Department of Animal Sciences at Rutgers, The State University of New Jersey, in New Brunswick.
Specifically, know the difference between non-water-soluble and water-soluble carbohydrates—and what your particular horse is sensitive to. A hay analysis can offer useful information about carbohydrates therein.
Starches are non-water-soluble (they don’t dissolve in water) and rapidly fermented in the hindgut, potentially triggering laminitic changes, Ralston says. Simple sugars and fructans are water-soluble carbohydrates that can cause laminitis in horses with endocrine issues, she says.
Hays harvested late in the day and dried quickly are often quite high (>20%) in water-soluble carbohydrates, says Ralston. Soaking hay for 30 minutes in warm water or eight to 16 hours in cold water before feeding can reduce that percentage. But don’t forget to discard the water! It’s saturated with the very water-soluble fractions that our endocrine-related post-laminitis horses should avoid.
Concentrate feeds are probably unnecessary for these horses, unless their hay is of particularly poor quality or they have returned to work after a full recovery, Ralston says. And even then, a good hay balancer should suffice for all but the very hardest of keepers.
Natural treats such as apples, carrots, and even celery can be welcome candy to a horse recovering from laminitis, she adds. However, avoid commercial treats, which are often high in sugars.
DON’T: Judge just by looking
Do you think your horse looks better physically? When it comes to managing horses with laminitis, nothing can replace the reliability of laboratory blood tests. These can include endocrine (insulin and adrenocorticotropic hormone) tests to pinpoint and monitor the inciting cause and general blood tests to help identify side effects (renal and gastrointestinal disease) from lengthy anti-inflammatory use for pain management, van Eps says.
Regardless of what caused the laminitis, radiographs are an important tool for monitoring the disease. They can reveal any bone remodeling, bone rotation, and damage to the laminar structures.
“Radiographs over a two-week and then one-month interval (post-laminitis) are useful,” van Eps says. “A lot of the changes can appear weeks to months even after lameness has disappeared.” Radiographs can also help farriers know how to best treat their laminitic patients.
DON’T: Cheat on care
You feel for your poor post-laminitic horse, waiting for what seems like forever in his prisonlike stall. But remember it’s in his best interest. “Owners feel like they’re torturing their horses, but those horses don’t want to be crippled in the long run or die!” van Eps says.
So despite your best intentions, don’t try to get around your veterinarian’s advice. Keep the horse on stall rest—even if he looks unhappy—but give him lots of love and hand-walking. And don’t try to win his heart through his stomach; overfeeding him will only make him worse.
“Whatever happens, don’t lie to your veterinarian,” van Eps adds. “We really need to know what’s going on with these post-laminitic horses, whatever it is.”
Laminitis is a disease that can have severe consequences. But if treated appropriately throughout the entire recovery period, horses have every chance of returning to full athletic potential. Know the type of laminitis you’re dealing with and degree of damage, follow your veterinarian’s advice, and be realistic about healing times and prognosis—all while keeping an optimistic outlook, for both you and your horse.
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