Laminitis remains one of the most devastating conditions affecting horses, but recognizing subtle signs and addressing the underlying cause early can improve long-term outcomes. During his presentation at the 2026 American College of Veterinary Internal Medicine Forum, held June 11-13 in Seattle, Washington, Andrew van Eps, BVSc, PhD, Dipl. ACVIM, professor at the University of Pennsylvania’s New Bolton Center, in Kennett Square, said successful treatment depends on identifying hoof damage before irreversible changes occur and tailoring therapy to the type of laminitis affecting the horse.

What is Laminitis in Horses?

Laminitis occurs when the lamellae, or the tissues that suspend the coffin bone (distal phalanx) within the hoof capsule, lose their structural integrity, allowing the attachment between the hoof wall and bone to fail. Van Eps listed three primary causes of laminitis: hyperinsulinemia-associated (endocrinopathic) laminitis; sepsis-related laminitis; and supporting-limb laminitis (when a horse with severe injuries develops laminitis in any of the other three limbs, especially the leg opposite the injury). Each damages the lamellae differently, so the prognosis and treatment of individual laminitis cases vary.

Diagnosing Laminitis in Horses

One of the biggest challenges is recognizing laminitis before obvious lameness develops. “Many horses with chronic laminitis show few or no outward clinical signs,” said van Eps. Sport horses might exhibit only behavioral changes or reluctance to work. He added that researchers found radiographic evidence of chronic laminitis in many horses that had never been diagnosed previously, highlighting the importance of imaging even when veterinarians suspect subtle disease.

While radiographs remain the clinical standard, van Eps also highlighted how positron emission tomography (PET) is expanding researchers’‘ understanding of laminitis. Unlike radiographs, which allow the veterinarian to detect structural changes after damage has occurred, PET allows them to identify areas of active bone remodeling and evaluate tissue function. In his research he showed even horses with subtle or seemingly inactive chronic laminitis can have ongoing inflammation within the lamellae and active remodeling of the distal phalanx, suggesting disease activity might persist long after an acute episode resolves.

Treating Laminitis in Horses

Laminitis treatment begins with identifying and aggressively managing the underlying cause, which might require additional diagnostic testing when the trigger is not immediately apparent.

 “Horses with hyperinsulinemia-associated laminitis need prompt insulin control through dietary management and, when appropriate, sodium-glucose cotransporter-2 (SGLT2) inhibitor therapy,” said van Eps. In horses with sepsis-related laminitis, controlling local and systemic inflammation remains the priority.

Beyond treating the cause, veterinarians should protect the damaged lamellae while they heal. Van Eps recommended confinement, frog and sole support, and strategies that reduce tension on the deep digital flexor tendon, such as easing breakover with therapeutic shoeing or orthotics. “Pain management also plays a critical role, but analgesia should be balanced with strict confinement and a controlled return to exercise to avoid additional mechanical damage before the lamellae have recovered,” he said.

Take-Home Message

Early recognition, appropriate imaging, and prompt treatment give veterinarians the best opportunity to preserve hoof function and improve long-term soundness in laminitic horses.