Laminitis in Horses: Causes, Prevention and Recovery Guide

Reviewed by Dr. Ali Ehtisham, DVM

Laminitis is not just a hoof problem. It is a whole-body inflammatory crisis that can permanently disable or kill a horse. It is one of the most common causes of severe, chronic pain in horses and one of the leading causes of euthanasia. Every horse owner needs to understand laminitis before it happens — not after. This guide covers the causes, early warning signs, what to do in an emergency, and how to meaningfully reduce the risk.

What Is Laminitis?

Laminitis is inflammation of the laminae — the highly specialised, interlocking tissue that suspends the pedal bone (coffin bone / P3) within the hoof capsule. Think of the laminae as thousands of tiny velcro-like interdigitating leaves that connect the pedal bone to the inner hoof wall. In a healthy hoof, these laminae bear the horse's entire weight, anchoring the bone securely within the hoof capsule with remarkable strength.

During a laminitic episode, the blood supply to the laminae is disrupted — in some cases excessively reduced (ischaemia), in others abnormally shunted, and in all cases resulting in inflammatory cell infiltration and tissue destruction. The laminae begin to fail. The interlocking tissue that suspends the pedal bone weakens. Without the structural integrity of healthy laminae, the deep digital flexor tendon — which constantly exerts downward pull on the back of the pedal bone — begins to rotate the bone downward within the hoof capsule. This is pedal bone rotation: the most serious structural complication of laminitis.

In the worst cases, the pedal bone does not just rotate but sinks — dropping straight downward within the hoof capsule, potentially penetrating through the sole of the foot. Even without penetration, significant rotation and sinking cause permanent damage to the internal hoof architecture that can never be fully reversed.

The pain of laminitis is extreme. The inflammation, tissue destruction, and structural disruption within the confined bony hoof capsule creates pressure that has been described in clinical literature as comparable to the most severe musculoskeletal pain a horse can experience. Horses with acute laminitis are genuinely suffering, and their care is an emergency.

What Causes Laminitis in Horses?

Rich pasture — fructan overload. This is the most common cause, particularly in spring and autumn. Grasses accumulate non-structural carbohydrates (NSC), primarily fructans, during periods of rapid growth and under certain weather conditions (cold nights, warm days, high sunlight). When a susceptible horse or pony consumes large quantities of high-fructan grass, the fructans reach the hindgut in undigested form and cause rapid fermentation, disrupting the gut microbiome and triggering a systemic inflammatory response that ultimately reaches the lamellar tissue. Ponies, native breeds, overweight horses, and those with metabolic conditions are particularly susceptible.

Grain overload. Accidental access to large quantities of grain, cereals, or starchy concentrate feed causes a starch overload in the hindgut, producing a similar inflammatory cascade to pasture-associated laminitis. This is an acute emergency — a horse that has broken into the feed room and consumed large quantities of grain needs immediate veterinary attention even before clinical signs of laminitis develop.

Obesity and insulin resistance. Equine metabolic syndrome (EMS) — characterised by obesity, regional fat deposits (particularly in the crest), and insulin dysregulation — creates a chronic underlying susceptibility to laminitis. Abnormally elevated blood insulin concentrations directly damage lamellar tissue even in the absence of the traditional carbohydrate overload trigger. This endocrinopathic laminitis is increasingly recognised as the most common form.

PPID (Cushing's disease). Pituitary Pars Intermedia Dysfunction — Cushing's disease — is extremely common in horses over 15 and causes insulin dysregulation, immune dysfunction, and abnormal cortisol-like hormone production. PPID horses are at high risk for laminitis year-round, not just during spring grass periods. Testing for PPID is an essential management step for any horse over 15 with laminitis history.

Prolonged hard surface standing. Supporting limb laminitis can develop in the opposite limb of a horse bearing excessive weight due to a severe injury in one leg. When a horse cannot bear weight on one limb and is forced to support their weight entirely on the opposite limb for extended periods, the mechanical load and altered circulation in the supporting limb can trigger laminitis. This is a secondary complication of severe lameness and one of the most difficult clinical scenarios in equine medicine.

Retained placenta in mares. Mares that fail to pass the placenta within 3 hours post-foaling are at high risk of septic laminitis triggered by systemic endotoxaemia. Retained placenta is a veterinary emergency — the risk of laminitis alone makes immediate veterinary intervention mandatory.

Early Warning Signs Every Owner Must Know

Pottery or shuffling gait. An early laminitic horse moves with an uncharacteristically careful, cautious gait — placing feet deliberately, appearing reluctant to land on the toe, and moving as if the ground is painful. On hard surfaces this may be very apparent; on soft ground it can be subtle. Any change in your horse's way of going on hard ground warrants careful observation.

The laminitis stance — leaning back on heels. The classic laminitis stance, particularly in the front feet, involves the horse standing with their front feet placed further forward than normal and their weight shifted back onto their heels. This reduces the painful loading of the front of the foot. When combined with hind feet brought further under the body to take weight off the fronts, this posture is highly characteristic of front foot laminitis.

Reluctance to move or turn. A horse with early or mild laminitis may seem fine standing still but reluctant to move — particularly reluctant to turn on a small circle, which loads the medial and lateral walls of the hoof unevenly. Forced turning may produce obvious discomfort.

Bounding digital pulse. In a healthy horse the digital pulse (felt at the back of the fetlock on either side of the midline) is very faint or undetectable. A bounding, clearly palpable digital pulse — felt as a consistent, forceful throbbing under gentle finger pressure — is one of the most reliable early indicators of foot inflammation. Learn to check and know your horse's normal pulse before a crisis occurs.

Warm hooves. Acutely inflamed hooves are warm to the touch compared to the horse's normal hoof temperature. Run the back of your hand along the hoof wall and compare to your horse's usual temperature. Significant warmth above normal is a laminitis sign, particularly when combined with a bounding digital pulse.

Lying down more than usual. A horse in significant foot pain may choose to lie down more than normal to relieve the weight-bearing pain. Increased lying-down behaviour — particularly when combined with the above signs — is a welfare indicator that veterinary assessment is urgently needed.

What to Do If You Suspect Laminitis

Call your vet immediately. Laminitis is an equine emergency. Every hour of delay in treatment is potentially more structural damage. Do not wait to see if it improves overnight. Call your vet, describe the signs, and follow their instructions. If your regular vet is unavailable, call an emergency equine practice.

Remove the horse from grass immediately. If the horse is on pasture, bring them in. Do not wait to confirm the diagnosis — if you suspect laminitis, grass access must stop now. If the horse is difficult or painful to move, use a trailer or seek guidance from your vet.

Deep, supportive bedding. Provide deep, soft bedding — sand is ideal as it allows the horse to dig in and position their feet for maximum comfort; deep shavings or shredded paper are acceptable. The goal is to provide a yielding surface that reduces concussion and allows the horse to adopt their own most comfortable foot position.

Do not walk the horse unnecessarily. Walking a laminitic horse — a traditional but now discredited approach — causes mechanical stress to the already-compromised lamellar tissue and worsens structural damage. Keep the horse as still as possible until veterinary assessment.

Cold hosing or ice while waiting for the vet. Cold therapy to the feet — cold hosing or standing the horse in ice boots or a bucket of ice water — has good evidence for reducing lamellar damage in early laminitis and is recommended while waiting for the veterinarian. This is one of the most important emergency measures an owner can take.

What the vet will do. Your veterinarian will assess pain severity, examine the digital pulses, check hoof temperatures, and likely recommend X-rays to evaluate pedal bone position. Pain management — typically phenylbutazone (bute) — will be started. They will advise on dietary restriction, bedding, and referral to a farrier for supportive shoeing as needed.

Treatment Options

Pain relief. Phenylbutazone (bute) is the most commonly used anti-inflammatory and analgesic for acute laminitis. It must be used at the dose and duration prescribed by your vet — the lowest effective dose for the shortest required period, given with feed to minimise gastric irritation. It is not a cure but an essential tool for managing pain and inflammation during the acute phase. Omeprazole is commonly co-prescribed to protect the gastric mucosa during bute treatment.

Box rest on deep bedding. Strict box rest on deep, yielding bedding is the foundation of laminitis treatment. The horse should remain stabled until the vet and farrier are satisfied that the acute inflammation has resolved and no further structural damage is occurring. Premature return to turnout or exercise is one of the most common causes of relapse.

Corrective farriery. A skilled equine farrier working with your vet is essential to supportive care. Heart bar shoes, egg bar shoes, and therapeutic shoeing approaches redistribute weight away from the toe, provide additional frog support, and reduce the rotational force on the pedal bone. Regular farriery monitoring is important throughout recovery.

Dietary restriction. Soaked hay (soaked a minimum of 12 hours in cold water, or 6 in warm, to leach water-soluble carbohydrates) replaces all fresh grass and standard hay during the acute phase and beyond. A strip of soaked hay fed in multiple small quantities throughout the day maintains gut motility and prevents gastric ulceration while managing carbohydrate intake. All grain, treats, and supplementary feeds should be removed. A targeted laminitis supplement or low-sugar balancer may be appropriate — discuss with your vet or an equine nutritionist.

Addressing the underlying cause. Treatment of the acute episode without addressing the underlying cause — obesity, EMS, PPID, pasture management — produces only temporary improvement. PPID horses require Pergolide treatment under veterinary supervision. EMS horses require long-term weight management and dietary carbohydrate restriction. Addressing the root cause is the only path to meaningful long-term prevention.

Recovery — What to Expect

Acute laminitis without rotation typically resolves within 2–8 weeks with appropriate management, and the horse can gradually return to work over the following months under veterinary and farrier guidance. Serial radiographs (X-rays) every 6–8 weeks monitor pedal bone position and guide the farriery and return to work timeline.

Chronic laminitis — repeated episodes or a single severe episode — may result in permanent changes to the internal hoof structure. Some horses with chronic laminitis live comfortable lives with careful long-term management: controlled grazing, regular specialist farriery, dietary restriction, and management of underlying metabolic conditions. Other horses with severe rotation or repeated refractory episodes cannot be maintained in a comfortable and humane condition, and euthanasia on welfare grounds becomes the kindest option. Your vet will guide you honestly through this assessment.

Prevention — How to Reduce the Risk

Grazing management. Strip grazing, track systems (allowing access only to a track around the perimeter of the field), and grazing muzzles (which reduce but do not eliminate grass intake) are all effective tools for managing high-risk horses. Avoid turnout on frosty mornings — grass accumulates fructans overnight in frost conditions and is particularly high-risk immediately after sunrise. Late afternoon and evening grazing on lush pasture is highest risk; early morning before the sun has dried the dew is typically lower.

Body condition score monitoring. Body condition score your horse monthly — ideally using the Henneke 9-point scale — and act on creeping weight gain before it becomes obesity. A horse maintained at a score of 3–3.5 has significantly lower metabolic laminitis risk than one at 6–7. Fat deposits over the crest, ribs, and hindquarters in a horse that appears otherwise fit are warning signs of EMS.

Regular farriery. Maintaining good hoof balance and wall integrity through regular farriery (every 6–8 weeks for most horses) supports hoof health and makes it easier to identify early changes in hoof quality or conformation that might indicate developing problems.

PPID testing for horses over 15. An annual ACTH (adrenocorticotropic hormone) blood test is recommended for all horses over 15 — ideally in autumn when PPID horses show highest ACTH values and are at highest laminitis risk. Treatment with Pergolide in PPID-positive horses significantly reduces laminitis risk.

Frequently Asked Questions

Can a horse fully recover from laminitis?

For mild first-episode cases treated promptly, yes — full recovery and return to work is possible. Severe episodes with pedal bone rotation carry a more guarded prognosis. Early intervention is the most important factor in outcome.

What should I never feed a laminitic horse?

Fresh grass, grain, cereals, starchy concentrates, and high-NSC hay. Replace with soaked hay (12 hours minimum) tested to be low in water-soluble carbohydrates, and feed only approved low-sugar supplements under veterinary guidance.

How do I know if my horse has a digital pulse?

Feel at the back of the fetlock on either side of the midline. A healthy horse has a very faint pulse. A bounding, clearly detectable throbbing pulse is abnormal and a laminitis warning sign. Practise on a healthy horse so you know their normal.

Is laminitis more common in spring?

Yes — spring and autumn are the highest-risk seasons because rapidly growing grass accumulates high levels of fructans. Cold nights followed by warm sunny days are particularly high-risk conditions.

Can laminitis be prevented completely?

Risk can be substantially reduced but not always eliminated. Good management — grazing control, weight management, PPID testing and treatment, regular farriery — dramatically reduces incidence in high-risk horses.

For more on equine health and nutrition, visit our horse care hub. For information on what horses should and shouldn't eat, see our guide on horse nutrition.

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Disclaimer: This article is for educational purposes only. Laminitis is a veterinary emergency — if you suspect your horse has laminitis, contact a licensed equine veterinarian immediately. Do not attempt to manage laminitis without professional veterinary guidance.