You are called to the stable because your horse can hardly move. It is standing in its stall or in the pasture and trying to relieve pressure on its front hooves by placing all its weight on its hindquarters and bringing its front legs forward. This characteristic stance is familiar to many horse owners, and there is little doubt about the diagnosis. Your horse is suffering from acute laminitis. This is one of the most painful conditions a horse can suffer from and, along with colic, is the leading cause of death in horses. Laminitis is always considered an emergency and treatment by a veterinarian is essential.
What happens during laminitis? The name itself suggests that this condition was difficult to research and still is, as "laminitis" comes from Old German and means "stiff limbs." This stiffness is caused by a very painful inflammation of the hoof corium. The hoof corium is the connecting link between the bony hoof bone and the hoof capsule and is also called the hoof bone carrier. This carrier has to withstand extreme loads and therefore consists of interlocking lamellae. Like a kind of zipper, it holds both sides together. In the early stages of laminitis, this leads to a circulatory disorder, which means that the individual lamellae are no longer adequately supplied with blood, become inflamed and detach from each other. Due to increased water retention (edema), the hoof corium swells. Limited by the rigid hoof capsule on one side and the bony hoof bone on the other, this swelling cannot spread in the hoof, causing severe pain. As the condition progresses, the destruction of the suspensory apparatus can cause the hoof to sink and, as a result of the pull of the deep flexor tendon, the hoof bone may also twist. In very severe cases, the tip of the hoof bone breaks through the sole of the hoof. The complete detachment of the hoof capsule, also known as hoof loss, is considered the final stage of laminitis.
The first symptoms noticeable to the owner are usually a stiff, clumsy gait, pain when turning or twisting, a warm hoof, or slight swelling of the coronet. A characteristic symptom is the relief posture that affected horses adopt.in rare cases, all four hooves are affected, and in extremely rare cases, only the hind hooves. If, as in most cases, only the front hooves are affected, the horse will place its hind legs as far under its body as possible in order to shift its weight to the hindquarters and relieve the front legs. These are brought forward as far as possible. When moving, the horse tries to step forward with the rear part of the hoof first. This so-called "heel-to-toe" gait is also a typical symptom of laminitis.
If you notice one or more of these symptoms in your horse, please call the veterinarian immediately. The sooner treatment can be started, the better the progression of the disease can be controlled. A thorough clinical examination by the veterinarian will reveal further typical findings, such as diffuse pressure sensitivity of the sole of the hoof and increased pulsation of the toe artery, which can be felt at the rear edge of the fetlock. An X-ray examination is essential to determine the severity of the disease. It provides information about any subsidence or rotation of the hoof bone and important clues for further treatment and hoof care.
Chronic laminitis develops from acute laminitis and, if not detected in the acute stage, is much more difficult to diagnose as it is often only recognizable by a change in the horse's gait. Radiographically, the chronic stage can be determined from the point at which changes in the position of the hoof bone in the hoof capsule can be detected. Another characteristic of chronic laminitis may be the appearance of a "laminitis hoof." This is characterized by a widened white line, a convex sole, elevated heels, and concave deformation of the hoof wall. This is also referred to as a deformed or bulbous hoof.
To date, the causes of laminitis are not fully understood. However, various risk factors are known, which can be used to distinguish between several types of laminitis. Overloading one or more limbs can lead to stress laminitis. This can occur, for example, due to additional strain on a limb following severe lameness. Feed-induced laminitis, on the other hand, is caused by the consumption of excessive amounts of carbohydrates. This excess carbohydrate leads to a change in the bacterial flora in the intestine, which causes an increase in toxins that are released into the bloodstream, leading to reduced blood flow in the hoof. Young grass, clover, or protein-rich hay can also trigger laminitis, especially in very overweight horses or ponies. Retained placenta or a uterine infection after foaling can also lead to the release of toxins that can trigger what is known as postpartum laminitis.
Metabolic diseases such as equine metabolic syndrome (EMS) or equine Cushing's syndrome (ECS) can also trigger laminitis. Both diseases involve a disorder of sugar metabolism. This leads to a sharp rise in blood sugar levels, as it can no longer be properly utilized. This excess sugar is "poison" for the cells, the blood vessels in the hoof contract and the painful fluid accumulation described above occurs.
It is also thought that prolonged or high doses of glucocorticoids (cortisone) can trigger laminitis. The administration of glucocorticoids must therefore always be discussed with the treating veterinarian in cases of laminitis.
How can I relieve my horse's pain in the first instance? If known, the triggers for the laminitis must of course be eliminated first. In the case of feed-induced laminitis, this means an absolute ban on concentrated feed for this horse. In the case of postpartum laminitis, it must be ensured that the afterbirth has been completely expelled.
The first measure should be to cool the hooves. Ice packs, cooling boots, or wrapping the hooves with ice bags are suitable for this. Thick padded bandages (tip: use disposable diapers) provide initial protection for the sole before the veterinarian arrives. The horse should now rest in a box with thick bedding and under no circumstances be moved on hard ground.
The primary goal of laminitis treatment is to relieve pain and take pressure off the affected hoof. Depending on the age of the horseshoe, it must first be either completely removed (if new) or left in place (if older than four weeks). The veterinarian should decide this on a case-by-case basis together with the farrier. In the case of a shoe that is not completely new, only the toe nails may be removed.
Hoof or plaster casts, modern hoof wedges, hoof boots, or orthopedic horseshoes can prevent the disease from progressing by minimizing the pull of the deep flexor tendon. To do this, the rear, unaffected part of the hoof is raised to relieve the front part, which is referred to as a "toe lift." The veterinarian will administer anti-inflammatory medication to counteract the inflammatory processes in the hoof. As these also relieve pain, strict box rest must be ensured so that the horse does not put too much weight on the affected hooves. Blood thinners or bloodletting with simultaneous infusion may also be useful in some acute cases. Please discuss the exact procedure in each individual case with your veterinarian.
Once the acute phase of the disease has passed, a precisely structured exercise program is just as important as quick and correct treatment. Your veterinarian will draw up an individual exercise plan for your horse based on the findings and the severity of the disease.
It is essential to keep the horse in its stall during the acute phase and to follow the exercise program very carefully, as the hoof's support system takes a very long time to fully recover. Even if the owner no longer notices any lameness, minimal overexertion can cause a relapse if the horse is exercised too much too soon.
Furthermore, adequate feed management must be ensured throughout the course of the disease, even if it is not obviously feed-related laminitis. Fresh grass and high amounts of carbohydrates should be avoided. The feed should be limited to feed that is rich in raw fiber and low in carbohydrates.
Give your horse enough time to recover, as this is the only way to ensure that it can be ridden normally again. Laminitis is a very serious disease that can be life-threatening, but it can be managed well with modern treatment methods and the right care and feeding plan.
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