Laminitis is one of the most painful diseases in horses. In the acute stage, it is always an absolute emergency. If left untreated, it can lead to a horse's limited or permanent unusability, permanent suffering and even the loss of any quality of life.
Laminitis in Horses: Definition and Progression
Laminitis develops as an inflammation of the hoof corium. As a result of the disease, the hoof corium swells so that the blood circulation in the hoof is disturbed. The swelling cannot expand in the hoof capsule, resulting in severe pressure pain.
Medically, laminitis is also known as laminitis —an inflammation of the laminae (thin layers) that connect the hoof bone to the hoof capsule. Learn more about the anatomy and function of the hoof corium in our separate guide.
In the further course of the disease, the hoof corium becomes very painful and partially or completely detached from the horn capsule. In very extreme cases, the horn capsule detaches completely (loss of horn capsule).
Mild and slowly progressing laminitis
Mild, insidious symptoms of laminitis are often overlooked. In veterinary medicine, this is also referred to as subclinical laminitis —the horse shows no dramatic signs, but harmful processes are already taking place within the hoof. A temporary lack of enthusiasm on the horse’s part may be interpreted as laziness. With a bit of luck, everything returns to normal after a few days. Only an attentive farrier might notice a slightly widened white line with signs of hemorrhaging or non-parallel hoof rings on the hoof wall.
Here too, there may already have been a slight change in the hoof bone position with a deviation of the hoof shape from the normal state. When a first relapse of laminitis occurs without improving keeping conditions and exercise, further, more severe relapses usually follow.
Typical signs of insidious (subclinical) laminitis:
● Reluctance to walk on hard ground
● Occasional weight-bearing on the front legs while standing
● Slight warming of the hooves (not always noticeable)
● Widened white line during hoof trimming
● Uneven or diverging hoof rings
That is why it is especially important to watch for the subtle symptoms of laminitis and interpret them correctly in order to prevent further damage.
Acute laminitis
In the case of a moderate, acute bout of laminitis, the signs are more obvious and should definitely be noticed by the attentive horse owner. The gait is reluctant, sluggish, clumsy.
In the acute phase of severe laminitis thrush, the horse can hardly move due to the pain and can only stand in pain. The more severe the laminitis, the more severe the inflammation and the resulting damaging effects on the structures in the hoof.
All laminitis episodes are absolute emergencies for the vet and cannot be postponed!
Chronic laminitis
In the chronic phase, the acute hoof dermatitis has subsided. The painful changes to the structures in the hoof have largely come to a standstill. The horse must now somehow cope with the damage inside the hoof capsule and all the resulting damage.
Healing, i.e. restoring the original shape and functionality of the hoof, is sometimes possible over a long period of time, depending on the severity of the damage.
Recognizing Laminitis: An Overview of Symptoms
Symptoms of acute laminitis
One of the first (often overlooked) recognizable symptoms of acute laminitis is a slight warming in the area of the heels and the overlying suspensory ligament. As the disease progresses, the entire hoof may become warm to the touch. A strong pulsation may be felt on the inside of the fetlock joint. The horse is reluctant to move, with short, hesitant steps and noticeable pain when turning. When standing, it often lifts the affected legs alternately due to the pain.
This can lead to the typical "laminitis posture". The horse shifts its center of gravity to the heels in order to relieve the toe area. The front and hind legs are pushed forward. Picking up a leg can become difficult or even impossible. If the horse is given the opportunity, it usually wants to lie down to take pressure and tension off the hoof structures.
The acute phase usually lasts 2 to 3 days. Due to the severe inflammation and swelling of the hoof corium, the blood supply to the hoof corium is significantly reduced. After this, the horn capsule is no longer warm, but cold.
Symptoms of chronic laminitis
Due to the severe inflammation in the acute phase, the connection between the coffin bone and the toe wall was destroyed. The coffin bone is pulled backwards and downwards by the pulling effect of the deep flexor tendon (coffin bone rotation). As a result, the tip of the coffin bone can even penetrate the sole of the hoof.
In most cases, the coffin bone also sinks downwards (coffin bone subsidence) due to the defective suspension apparatus in the horn capsule. The chronic stage begins with these changes of the position of the coffin bone. The painful inflammation usually subsides over the next few weeks, but the change in the horn capsule remains. As the condition progresses, the shape of the hoof eventually changes noticeably.
Typical symptoms of chronic laminitis are
- Increased heel first landing
- Widening of the white line in the toe area.
- Development of the beak hoof (toe wall moves away from the front)
- Heel gets higher
- Formation of a misshapen hoof
- Little to none or even convex curvature of the hoof sole.
- Pressure-sensitive hoof sole
- Growth rings of the hoof wall that are not parallel but diverge towards the heels
Even after the acute inflammation has subsided, the horse usually remains sensitive on the sole of the hoof, and shows a restrained gait. It avoids hard ground. It often puts more weight on the heels when walking or standing to relieve the toe area. The horse's appearance and posture change for the worse.
What are the causes of laminitis in horses?
The causes of laminitis are varied and complex, and new findings and correlations are constantly being added. It is often a combination of several causes. Obesity plays a decisive role in most horses.
Fodder laminitis
The best known and probably most common cause is incorrect feeding. A sudden change in the intestinal environment due to an individual or sudden excess of starch, sugar or fructans causes crude fiber-digesting bacteria to die off and release massive amounts of toxins. This can then lead to inflammatory reactions in the hoof corium.
A typical example is starting the grazing season without gradually acclimating the horse to the grass. Grazing at times when the fructan content of the grasses is particularly high, or a sudden, significant change in diet—such as switching from hay to haylage or introducing concentrated feed—can also trigger laminitis.
What are fructans, and when are they dangerous?
Fructans are storage carbohydrates that grasses accumulate when under stress. The fructan content in pasture grass is particularly high when:
● Frost and sunshine occur simultaneously (typically in spring and fall)
● The grass is under drought stress
● Rain falls suddenly after a prolonged dry spell and the grass grows rapidly
● Temperatures are below 5°C, but the sun is shining
obesity
The ticking time bomb. Often undiagnosed, it is linked to metabolic disorders such as EMS (Equine Metabolic Syndrome). These horses have often already experienced minor bouts of laminitis that went unrecognized, until the proverbial straw breaks the camel’s back and triggers a truly severe episode of laminitis.
How can I tell if my horse is overweight?
The so-called Body Condition Score (BCS) helps with this assessment. It uses a scale of 1–9 to evaluate how much fat the horse has put on. A BCS of 5 is considered ideal; a score of 7 or higher indicates that the horse is overweight. Typical signs of excess weight are:
● Fat deposits at the mane line (whipperig)
● Fat deposits at the base of the tail
● Fat deposits above the eyes
● Ribs difficult or impossible to feel
● Lack of a waistline when viewed from above
If in doubt, the veterinarian can determine the BCS and help manage weight loss.
Exertional laminitis (mechanical laminitis)
Overloading of the hoof sole due to mechanical impact, e.g. uneven hard ground (unpaved paddocks during long periods of frost), high speed on hard ground (endurance rides), barehoof rides on hard uneven ground.
Chronic diseases such as Equine Cushing's Syndrome (ECS) and Equine Metabolic Syndrome (EMS)
Horses with EMS or ECS are more likely to suffer from laminitis due to the disturbed insulin or hormone balance.
Medication
Some horses, especially if they already have a metabolic problem, react to cortisone treatment, for example with laminitis.
Poisoned laminitis
Triggers can be contamination of the feed (e.g. borreliosis bacteria), but also poisonous plants, moldy bread and insecticides in the feed.
Postpartum laminitis
Poisoning can for example, can also be caused by only partial shedding of the egg membrane/afterbirth after the foal has been born.
Irritation of the coronary band
Vasodilating ointments can lead to irritation of the coronet band.
Is my horse at risk? Quick check
Not every horse is equally prone to laminitis. With this quick check, you can assess whether your horse is at risk:
Your horse is considered at risk if several of the following apply:
- Pony, Icelandic horse, Haflinger, Norwegian horse, or other hardy breed
- Visible excess weight or fat deposits (BCS > 6)
- Has had a bout of laminitis in the past
- A diagnosis of EMS or Cushing's disease (PPID) has been made
- Little exercise despite an abundant food supply
- Hooves are often warm, or the horse is sensitive
- A pulse can often be felt in the fetlock arteries
- Age over 15 (increased risk of Cushing's syndrome)
The more of these points apply, the more important preventive measures such as controlled pasture management and adjusted feeding become.
How can laminitis be treated in horses?
Acute laminitis: What can the owner do?
The vet should be contacted immediately when the first symptoms of laminitis are recognized, as this is an emergency! Rapid treatment of laminitis within the first 48 hours can avert or reduce the chronic stage.
5 tips for acute laminitis treatment
- Movement is harmful: every step leads to further laceration of the connection between the horn capsule and the coffin bone. It is therefore important to provide the horse with deep (at least 30 cm), soft, yielding bedding (shavings, peat, sand or similar). Straw is unsuitable. The horse should be able to stick its toe down into the bedding without much effort and lie down. (Practical test to see if the amount of bedding is sufficient: From a standing position, let yourself fall onto your knees with a swing. Is the landing soft and comfortable?) Lying down reduces the pull of the deep flexor tendon on the coffin bone. This reduces the risk of rotation of the coffin bone. The vet will probably prescribe anti-inflammatories. These also have a pain-relieving effect. However, this must not lead to the horse moving more again.
- Permanent cooling of the hooves: It is often recommended to cool the hoof to reduce inflammation. This does not work with laminitis! After each cooling, the part of the body reacts with increased blood circulation, which means that the inflammation is stimulated again. Cooling only works for acute laminitis if the cold stimulus (ice water) remains on the hoof for at least 72 hours. This means constantly monitoring and renewing the compresses over this period. Alternatively, the horse can be placed in flowing water (paddock in a stream) for this period. This is only possible if the horse can comfortly stand.
- Naturopathy: Naturopathic methods (e.g. homeopathy or leeches) can be supportive.
- Diet for obese horses: If the horse is obese, you should use the period of rest in the stable to carefully put the horse on a diet. However, you should seek professional advice here. Simply reducing the amount of forage too much can be dangerous.
- Care products:You should use the White Line with a suitable care product, e.g., Keralit Hoof Hardener. The prerequisite for this is that the horse can allow its hooves to be handled without pain.
Transition to the chronic phase: What should be done?
After a few weeks of rest in the box, the horse should be able to stand on its four legs and move freely in a suitable exercise area without painkillers.
Any forced movement (including bullying by other horses) should be avoided. The hoof trimmer can then try to gradually restore the position of the coffin bone parallel to the hoof wall. An informative x-ray image of the position of the coffin bone is helpful.
Restoring the original, functional hoof shape is a long process and takes at least as long as it takes for the hoof horn to grow completely downwards from the coronary band(at least twelve months). Stability between hoof capsule and coffin bone is regained only when this has happened. Only then can the horse be carefully loaded again. If the load is applied too early or too heavily (rider's weight, surface, speed), new damage will be inflicted again, leading to further inflammation of the hoof corium.
Professional correction of the hoof must continue to be carried out meticulously. It can take several months to years until the original, functional hoof shape is restored. Permanent sensitivity often remains on the sole of the hoof. A complete restoration of the horse's performance is usually questionable. Depending on the severity of the damage, it may already be a success if the horse can live pain-free without any exercise.
Chronic laminitis: How to help your horse
It is not always possible to completely restore the hoof shape and coffin bone position.
Hooves damaged by laminitis have a dilated white line. Their structure is softer and provides an open attack surface for bacteria and fungi. Small stones are easily pushed in. All this further damages the white line. This often leads to an increase of hoof abscesses
A clean, dry stable and paddock in combination with routine care can improve the delicate hoof horn. The daily, dry cleaning of the white line and a care product to protect against horn decomposition, such as the Keralit Hoof Hardener is very useful. As a result of the altered horn capsule, small cracks and fissures appear in the hoof wall. These are also entry points and a fertile ground for fungi and bacteria, which damage the hoof wall even more. The Keralit hoof bath counteracts the horn decomposition processes.
Hooves damaged by laminitis are sensitive on the sole. Hard ground, gravel and hard unevenness (stones on the ground) cause pain and can trigger a new inflammation of the hoof corium. Barehoofed horses with laminitis therefore need soft, yielding ground without stones, whether in the paddock or on excursions.
A suitable hoof boot can be helpful for short distances. Alternatively, a permanent hoof protection (laminitis shoe) should be applied, preferably with pad and packing (e.g. Luvex laminitis pad) to protect the sensitive hoof sole.
A suitable product should be placed between the hoof sole and pad to protect against white line disease, e.g. Keralit Undercovershould be applied. In the case of horseshoes, prolonged hot-fitting can
trigger a new problem on the dermis of the hoof.
The weight of the horseshoe or shoe should be kept as low as possible. Plastic hoof protection, either nailed or glued, can be a good alternative.
Rider weight and speed increase the strain on the hoof. It is essential to pay attention to signs of pain during exercise.
Preventing a recurrence of sciatica
A horse that has already experienced a flare-up of laminitis is at high risk for further flare-ups. It is essential to meticulously address any potential causes. If the horse is overweight, the following should be taken into account:
- Adjust the amount of feed (weigh the hay!)
- Low-fructan and low-energy hay, straw (be careful not to use too much, as there is a risk of constipation!)
- Non-toxic, suitable branches to nibble on as an activity
- No grazing or severely restricted grazing (which greatly increases the risk of a relapse)
- Supplemental feeding with a mineral feed tailored to horses with laminitis, such as ATCOM Rehe-Vital – sugar-free and specially developed for horses with sensitive metabolisms
Safe pasture management when there is a risk of laminitis
For horses with a history of laminitis or an increased risk of developing it, pasture management is crucial. The greatest danger comes from grass high in fructans.
When is grazing particularly risky?
| condition | fructan content | Recommendation |
| A frosty night + a sunny morning | Very high | Avoid pastures |
| Cool (below 5°C) + sunny | High | Short time slots, eating restrictions |
| After a dry spell + rain (growth spurt) | High | Caution |
| Mild, cloudy, no frost | Lower | More relaxed |
| In the afternoon when the weather is warm | Lower | A better time slot |
Practical tips:
● Eating Brake/Muzzle: Significantly reduces grass intake
● Best time: Better in the afternoon than in the morning after a frost
● Paddock alternative: A dry paddock without grass is safer
● Hay before grazing: Fills the horse up beforehand and reduces cravings for grass
● Grazing: Gradually increase in the spring (starting with just 15–30 minutes)
Soaking hay and feed analysis
For horses with metabolic issues or those recovering from laminitis, it may be beneficial to reduce the sugar and fructan content in their hay.
Soaking hay – here's how:
● Soak the hay in cold water for 30–60 minutes
● The water binds water-soluble carbohydrates (sugars, fructans)
● Important: Discard the soaking water; do not feed it to the horse
● Feed soaked hay promptly (do not leave it standing—risk of mold)
● Soak for a shorter time in the summer, as bacteria multiply more quickly
Hay Analysis: If you want to be on the safe side, you can have your hay tested in a lab for sugar and fructan content. As a general guideline, the combined sugar and fructan content should be less than 10%.
Chances of recovery from laminitis
The earlier laminitis is recognized in the acute stage and the faster suitable measures are taken, the greater the chance of reducing or even preventing negative changes in the horn capsule.
Once the inflammation has subsided, x-rays provide information about the damage that has occurred. In rare, fortunate cases, the coffin bone is still in its old position and the connection to the hoof capsule has been preserved. After a few weeks, the laminitis can be regarded as healed and the horse is spared a chronic progression.
In typical chronic cases, healing can only take place if the original shape and functionality of the hoof can be restored. Depending on the severity of the damage, this can take months to years or may not be possible at all.
How do I prevent laminitis?
- The most important measure to prevent feed-induced laminitis is to avoid obesity of the horse. The calculation of the body condition score, a horse scale and advice from the vet make it easier to assess the feed condition.
- Correct feeding and grazing with a sense of proportion as well as sufficient exercise stimulate the metabolism and reduce the risk of EMS.
- Theright hoof protectionor a trulysuitable surface for walking—both in the paddock and during trail rides—should ensure that the horse moves frequently and enjoys doing so. Learn more in our guide to the basics of horse hooves.
- Starch and sugar-reduced feed, hay from low-energy grass varieties, plenty of activity and exercise stimuli are the corner stone.
- Your veterinarian can provide guidance on all cases of laminitis predisposition caused by pre-existing conditions. A mineral supplement specifically formulated for horses with laminitis, such as ATCOM Rehe-Vital can be fed as a supplement.
Which horse breeds are particularly at risk of laminitis?
The greatest danger certainly exists for horse breeds that genetically come from an area with a rather meagre, low-energy feed supply. These include in particular the robust horse breeds such as Icelandic horses, Shetland Ponies, Norwegians and Haflingers, but also Iberian horses, breeds from South America and Arabian horses. These horses are not genetically bred for our Central European pastures with their rich feed supply - especially not in combination with too little exercise.
Horses that easily gain weight are prone to obesity and thus to suffer from metabolic laminitis. However, the risk of obesity affects all types of horses.
Frequently Asked Questions About Laminitis in Horses
How long does an episode of laminitis last?
The acute phase of a laminitis episode usually lasts a few days. During this time, damaging processes take place within the hoof. The sooner treatment is administered, the less severe the damage will be. However, the subsequent recovery phase can last anywhere from weeks to months, depending on the severity of the episode.
How long does a horse with laminitis need to be kept in a stall?
The horse should be kept in the stall for at least 2–4 weeks until it is pain-free and a veterinarian has confirmed that the condition has stabilized (possibly via X-ray). In severe cases, the rest period may last several months. It is important to provide thick, soft bedding (at least 30 cm deep) so that the horse can lie down.
Can laminitis be cured?
It depends on the severity. With early treatment and minimal or no rotation of the navicular bone, a full recovery is possible. In severe cases involving significant sinking or rotation of the navicular bone, a full recovery is often not possible. However, many horses can lead pain-free lives with appropriate management.
Can a horse in rehabilitation ever go back out to pasture?
This is a decision that must be made on a case-by-case basis. Many horses in rehabilitation can graze again in a controlled manner with strict pasture management (using a grazing muzzle, limiting grazing times, and avoiding risky situations such as frost and direct sunlight). For horses with EMS or recurrent episodes, permanently avoiding pasture is often the safest option. Discuss this with your veterinarian.
How can I tell if my horse has EMS or Cushing's disease?
Typical signs of EMS include obesity, fat deposits (especially along the mane), laminitis with no apparent cause, and insulin resistance. Cushing’s (PPID) often manifests as a long, curly coat (even in summer), delayed coat shedding, muscle wasting, increased thirst, and susceptibility to infections. A veterinarian can diagnose both conditions through blood tests.
What is the difference between acute and chronic laminitis?
In acute laminitis, there is active inflammation of the hoof corium—the horse experiences severe pain, has warm hooves, and can barely move. Chronic laminitis describes the condition following the inflammation: the hoof bone has shifted position (rotation/sinking), and the hoof shape is permanently altered. The horse is often tender and sensitive, but the acute inflammation has subsided.