I've personally experienced two (now three, as at March 2020) first-hand cases of laminitis with our own family horses. The first was with our daughter's first pony, the adorable Molly, a hardy native type who we bought from a gypsy horse trader.
For those of you who know me, you'll know that with me it only takes one look and that's it - I'm hooked. Well, it only took one look to realise that Molly had full onset chronic laminitis, and to be honest I think that was the reason I took her there and then and didn't even quibble the price. Apart from the fact that I instantly fell for her, I also knew there was no way she was going to be treated appropriately, and I had no intention of letting that happen.
The second time was with daughter's second pony, Dinky. He literally crashed overnight, after we'd only owned him for 6 weeks, and whose management had been entirely lami-preventive. However, by this time we'd moved to an extremely toxic enviroment caused by localised agri crop spraying, and I firmly believe that this was a contributory factor as to why Dinks, and our other horses, became extremely ill as a result of their environment. For the full story, read our chapter ABOUT US.
I learnt so much from Molly and Dinks. When you see how brave and stoic these little ponies are while enduring crippling pain, it’s a humbling experience. Since then, and wearing my EquiNatural hat, I’ve heard so many sad stories from our clients with their horses and ponies enduring laminitis. On the positive side, the good news is that laminitis is one of the most researched and studied equine conditions, and that research is now shouting out two very clear messages :
- Laminitis can affect any horse, any pony, any breed – including TB’s.
- In most cases, Laminitis is PREVENTABLE.
So, what is Laminitis?
Laminitis is a serious inflammation of the sensitive laminae, or layers of tissue, inside the hoof. It is utterly debilitating, and can afflict any horse, young or old, and any breed.
The laminae have just one item in their Job Description – to secure the pedal bone (the wedge-shaped bone within the foot) to the hoof wall. There are two types of laminae in the hoof - the ‘sensitive’ which supports the pedal bone, and the ‘insensitive’ which is attached to the inner hoof wall – and they bind to each other to protect the pedal bone. However, when a ‘trigger’ happens higher up in the system which causes the laminae to inflame (known as ‘acute’ laminitis), the function and form of the hoof as a whole can then be potentially compromised. If not caught in time, the progression of laminitis from ‘acute’ to ‘chronic’ can be swift, and severe.
Research (2012) showed that chronic laminitis is not just limited to the foot, specifically that the digestive and immunity systems also affected, and that it should now be considered a 'multi-system' disease. This is all the more important, considering that the usual conventional vet/farrier route is simply to focus on just making sure the feet are comfortable, without considering preventative measures for gut health and immunity boosting.
Chronic cases are termed as such due to the displacement, or sinking, of the pedal bone (also known as ‘rotation’, although in reality it doesn't actually rotate). The bond between the sensitive and insensitive laminae separates, which means the outer hoof wall can no longer support the bone structure within the hoof. The pedal bone then becomes loose in the hoof structure, and the hoof structure itself becomes ‘mobile’. The horse’s bodyweight, together with pressure from movement, can then cause the pedal bone to displace downwards, tearing through the weakened laminae.
The veins, arteries and the sole corium (a blood filled gel pad which aids in shock absorption and produces the sole horn) surrounding the hoof wall and sole are destroyed as the pedal bone, followed by the leg bone column, sinks (founders) through the hoof and penetrates the sole, devastating the entire hoof. NB – the more the hoof wall is raised, with no sole support, i.e. remedial heart-bar shoes, the further the bone column can sink, which is why there is now a school of thought that doesn't consider shoeing a laminitic hoof for 'protection' appropriate.
If the laminitis gets to this stage, the horse's life could now be seriously at risk, although remarkably it is still survivable. A vet may recommend euthanasia, however, due to the extreme degree of suffering, and the risk of infection.
What's actually happening physiologically
Whether the laminitic trigger is feed induced or brought on by metabolic syndrome, the laminae in the hoof is affected by the disruption of a healthy blood flow to and from the hoof. It’s all about healthy blood flow, and the only way to achieve this is to have a healthy system. A depressed immunity, a poor/inappropriate diet, a sluggish digestive system, leads to overburdened (toxic) blood, which does not a healthy horse make.
Cut to 2013/2014, researchers at the University of Queensland studied blood flow to the hoof in horses in temperate conditions. In normal healthy horses, it was noted that there were periods of normal blood flow interrupted with long periods of very low flow. The same studies were carried out on horses in the initial (low-grade) and ‘acute’ stage of laminitis, which showed that blood flow increased prior to the development of pain.
Those with heat in the hooves (which indicated vasodilation, where the nervous system (CNS) automatically recognises that it must provide more nutrients to metabolically active tissue and so widens the blood vessels and releases excess heat) developed onset laminitis. The studies then showed that if vasoconstriction occurred (where the blood vessels constrict and essentially decrease the blood flow), laminitis did not transpire.
In other words, cool those legs and hooves - cold hosing, ice buckets, whatever you can lay your hands on to reduce the heat and inflammation. Recognising the early signs of laminitis is crucial. Reduce the inflammation and heat, and you could well be on your way to preventing onset laminitis. However, if left untreated, the horse’s life can potentially be put at risk if the bone structure and the hoof wall separates.
How to recognise the symptoms
The early 'acute' state can show early warning signs - uncoordinated movement, anxiety, increased heart rate, immobility, a reluctance to turn. Later signs, but still in the acute stage, may be a rocked-back stance, lameness, reluctance to move forward, and signs of pain such as heavy breathing, flared nostrils, and patches of sweat.
For the record, with Molly and Dinky, both presented with different symptoms - with Molly we had uncoordinated movement and awkward stiff walking; with Dinks we had seriously heavy breathing, anxiety and significant sweating, enough to make me first think that he was having an extreme respiratory pollen reaction.
Whether you see the obvious signs or not, one of the easiest ways to monitor is to check for digital pulses. If your horse or pony is out on grass, check the hooves every day. If you feel the pulse bounding, and/or any unusual warmth in the hooves, or you see the formation of event lines appearing below the coronary band, usually waving down towards the heels, these could be the first signs of the early stages, also known as low-grade laminitis (LGL), and your signal to take preventative action.
Updated March 2020 - Our Mac went down with what our trimmer termed low-grade lami. Heat for sure in his hooves but no sign of event lines, yet he couldn't walk. His pulses, to me, weren't throbbing, just seemed slightly raised, but our trimmer said they were proper throbbing, although he reckoned it was still at low-grade stage. Mac very stoically shuffled into a small corrall we rigged up next to our field shed (we couldn't get him to the yard and a stable) and we got him on our TriBute straight away with a pile of hay. He wasn't really interested in eating, just stood still a lot or laid down. Three days later he was shuffling, Day 4 we let him back out with his buddies with a muzzle. He shuffled within his comfort levels while staying on the TriBute for a week in total, then we switched him down to our DuoBute for the summer. He's high up on the Metabolic Spectrum, full onset IR, very cresty/fat-pads, and at the ripe age of 20yo this is the first lami bout he's had with us in 4-yrs. Needless to say he's permanently on lami-watch.
Early intervention is critical
Get your horse off the grass immediately and treat with cold therapy, i.e. cold hosing or cold-water bucket soaking, with ice-cubes in the water if you can get them (never use ice directly on the skin as it can destroy skin tissue) to help reduce the inflammation.
Apply for 15-30 minutes every few hours for a few days until you notice a significant difference. If your horse develops laminitis, your horse is now experiencing severe pain and inflammation which need immediate addressing. Call the vet immediately and continue to apply cold therapy which will help reduce the inflammation and potentially reduce any damage.
If your horse can move, get him onto a soft, deep bed or a conformable surface with as little pressure on the sole as possible. Bring a field buddy in with him so he has company, to help reduce any stress he may be feeling. If he can’t move, don’t force him as this can cause physical damage to the hoof structure – far better that the vet sees the horse where he is comfortable.
What can we do?
With research demonstrating that the first part in the process of developing laminitis is from overburdened blood-circulation trigger factors, preventing laminitis is all about healthy blood flow. To achieve this, we simply have to keep our horse as healthy as possible.
- Keep your horse’s immune and digestive system strong and healthy. Treat all illnesses and conditions appropriately to maintain as healthy a horse as you can. And keep your horse happy - turnout, company, movement. A depressed horse will have a weakened immunity.
- Diet, Diet, Diet - Fibre, Fibre, Fibre. No sugar, no molasses, check ingredients and analysis on processed feed bags. Feed your horse like a horse with clean, healthy forage and fibre – it really is all he needs.
- Add a spoonful of Bicarb of Soda to daily feed, or offer a water bucket with bicarb in it, to help with hind gut acidosis.
- Become Grass-Aware! Horses cannot digest fructans - they travel straight to the hind gut where they ferment. Cue hind-gut acidosis.
- Spring/Summer. Look at setting up a track system which is incredibly easy to implement, and allows plenty of movement while keeping grass consumption down.
- Don’t be fooled by 'foggage'. The brown grass you see in late autumn? Spread it apart and you’ll more than likely see some green at the base, which is high in sugar and starch. If it hasn’t rained for a while, again be careful – dry grass can actually have a higher NSC percentage than green, lush-looking grass.
- Winter. Keep horses off frozen frosty grass - beware those glorious ice-blue, sunny frosty days. Don’t think you're out of the woods once summer is over - as autumnal nights cool down, the dangerous carbohydrates once again increase. Sugar levels rise in intense sunlight, including winter sun, and high sugar levels trigger formation of fructan. These levels reach a peak in the late afternoon and during the dark hours, the grass uses this fuel for itself, with the levels at their lowest by morning. But - frosty nights prevent grass from using as much NSC, resulting in a higher NSC concentration during the day, which is then frozen overnight as the temperatures drop. It’s akin to a field full of sugary-sweet, frozen grass lollies, and for our horses it’s yummy. And a recipe for potential disaster.
- Obesity must be avoided at all costs. If you can’t exercise, restrict. But – do NOT starve your horse. Feed a managed diet with plenty of high fibre forage, low sugar, and appropriate vitamins/minerals to support the system.
- Add a good Probiotic. Feed the gut flora to sustain a healthy population of the microbiome's beneficial bacteria to bad.
- If your horse does develop laminitis, it is important to remember not to restrict the diet of a laminitic-prone equine - right now they need a clean, nutrient-rich, balanced diet with vitamins and minerals to help support the healing process during recovery.
The symptoms of laminitis are awful to witness, with the obvious pain and distress being enough to make us want to do all we can to prevent it ever happening again. Good supportive care such as proper nutrition and restricting grass intake can really help to keep a laminitic-prone horse healthy.