Understanding Laminitis in Horses with HorseWorld

People often associate horses with grass and grazing with images of sunny days in the meadow, horses strolling and grazing to their hearts content.

Sadly, for many horses, ponies, and donkeys, this isn’t quite the reality. Equids evolved to travel many miles each day in search of food, that was often sparse, fibrous, and seasonally variable. Their bodies are designed for movement, regular foraging, and survival on low-quality grazing that changes with the seasons.

Despite the relatively short period of domestication, and the development of many different sizes and breeds, the horse’s body and digestive system still function much as they did before selective breeding. With modern management practices such as stabling, small paddocks with uniform grass species, and unnecessary rugging and supplementary feeding, many horses are now overweight and therefore at increased risk of pasture-associated laminitis.

Horses with conditions such as Cushing’s disease (PPID) and Equine Metabolic Syndrome (EMS) are even more prone to laminitis. These conditions affect how the body handles insulin, making it harder for them to cope with the sugars found in grass, especially during periods of rich or fast-growing pasture.

What is Laminitis?

Laminitis is a very painful condition affecting the structures inside a horse’s hoof. In severe cases, it can lead to long-term damage and can even become life-threatening if not treated quickly and managed carefully.

The bone inside the hoof is called the pedal or coffin bone. It is held in place within the hoof capsule by interlocking soft tissue structures called the laminae.

During a laminitic episode, the laminae become inflamed. This inflammation can disrupt blood flow, weakening and stretching the laminae, and ultimately will lead to separation between the hoof wall and the pedal bone.

If not treated promptly, or if episodes reoccur, the condition can progress to a severe stage commonly referred to as “founder.” At this point, the laminae can no longer support the pedal bone, which may rotate or sink within the hoof capsule, causing extreme pain and significant lameness.

Causes of Laminitis

In pasture-associated laminitis, the primary trigger is high intake of sugars, starches, and fructans. These are found in lush, fast-growing grass, stressed pasture or excessive intake of high-calorie concentrate feeds.

Horses naturally evolved to graze for up to 16–18 hours a day on small amounts of fibrous vegetation. Their digestive systems are not adapted to handle sudden or large quantities of sugar.

What can happen internally:

The trigger

• Overindulgence or sudden influx of high sugar food can lead to insulin resistance and excess insulin in the blood.

The response

• Excess insulin in the blood can cause narrowing of blood vessels and lead to decreased blood flow to the hooves and widespread inflammation.

The damage

• The restricted blood flow and inflammation can lead to the laminae become stretched and weakened, and therefore less able to support the pedal bone.

Risk Factors

Some horses are more prone to laminitis than others. Common factors that increase risk may include:

• Hormonal conditions such as Pituitary Pars Intermedia Dysfunction (PPID or Cushing’s disease), which increases insulin dysregulation.

• Equine Metabolic Syndrome (EMS), where horses have increased insulin resistance so are therefore at greater risk of laminitis.

• Age, as older horses may find it harder to regulate insulin function and overall metabolic balance.

• Genetic predisposition, with some breeds—particularly native breeds and ponies—being more prone to PPID, EMS, and laminitis.

• Obesity, which places additional strain on the body’s ability to regulate insulin and manage energy from food.

Signs and Symptoms

Laminitis can present with both subtle signs that may be easily missed, and severe signs where the horse is clearly in extreme pain. It most commonly affects the front feet, although it can occur in any or all hooves.

It is important to remember that although early intervention can significantly reduce progression and improve outcomes, once visible signs appear, some damage has already occurred and the laminae may not return to full original strength.

Subtle Signs

• Reluctance to walk on hard, uneven, or stony ground

• Avoidance of certain areas

• Reluctance to walk to or from the field

• Stumbling or appearing “footy”

• Taking shorter, more careful steps, especially on turns

• Shifting weight frequently when standing

Additional Early Indicators

• Digital pulse: A stronger-than-normal or “bounding” pulse can indicate inflammation. (See Top Tips on how to check the digital pulse).

• Warm hooves: Feel the hoof capsule with the palm of your hand. Increased heat may signal inflammation (compare all feet).

• Cresty neck: Overweight horses and those with EMS may carry fat accumulation on the crest of the neck, a firm or hardened crest can indicate insulin dysregulation risk.

Obvious Signs

• The classic laminitis stance, with the horse leaning back to shift weight off the front feet, the front feet will be placed out in front of the head

• Extreme reluctance or inability to move

• Unable to lift a foot when asked (due to severe pain in the other foot)

• Lying down more than usual or being unable/unwilling to stand

Treatment & Recovery

Immediate Action

Laminitis is a medical emergency - contact a veterinarian immediately.

Key first steps include:

• Remove the horse from pasture and access to high sugar feeds

• Provide a low-sugar and high-fibre diet, predominantly forage based

• Ensure continuous access to appropriate forage (avoid long fasting periods)

• Soak hay to reduce sugar content if necessary and allow for a greater amount to be available

• Stable the horse on deep, soft bedding and ensure food and water is within easy reach

• Provide hoof cushioning with pads and bandaging. See Top Tips for more information

• Apply cold therapy to reduce inflammation by placing the feet in cold/iced water

• Administer Non-steroidal anti-inflammatory drugs (NSAIDs) as prescribed by a veterinarian to relieve pain and reduce inflammation

Long-Term Management

Once stabilised, ongoing management is essential to reduce the risk of recurrence.

• Support with a well-balanced, low-sugar diet with appropriate vitamin and mineral support

• Encourage movement (once approved by a vet)

• Use non-grass turnout options (e.g., track systems and sand paddocks) See Top Tips for more information

• Work closely with a farrier for correct hoof balance

• Use radiographs (x-rays) where needed to guide trimming

• Monitor body condition score (BCS) and maintain a healthy weight range

Misconceptions

• “It only happens in spring”: Although risks are high in spring, grass sugar levels vary year-round depending on weather, stress, and grass type.

• “Laminitis can be cured”: Laminitis causes structural damage; while it can be managed successfully, prevention is critical.

• “Only fat ponies get it”: While overweight native breeds are at increased risk, laminitis can affect all equids and over 90% of cases are linked to underlying hormonal conditions, such as PPID/Cushing's or EMS.

• “Short, sparse pasture is safe”: Overgrazed or stressed grass can be very high in sugar (fructans), sometimes making it more dangerous than long, mature grass that may have a lower sugar content.

Other Causes of Laminitis

Whilst we have focused on pasture-associated laminitis in this article, there are other causes:

• Concussive (mechanical overload): This can be caused by excessive stress or impact on the feet. This may be from when a horse works for long periods on hard ground, carries uneven weight due to lameness in another limb, or experiences repeated concussion from roadwork.

• Toxic: This occurs when toxins enter the bloodstream, often linked to a serious illness or infection. Examples include retained placenta in mares after foaling or other severe systemic infections.

Top Tips

Prevention remains the most effective approach to laminitis management:

• Monitor weight and body condition closely to ensure the horse remains within a healthy range.

• Be cautious with grazing, especially during high-risk periods such as during periods of growth (spring, autumn, after rain during a dry spell) or on cold but sunny days.

• Use restricted grazing housing systems where possible. See the HorseWorld website for more advice and information on various topics.

• Regularly check digital pulse and hoof temperature. To take the digital pulse: On the back of the fetlock or upper pastern rest your index and middle finger on the neurovascular bundle (an artery, vein and nerve). A healthy pulse will be very faint (or not felt at all) whereas a strong or “bounding” pulse is a sign of inflammation and/or pain.

• Feed and hay should have a Digestible Energy level typically below 10–12% Non-Structural Carbohydrates (NSC).

• Use padding or hoof protection where advised – baby nappies make great pads for cushioning feet – secure in place with vet wrap type bandages.

• Be aware that shod horses may mask early signs, so additional monitoring is essential.

Final note

Laminitis is a serious but often preventable condition. Understanding the risks and recognising early signs can make a huge difference to your horse’s health and wellbeing.

This blog post was written by the team of experts at HorseWorld in Bristol. HorseWorld is a horse rescue charity based in the South-West. For more information, please visit our website: