Laminitis Diagnostics and Management

Despite the somewhat unappreciated snowfall earlier this week, after a pretty brutal winter spring is just around the corner! While this does mean more fun weather to go ride in, it unfortunately does mean we need to start keeping an eye on our laminitis prone horses and ponies.

How do we evaluate lamintis risk?

We will often use obesity as a simple starting point for a horse’s laminitis risk, but it’s not the full picture. Some horses carrying a little extra do surprisingly well metabolically, and some unfortunately can have a higher risk while not appearing as dramatically overweight.

Insulin testing has been the main focus of evaluating a horse’s metabolic risk of laminitis, and for good reason. The insulin itself is the mechanism that weakens the laminae between the coffin bone and hoof wall that allows the gradual breakdown over time.

We can also test leptin and adiponectin. Leptin is a hormone produced by fat cells, and correlates with obesity and high body condition score; it can be a useful marker for our progress in restoring fitness. Adiponectin is involved in glucose and fatty acid metabolism, and can be actively protective in limiting lamininitic damage. So while we want leptin to be lower, we want adiponectin to be higher. Some upcoming research presented as an abstract in last year’s American College of Veterinary Internal Medicine proceedings supports the ratio of the two to be very predictive of a horses laminitis risk. This can help lessen worry if that ratio is good in a horse that is carrying some extra weight, or help screen for horses that are at higher risk without looking outwardly obese, particularly before diet changes or treatments that could increase laminitis risk, such as steroids.

Another tool we have to catch our laminitis prone patients early is screening radiographs. Baseline balance radiographs are always useful in identifying the position of the coffin bone to assist a farrier in the trim, but they also can show early signs of inflammation and movement that may not show much outward appearance yet. They’re a great first step if your keen-eyed farrier has any concerns about growth rings not being in line or a stretched white line.

If we find elevated risk of laminitis, what do we do about it?

Dry lots while only eating hay that has had the sugar soaked out of it gives us the best control, and a nibble net can keep them occupied for longer; you do need to watch out for how much they can graze under the fence, though. Scrubby looking weeds or grazed down grass can have a surprising amount of sugar. Hay should be soaked for 30-60 minutes, and the saturated water discarded after, so fresh water can soak out the maximum amount of sugar.
A grazing muzzle can be a good balance to limit intake while also allowing the mental relief of being out with their friends and the activity of walking around to graze (which can be as much as 6 miles!) Wear on teeth needs to be monitored, as does any holes of the muzzle wearing larger (or friends helping remove them).

While partial turnout is tempting and can be easier to accomplish, they’re smart enough to know when their time on grass is limited and make up for lost time; they can eat a full day’s worth in as little as 4 hours!

Like so many things, the more we learn about laminitis and learn how complicated it can be, it can give us what can feel like an overwhelming number of options. However, as anyone who has helped support a horse with laminitis can attest, it can be very painful and distressing to both horse and owner, and an ounce of prevention is worth many pounds of cure. If the laundry list of above diagnostics and recommendations feels intimidating, I would not let that stop anyone from taking just one or two steps that are achievable. We are always happy to chat about what realistic options are, where is the best place to target our resources, and what risks go along with any choice.