By: Dr Rosie Alcorn BVSc PG Cert VPS Cert AVP MRCVS
Laminitis is a common and painful condition affecting the laminae of the equine foot. It can affect horses, ponies and donkeys. It is a complex, multifactorial condition with several possible causes.
The laminae are structures that attach the hoof wall to the pedal bone, functioning a bit like Velcro. When the laminae become inflamed, this attachment is weakened or disrupted, leading to significant pain (imagine constantly wearing extremely tight shoes).
In severe cases, structural failure of the laminae can occur, resulting in rotation or sinking of the pedal bone. This is known as founder.
Although laminitis is a condition in itself, it is usually caused by underlying issues. It can be broadly categorised into:
1. Endocrine Laminitis (Most Common)
Associated with:
Equine Metabolic Syndrome (EMS)
Pituitary Pars Intermedia Dysfunction (PPID)
2. Inflammatory (Sepsis-Related) Laminitis
Occurs secondary to systemic illness or inflammatory conditions.
3. Supporting Limb Laminitis
Develops when one limb bears excessive weight due to injury or lameness in the opposite limb
Common after fractures, severe lameness or orthopaedic surgery
This article focuses on laminitis associated with EMS and how to manage it.
Equine Metabolic Syndrome is characterised by insulin dysregulation, meaning the horse’s body does not properly regulate insulin, glucose and fat metabolism.
EMS is strongly linked to laminitis and obesity and is common in native pony breeds.
Hyperinsulinaemia (high insulin levels) is believed to play a major role in triggering laminitis. The exact mechanisms are still being researched, but inflammation is thought to be involved. Recent research suggests the gut microbiome may also play an important role.
Obesity does not directly cause EMS; however, it significantly worsens insulin dysregulation.
Horses with EMS are more likely to be overweight, and overweight EMS horses are at a high risk of laminitis.
Dietary Management for Laminitic Horses
Diet is the most important tool in managing EMS and preventing laminitis. The aim of dietary management is to:
Prevent or reduce obesity
Control insulin levels
Minimise intake of non-structural carbohydrates (NSC)
This can be compared to managing diabetes in humans - keeping blood sugar levels stable is key.
What to Avoid in a Laminitic Diet
Grains and cereal-based feeds (high in NSC)
High-sugar treats (apples, carrots, etc.)
High-calorie feeds in overweight horses
Forage should form the basis of the diet. Research shows the gut microbiome is linked to laminitis, so supporting gut health is essential.
To create a calorie deficit:
Feed 1.25%–1.5% of body weight (dry matter) per day in forage
Equivalent to 1.4%–1.7% as fed
Provides approximately 64%–94% of maintenance energy needs
Choosing the Right Hay
Aim for low NSC hay (<10%)
Feed little and often to prevent long periods without forage
Straw can be safely used if introduced gradually. It is a low-calorie option and increases chewing time, which helps buffer stomach acid
Remember to replace like for like, straw should not be added on top of the hay ration but included within the daily allowance.
Reduces sugar content by 24%–43%
Recommended for insulin-sensitive horses
Soak for 7–16 hours in cool conditions
In warm weather, limit soaking to 1–2 hours to avoid bacterial growth
Consider steaming after soaking for improved hygiene
Note that soaking also reduces the nutrient value of hay, as well as its calorie content.
Haylage often produces a higher insulin response than hay
It is more palatable, increasing the risk of overeating
Haylage is generally not recommended for horses with EMS
Pasture Management for Laminitic Horses
High-NSC grass increases insulin spikes
Much of the grassland in the UK and Ireland is bred for dairy production and is high in energy
Restricting grazing time alone is often ineffective, as ponies can consume large amounts quickly
Effective Grazing Strategies
Use grazing muzzles to reduce intake (by approximately 77–83%)
Remove pasture access completely during the initial 6–12 weeks of a laminitis episode
Reintroduce grazing cautiously once insulin control improves
Use a small, poor-quality paddock with minimal grass cover
Restricting calories also restricts nutrient intake. A low-calorie (or zero-calorie) balancer should be fed to provide essential vitamins and minerals.
This supports laminar tissue repair and ensures horses on restricted diets remain healthy.
Exercise is important but must be approached carefully. Do not exercise horses with active or recent laminitis. The following recommendations are based on the EMS veterinary consensus statement:
Non-Laminitic Horses with EMS
Low- to moderate-intensity exercise
30 minutes, 5 times per week
Target heart rate: 130–170 bpm
Previously Laminitic Horses (Recovered and Stable)
Low-intensity work on soft surfaces
30 minutes, 3 times per week
Target heart rate: 110–150 bpm
Laminitis should always be managed alongside a veterinary surgeon. While medical treatments are available, drug therapy should never replace appropriate diet and exercise management.
Laminitis associated with Equine Metabolic Syndrome is a serious and potentially life-threatening condition with long-term consequences.
Dietary management remains the most important tool for both prevention and treatment. Careful control of weight, nutrition and grazing is essential to keep EMS horses healthy, safe and sound.
The Keyflow Range
International Stockists
United States