Laminitis is an inflammation of the laminae that anchor the coffin bone to the hoof wall. It's painful, can worsen at lightning speed, and should always be treated as an emergency. The risk increases especially in spring, when grass grows quickly and is high in sugar.
What Laminitis Is
Inside the hoof are thin laminae that hold the coffin bone in place within the hoof wall. In laminitis, those laminae become inflamed and weakened. In a severe case, the coffin bone loses its grip and can rotate or sink within the hoof, visible on X-ray as rotation or sinking. According to the KNMvD guideline on laminitis in horses (Leidraad Hoefbevangenheid Paard, version March 16, 2026), that can happen within a few days, sometimes even within a few hours. That's the stage you want to avoid at all costs, because it's difficult to reverse and largely determines whether a horse can walk normally again.
It mainly affects the front hooves, but it can occur in all four hooves. See also the explanation of the hoof and lameness in the glossary.
The Main Causes
Laminitis is almost always the result of an underlying problem, not an accident. The Utrecht University Animal Hospital (UDI, Universitair Dierenziekenhuis) and the guideline name three pathways:
- A disrupted sugar metabolism (the largest group). In horses with EMS or Cushing's disease (PPID), the body responds abnormally to insulin. The guideline calls this insulin dysregulation and writes that, according to some authors, it accounts for up to 90 percent of cases. The UDI gives a lower floor: at least 50 percent of horses and ponies with laminitis also have PPID or EMS. So the share can differ by source. Triggers are grass that is too rich in sugar or too much feed (for example, a horse that empties the feed bin), and in horses with an underlying problem also treatment with corticosteroids. According to the Dutch Farriers' Association (NVvH, Nederlandse Vereniging van Hoefsmeden), spring grass is extra risky because it then contains a lot of fructan.
- Overloading one leg. If, due to an injury in the other leg, a horse bears weight on one leg for a long period, laminitis can develop in that supporting leg. The guideline names, among other things, a trauma, a tendon injury, or surgery on the other leg. The UDI also names long periods of walking on a hard road.
- Serious illness. A severe infection, diarrhea from bowel inflammation, bowel surgery for colic, a retained placenta in a mare, or a uterine infection can trigger laminitis, because bacterial toxins reach the hoof through the blood.
According to the guideline, age and breed play a big part in the form involving insulin problems, and according to the NVvH excess weight is a risk factor. The Equine Endocrinology Group says EMS is more common in ponies and Morgan horses, among others, and writes that obesity is a risk factor for pasture-associated laminitis in ponies. But the other causes can affect any horse.
Recognizing the Symptoms
According to the guideline, pain in the hooves is the main symptom. The sooner you intervene, the better the outcome. Watch for these signs:
| Sign | What You See |
|---|---|
| A sawhorse stance | With the front hooves affected, the horse stands with its front legs stretched forward and its hind legs far under the body, to relieve the front hooves. If all four hooves are affected, it stands with its feet under it and shifts from foot to foot |
| Reluctance to move | Stiff, cautious walking, as if "walking on eggs"; a horse with severe laminitis won't walk, or only with a lot of encouragement |
| Warm hooves | One or more hooves feel distinctly warmer than normal |
| Bounding pulse | A palpable, throbbing pulse in the arteries at the back of the pastern, just above the hoof |
| Sensitive hoof | A pain response to pressure on the hoof, in the first stage often around the tip of the frog. If there is no pain response, laminitis is still not ruled out |
Not sure whether it's laminitis or ordinary lameness? Treat it as laminitis until the vet determines otherwise. The coffin bone can rotate or sink within a few days, sometimes within a few hours, so don't wait.
First Aid During an Acute Attack
Laminitis is an emergency. The steps below are general; the vet determines the diagnosis and treatment. The guideline is written for vets. The UDI names what you can do as an owner until the vet arrives.
- Call the vet immediately and describe what you see. Ask whether someone can come right away.
- Don't let the horse walk. According to the UDI, walking hurts a lot and can cause the connection between the coffin bone and hoof wall to separate further. Don't transport the horse without consulting the vet either: the guideline calls transport extremely stressful in the acute stage, because it can quickly make the problems worse.
- Put the horse in a roomy stall with soft bedding and water at all times. The UDI wants the horse to have a place where it can and wants to lie down. The guideline wants it to walk as little as possible for 1 to 2 weeks and preferably lie down a lot.
- Cool the feet. The UDI names rinsing with water or a wet bandage that is rewetted every hour. The guideline describes cooling with ice water up to and including the fetlock and wants cooling for at least 2 days. Ask the vet how best to do this.
- Adjust the feed. No concentrate feed and no grass: only water and hay. The guideline sets the limit at no more than 100 grams of sugar per kilogram of dry matter in the hay and advises having a sample tested. Until the result is in, you can soak the hay in water for 30 to 40 minutes. If the sugar content is very high (above 150 grams per kilogram), soaking isn't enough; discuss it with the vet.
- Don't give medication on your own initiative. According to the guideline, pain relief is the basis of treatment, but the vet chooses the product. The severe pain also keeps the horse from walking. That's why pain relief should come with a roomy stall with comfortable bedding.
- Don't have the farrier correct the hoof angle or nail on shoes. The guideline says the acute stage is not the time for that. The vet and farrier can support the heel and frog, though, for example with a hoof bandage or support pads.
The vet examines the horse and, if needed, has blood tested for PPID and EMS. According to the guideline, X-rays usually give little information in the acute stage and are unwise if the horse would have to walk or be transported for them; they can be taken on site if needed. Working with the farrier (the specialist who trims and shoes the horse's hooves) is important afterward.
Recovery and Outlook
Recovery takes time. The guideline roughly allows for at least a week of stall rest for every day the acute episode lasts. The chance of recovery depends on how things go:
- In a 1999 English study of 216 horses, cited in the guideline, 75 percent returned to their old level or better, 22 percent were euthanized or slaughtered, and 3 percent could no longer be ridden.
- Horses that improve on medication within a few days have a better prognosis, according to clinical experience in the guideline. If there is no improvement after days to 2 weeks, the prognosis is poor. Sinking of the coffin bone is less favorable than rotation.
- If the coffin bone breaks through the sole (a sole penetration), this is seen in the Netherlands as an absolute reason for euthanasia.
- Horses with insulin problems or earlier attacks have a higher chance of another attack.
If the horse keeps having trouble (chronic laminitis), the vet and farrier work closely together. The guideline advises reassessing the shoeing after 6 to 8 weeks, not nailing on shoes while the horse is in pain, and composing the ration carefully. Exercise is only stepped up once the pain relief has been tapered off.
Prevention, Especially in Spring
Many episodes can be prevented by managing feed and weight. For at-risk horses (ponies, horses with EMS or Cushing's, overweight horses) this matters year-round, and especially in spring.
- Limit turnout. The UDI advises letting a horse out only in limited amounts on "rich" pasture. The Equine Endocrinology Group writes that many horses with EMS develop laminitis after being turned out on a new pasture or during rapid grass growth in spring or late summer. Read more about turnout (time outside in the pasture) in the glossary.
- No free turnout with excess weight or insulin problems. The guideline wants turnout avoided as long as there is excess weight or insulin dysregulation. Once the horse is stable, limited turnout with a grazing muzzle or strip grazing is possible. According to the guideline, the muzzle is often better, because horses with limited grazing time eat more and faster.
- Keep an eye on weight. Have an overweight horse lose weight slowly and in consultation with the vet (UDI). According to the Equine Endocrinology Group, a thickened neck and fat near the tailhead can point to EMS.
- Close the feed bin securely and don't give more concentrate feed than needed. Choose low-sugar forage and have it tested: the guideline names less than 100 grams of sugar per kilogram of dry matter as the target. See the feeding guide.
- Have underlying conditions tested. For a horse with recurring episodes, an abnormal coat, or unexplained weight gain, it's worth having the vet check for EMS or Cushing's disease.
- Ask the farrier what they see. According to the guideline, a widened white line can reveal an earlier, unnoticed attack.
In Closing
Laminitis is serious, but a lot can be gained by staying alert and acting promptly. Know the sawhorse stance, the warm hoof, and the bounding pulse, and treat those signs as an emergency, not as something to wait a day on. Don't let the horse walk, put it in a roomy stall, and adjust the feed right away. For diagnosis, pain relief, and the recovery plan, the vet is and remains the source; when in doubt, call too early rather than too late.
Sources (verified September 2, 2026, guideline and recovery November 2, 2026): KNMvD: Laminitis in Horses guideline (Leidraad Hoefbevangenheid Paard), version March 16, 2026 · Utrecht University Animal Hospital: Laminitis · NVvH: Laminitis · Elliott et al. 2023, Equine Veterinary Journal (endocrinopathic, sepsis-related, and support-limb laminitis) · Equine Endocrinology Group: Equine Metabolic Syndrome
See also: When to Call the Vet · Hoof Care and the Farrier · How to Feed Your Horse Well