START HERE & OVERVIEW - Help! My horse has Laminitis

My horse has laminitis. What do I need to know right now?

If your horse has just developed laminitis, don't feel you need to read everything in the 'Lessons from Missy' series right away, there is a lot of information here and we understand this is a stressful time!

Start with the practical steps below and come back later when you have breathing space.

The onset of laminitis can be sudden, overwhelming and extremely stressful. There is so much conflicting advice available that it can be difficult to know where to start, especially during those first few days.

Here is a practical guide to help get your horse started on the path to recovery.

STEP 1

Implement the Emergency Diet immediately

Most cases of laminitis are associated with abnormally high insulin. Unless there is another clear cause, such as a feed-room break-in, retained placenta, severe systemic illness or supporting-limb injury, the safest initial approach is to manage the horse as though high insulin may be involved while the cause is investigated.

The Emergency Diet is a temporary short-term diet, generally used for around two weeks while you arrange hay testing, diagnosis and a properly balanced long-term feeding plan. Its purpose is to reduce hydrolysable carbohydrates, ESC plus starch, as quickly as possible while still providing enough forage and essential nutritional support.

Emergency Diet: Quick Guide

For a 500 kg horse, adjusted proportionally for body weight:

Remove all access to pasture, including short or apparently eaten-out grass.
Stop apples, carrots, treats, grain, sweet feeds and most bagged feeds.
Feed grass hay at 2% of ideal body weight or 1.5% of current body weight, whichever gives the larger amount.
Weigh hay dry, before soaking.
Until the hay has been tested, soak it for 30 minutes in hot water or 60 minutes in cold water, then drain thoroughly.
Use only a small amount of a suitable low-HC carrier feed, just enough to carry the supplements. We recommend Speedibeet or Maxisoy Hulls.
Feed the hay allowance across the day, using slow feeders where appropriate.
Test the hay as soon as possible. If ESC plus starch is 10% or less, soaking is generally no longer required, and the long-term diet can be balanced to the hay analysis where possible.
Add daily:

Missy's Bucket Minerals - any version is suitable, Basics, Original or Gut-Plus.
5 g elemental magnesium (10g Magnesium Oxide). Not needed if the Missys Bucket you use has added Magnesium.
approximately 60 g ground linseed/flaxseed or chia
2,000 IU vitamin E
1–2 tablespoons iodised white salt in the carrier feed
Provide additional plain or iodised salt free choice

The Emergency Diet in more detail

Remove the horse from pasture

The horse must have no access to grass during the acute stage. This includes short grass, frosted grass, stressed grass and areas that appear to have been grazed bare.

A sand yard, arena, round yard, stable or another secure grass-free area can be used. The surface should be comfortable and non-edible. Avoid straw bedding, as some horses will eat it.

The concern is not simply whether the pasture looks lush. The important issue is how much hydrolysable carbohydrate it supplies and how strongly the individual horse’s insulin responds.

Stop other feeds and treats

Immediately stop:

Grain and grain-based feeds
Sweet feeds
Molasses
Apples and carrots
Sugary treats
Unnecessary bagged feeds
Any feed that cannot confirm an appropriate carbohydrate level

The ECIR target for metabolic horses is less than 10% HC, calculated as ESC plus starch. For bagged feeds, starch should preferably be below 4% and fat below 4%.

Prescription medication should not be stopped without discussing it with the prescribing veterinarian.

Work out the hay allowance

Feed:

2% of the horse’s ideal body weight or 1.5% of its current body weight, whichever amount is greater.

For example, a horse currently weighing 600 kg with an ideal weight of 500 kg would receive:

1.5% of 600 kg = 9 kg
2% of 500 kg = 10 kg

The horse would therefore receive 10 kg of hay per day, weighed dry before soaking.

Do not simply reduce an overweight horse to a very small quantity of poor-quality hay.

Starvation diets can worsen insulin resistance and increase the risk of hyperlipaemia, particularly in ponies, miniature horses and donkeys.

Soak untested hay

You cannot reliably tell whether hay is suitable by looking at its colour, texture, smell or species.

Until testing confirms that the hay contains 10% HC or less, soak it to reduce soluble sugars:

30 minutes in hot water, or
60 minutes in cold water

Drain the hay well and dispose of the soaking water where the horse cannot drink it. It will contain some of the carbohydrates removed from the hay.

Soaking does not remove a predictable amount from every hay, which is why testing remains preferable. Once testing shows that ESC plus starch is 10% or less, routine soaking is usually unnecessary.

Divide the daily allowance across the day and use a suitable slow feeder if the horse consumes it too quickly. The priority is providing the correct total amount of appropriate hay, not unlimited access to unsuitable hay.

Use only a small carrier feed

The carrier feed is not intended to provide a large meal. It is simply used to deliver minerals, salt, magnesium, vitamin E, linseed and any medication.

Plain unmolassed beet pulp that has been rinsed, soaked and rinsed again is the preferred carrier. Soy hull pellets may also be suitable. Any commercial carrier should guarantee:

HC below 10%
Starch preferably below 4%
Fat preferably below 4%.

Use only enough to ensure the horse eats the supplements.

Magnesium

Provide 5 g of elemental magnesium daily for a 500 kg horse, adjusted for body weight.

This is the amount of actual magnesium, not 5 g of magnesium oxide powder. Magnesium products contain different percentages of elemental magnesium, so check the product analysis and calculate the quantity required.

For example, if a magnesium oxide product contains 50% elemental magnesium, approximately 10 g of that product would supply 5 g of elemental magnesium.

This is a temporary Emergency Diet amount. Once the hay is tested, magnesium should be included as part of the full mineral balance rather than automatically continued at a standard dose.

If Using Missy's Bucket Minerals Basics or Gut-Plus versions you will not need extra Magnesium as its already included≥

Linseed, flaxseed or chia

Feed approximately 60 g of freshly ground or stabilised linseed/flaxseed or chia daily for a 500 kg horse.

This provides essential fatty acids that may be low when the horse has no access to fresh pasture.

Whole linseeds should be freshly ground so the horse can digest them properly. A small coffee grinder works well. Stabilised ground linseed is another practical option. It can be ground in bulk then frozen in daily portions.

Vitamin E

Provide 2,000 IU of vitamin E daily for a 500 kg horse.

Vitamin E requires contact with fat for effective absorption, so it can be fed in the same meal as the ground linseed or chia. Human Gel caps from Chemist Warehouse are a good option.

Salt

Add 1–2 tablespoons of iodised salt per day to the carrier feed for a horse of approximately 450–500 kg, adjusted for body size.

Also provide additional plain or iodised salt free choice.

Introduce salt gradually if the horse is not accustomed to it, particularly if appetite is poor.

What about a vitamin and mineral supplement?

The Emergency Diet uses temporary amounts of magnesium, essential fatty acids, vitamin E and iodised salt. It is not expected to create a completely balanced long-term diet.

A suitable low-HC mineral supplement may be used where its nutrient levels are known and appropriate, but no premixed product can be assumed to perfectly balance every hay.

The long-term goal is to test the hay and supplement the nutrients that are deficient while accounting for excesses and mineral interactions. However in some cases we understand that this is not possible

If you are on Agistment or only able to buy small quantities of hay at a time, the best option is to choose a Mineral Mix that is designed to balance the average pasture and hay, something like Missy's Bucket is ideal.

STEP 2

Obtain an accurate diagnosis

Laminitis is the result of an underlying disease or trigger. Finding and addressing that trigger is essential.

The two most common underlying endocrine conditions are:

Equine Metabolic Syndrome or EMS
Pituitary Pars Intermedia Dysfunction or PPID, previously called Cushing’s disease

They can occur separately or together, and their management is different:

EMS is managed primarily through diet and, once the feet are safe and comfortable, exercise.
PPID requires medication, usually pergolide or sometimes cabergoline.
A horse with both conditions will require both approaches.

Talk to your veterinarian about appropriate testing, including insulin, glucose and ACTH where indicated.

Testing protocols and sample handling matter. Ideally, the horse should not be fasted before insulin or ACTH testing and should not be exercised or transported immediately beforehand. The results also need to be interpreted alongside the horse’s history and clinical signs.

Some non-endocrine causes, such as grain overload, retained placenta, severe infection or supporting-limb laminitis, require different urgent treatment. These should be investigated immediately when suspected.

STEP 3

Find a hoof-care professional experienced in laminitis rehabilitation

The hooves must be trimmed according to the internal structures, not simply according to the outside shape of the hoof.

If your budget allows, obtain lateral radiographs of the affected feet. These show the position of the pedal bone within the hoof capsule and help guide the trim. They can also provide important information about the degree of damage and prognosis.

When radiographs are taken, ask for external markers that clearly identify:

The dorsal hoof wall
The coronary band
The tip of the frog

Ideally, the veterinarian and farrier or trimmer should communicate directly and agree on the trimming goals.

In the early stages of rehabilitation, trims may be needed every two weeks. The ECIR protocol recommends no longer than four-week intervals, with two-week intervals often preferable early in recovery.

Hoof boots and conformable pads can make the horse much more comfortable and provide support while the hoof is being realigned. The horse should also have a soft, supportive area where it can stand and lie down.

Pain medication

Pain relief may be needed during the acute stage, but medication is not a substitute for removing the trigger, correcting the diet, supporting the feet and applying an appropriate trim.

While a horse is receiving medication that masks hoof pain, movement should be restricted so the horse does not overload unstable and damaged laminae.

NSAIDs can also have gastrointestinal, renal and healing-related risks, particularly with prolonged use. Their dose and duration should therefore be discussed on an individual basis.

STEP 4

Allow movement only when the horse is ready

Movement is important, but it must be introduced at the right time.

Do not force a painful laminitic horse to walk.

During the acute stage, restrict unnecessary movement and allow the horse to lie down. Pain is a sign that the feet are not ready to tolerate increased loading.

Once:

The laminitis trigger has been identified and controlled
The horse is off pain medication
The feet have been appropriately trimmed
The hooves are supported with boots and pads where needed
The horse is comfortable and willing to move

…the horse may be allowed to move voluntarily in a small area with supportive footing.

Controlled hand walking can begin later with very short walks, often only two to five minutes, in straight lines, in boots and on a soft surface. The horse should finish the walk moving at least as comfortably as it did at the beginning. If it becomes less comfortable, stop and reassess.

Other things to consider

Provide a friend

Social isolation can be extremely stressful for a horse.

Where possible, provide a calm companion nearby so the horse has safe visual or physical contact without being chased or bullied. This can reduce anxious fence-walking and unnecessary movement.

Do not starve the horse

The horse still needs adequate forage and nutrients.

Very severe feed restriction can increase stress, worsen insulin resistance and trigger hyperlipaemia. Follow the bodyweight calculation rather than guessing or drastically reducing the ration.

Be prepared for a long recovery

Laminitis rehabilitation is rarely completed in a few weeks. The damaged hoof wall must grow down and be replaced by new, well-connected growth. Depending on the severity of the original damage, this may take many months.

The Emergency Diet is only the beginning. Long-term recovery requires the whole DDT+E approach:

Diagnosis
Diet and appropriate medication
Trim
Exercise, when the horse is sound enough

No supplement, medication, feed, shoe or trim can replace the complete management plan.