Prevention Checklist: The Key Points

Most cases of laminitis can be prevented or significantly reduced by managing the horse's individual risk factors. Here's a practical checklist to get you started.

✓ Know whether your horse is at risk.
Learn the common risk factors, including EMS, PPID, obesity, previous laminitis, easy-keeper breeds and advancing age.

✓ Obtain an accurate diagnosis.
If your horse is at risk, work with your veterinarian to investigate insulin, glucose and ACTH where appropriate. You can't manage what you haven't identified.

✓ Maintain a healthy body condition.
Aim for a lean, healthy horse rather than waiting until obesity becomes obvious. Monitor body condition, regional fat deposits and cresty neck score regularly.

✓ Control hydrolysable carbohydrates (HC).
Base the diet on appropriate forage, test your hay where possible, and keep ESC + starch under control. Remember that hay, pasture and bagged feeds can all contribute.

✓ Manage pasture carefully.
Don't rely on simple rules like "morning grass is safe." Instead, manage grazing according to your individual horse's insulin status and risk factors.

✓ Exercise regularly.
Regular exercise is one of the most effective ways to improve insulin sensitivity, but only once the horse is sound and comfortable enough to work.

✓ Manage PPID appropriately.
Older horses and those showing signs of PPID should be investigated and treated where necessary to reduce laminitis risk.

✓ Maintain regular hoof care.
Routine trimming helps maintain healthy hoof mechanics and allows subtle changes to be detected before they become major problems.

✓ Monitor your horse regularly.
Keep an eye on body condition, digital pulses, hoof growth, comfort on different surfaces and any early signs of foot soreness.

✓ Plan ahead for high-risk periods.
Don't wait until the spring flush or autumn pasture growth. Have your management plan in place before conditions change.

✓ Remember that prevention is a complete management plan.
No supplement, feed, medication or trimming method can prevent laminitis on its own. Long-term success comes from combining diagnosis, diet, appropriate medication, hoof care and exercise.

 

Practical Management Strategies to Reduce Risk

 

Key message

Most cases of laminitis are associated with abnormally high insulin levels. Prevention therefore depends on identifying horses at risk, keeping insulin under control and acting quickly when something changes.

There is no single feed, supplement, medication, trim or management trick that can prevent laminitis on its own. The most effective approach combines diagnosis, diet, appropriate medication, hoof care, exercise and regular monitoring.

 

Know whether your horse is at risk

Some horses are much more susceptible to hyperinsulinaemia and laminitis than others.

Higher risk horses may include:

• Ponies, miniature horses and many native or hardy breeds

• Arabians, Morgans and some Spanish breeds

• Horses with a cresty neck or regional fat deposits

• Horses that gain weight easily

• Horses with a previous history of laminitis

• Horses with Equine Metabolic Syndrome, or EMS

• Older horses and those showing possible signs of PPID

• Horses receiving very little exercise

• Horses living on rich pasture or receiving more calories than they use

A horse does not need to be obviously overweight to have dangerously high insulin. Some horses appear to have a reasonable general body condition but carry abnormal fat around the neck, shoulders, tail head or hollows above the eyes.

The 2025 NO Laminitis! Conference proceedings specifically recommend being proactive about insulin testing in predisposed horses rather than testing only those that look obese.

 

Obtain an accurate diagnosis

Prevention begins with understanding the individual horse.

If your horse has had laminitis, has suspicious fat deposits, is an unusually easy keeper or belongs to a higher risk group, consider testing for:

• Insulin

• Glucose

• ACTH, particularly where PPID is suspected

EMS and PPID can occur separately or together.

EMS is managed primarily through diet and exercise. PPID generally requires medication, usually pergolide or sometimes cabergoline. If both conditions are present, both need to be addressed.

Blood testing protocols matter. Horses should not usually be fasted before routine insulin, glucose and ACTH testing. Heavy exercise, transport, acute stress, serious illness and pain may affect results, and appropriate sample handling is essential.

 

Keep body condition healthy

Maintaining a healthy body condition is one of the most important ways to reduce laminitis risk.

Your original book recommended keeping most horses around a body condition score of 5, with metabolically susceptible horses often better maintained around 4.5 to 5.

Learn to assess more than overall weight.

Regularly check:

• The crest of the neck

• Fat behind the shoulders

• Fat around the tail head

• Fat above the eyes

• The ribs

• The topline

• Changes in the sheath or udder area

It is common for owners to underestimate body condition because overweight horses have become normalised. The 2025 conference proceedings emphasise that this change in perception is one of the barriers to preventing EMS and laminitis.

Weight loss should be gradual and carefully managed. Starvation diets are not appropriate and may worsen insulin regulation or increase the risk of hyperlipaemia, particularly in ponies, miniature horses and donkeys.

 

Control hydrolysable carbohydrates

The carbohydrates that matter most for insulin control are hydrolysable carbohydrates, or HC.

HC is estimated by adding:

ESC plus starch

These are the carbohydrates digested and absorbed as glucose, causing insulin to rise.

For horses with hyperinsulinaemia, ECIR recommends hay with HC at or below 10 per cent as the foundation of the diet.

Practical strategies include:

• Test the main forage source

• Choose hay with ESC plus starch at or below 10 per cent

• Avoid grain and sweet feeds

• Check bagged feeds rather than relying on marketing terms such as low sugar

• Keep starch preferably below 4 per cent in carrier feeds

• Avoid unnecessary sugary treats

• Feed an appropriate quantity of forage rather than allowing unlimited access to unsuitable hay

• Balance vitamins and minerals to the forage analysis

If hay has not been tested, soaking may be used as a temporary safety measure, but the amount of sugar removed varies. Hay testing gives a much clearer basis for long term management.

Fresh pasture is highly variable.

Its HC content changes with:

• Season

• Weather

• Plant maturity

• Rate of growth

• Time of day

• Grass species

• Rainfall and drought stress

• Temperature

For this reason, general rules such as morning grass is safe or warm season grass is always safer should be treated with caution.

 

A horse with uncontrolled hyperinsulinaemia should not have access to fresh pasture.

Where pasture access is appropriate for an individual horse, possible management tools include:

• Restricting grazing time

• Using a properly fitted grazing muzzle

• Creating a genuinely grass free yard

• Using a track system

• Monitoring body condition and digital pulses closely

• Removing pasture access at the first sign of increasing risk

A grazing muzzle reduces intake but does not make high risk pasture automatically safe. Some horses learn to consume significant amounts despite wearing one, and muzzles must be checked carefully for fit and rubbing.

For many years, pasture associated laminitis was blamed mainly on fructans.

The current ECIR approach places the focus on hydrolysable carbohydrates, especially simple sugars and starch, because these are the components that raise glucose and insulin.

Very large experimental doses of chicory derived fructan can produce severe hindgut disturbance and systemic inflammatory laminitis. However, naturally occurring pasture and hay fructans have not been shown to cause the insulin rise responsible for metabolic laminitis.

 

Exercise regularly when the horse is sound

Exercise is one of the most effective tools available for improving insulin sensitivity.

Structured exercise is recommended where possible and also increasing general movement through management, such as a paddock perimeter track, can be useful.

Options may include:

• Riding

• Driving

• In hand exercise

• Leading one horse from another where safe

• Hill work

• Track systems

• Separating food, water and shelter to encourage movement

• Keeping compatible horses together so they move naturally as a group

Formal exercise should be regular and sufficiently active to improve fitness, but the amount must suit the horse’s age, soundness and current condition.

An acutely laminitic horse must never be forced to exercise.

Exercise is introduced only after the horse is comfortable, the feet are stable and the rehabilitation stage allows it. ECIR describes exercise as the best insulin buster available, while also stressing that a painful laminitic horse should not be forced to move.

 

Manage PPID properly

In older horses, preventing laminitis also means recognising and controlling PPID.

Possible early signs include:

• Delayed or incomplete shedding

• Loss of topline muscle

• A pot bellied appearance

• Increased drinking or urination

• Recurrent infections

• New allergies

• Unexplained tendon or ligament problems

• Regional fat deposits developing later in life

• Repeated or seasonal laminitis

PPID treatment should be monitored through clinical signs and appropriate blood testing. The ECIR goal is to keep ACTH controlled throughout the year, because uncontrolled PPID may worsen hyperinsulinaemia and increase laminitis risk.

In the southern hemisphere, the seasonal ACTH rise generally occurs from February to May. Horses with PPID or a history of seasonal laminitis may need testing and treatment review before this period begins.

 

Maintain regular hoof care

Good hoof care does not remove EMS or control insulin, but poor hoof mechanics can make the consequences of laminitis worse.

Regular trimming helps maintain:

• Appropriate toe length

• Balanced hoof proportions

• Functional breakover

• Sole and frog health

• Better overall hoof mechanics

Professional hoof care is recommended at approximately four week intervals. For laminitic horses, shorter intervals often needed during early rehabilitation.

Regular hoof care also provides another opportunity for an experienced professional to notice subtle changes such as:

• A stretched white line

• New hoof rings

• Increased flare

• Changes in sole depth

• Bruising

• Changes in hoof balance

Hoof care is part of the prevention plan, but it cannot replace controlling the underlying metabolic risk.

 

Monitor your horse regularly

Prevention is most effective when small changes are noticed before they become a full laminitis episode.

Useful routine checks include:

• Monitor body condition and weight

• Feel the crest of the neck for increasing thickness or firmness

• Check for new regional fat deposits

• Learn what your horse’s normal digital pulse feels like

• Watch for shorter strides or reluctance to turn

• Notice changes on firm or stony ground

• Look for increased lying down or shifting weight

• Monitor hoof growth and changes in the white line

• Review blood results where appropriate

• Keep track of seasonal changes in pasture, weight and exercise

 

Early laminitis may appear only as:

• Mild foot soreness

• A shortened stride

• Reluctance to turn

• Increased digital pulses

• Sudden sensitivity on hard ground

• Unexplained behavioural resistance to movement

 

Prepare before the high risk season

Laminitis prevention should begin before the first warm spell or obvious spring flush.

In southern Australia, the first pasture growth may begin during August, depending on the weather. Horses at risk should already have a management plan in place before this occurs.

That plan may include:

• Body condition assessment

• Insulin testing where indicated

• Reviewing PPID control at the appropriate time of year

• Organising a grass free area or track turnout area

• Checking and fitting a grazing muzzle

• Sourcing safe hay

• Planning the horse’s exercise program

• Scheduling regular hoof care

• Establishing baseline digital pulses

• Deciding what changes will trigger removal from pasture

It is much easier to restrict grass before a laminitis episode than to rehabilitate a horse afterwards.

Build a plan you can maintain

The best management plan is one that is safe, appropriate and realistic enough to maintain.

A perfect plan that lasts one week is less useful than a sound plan that becomes part of the horse’s normal routine.

 

What Feeds and Supplements can help?

There are feeds and supplements that may help correct nutritional deficiencies or support hoof and metabolic health. However, no supplement can compensate for:

• Uncontrolled pasture intake

• Excess calories

• Untreated PPID

• Lack of exercise

• Poor hoof mechanics

• Failure to recognise rising insulin

• Delayed action when early signs appear

 

Laminitis prevention is a complete management approach.

It requires the same core principles used by ECIR:

• Diagnosis

• Diet and appropriate medication

• Trim

• Exercise

 

Prevention is better than rehabilitation!

Laminitis can cause months of pain, expense and difficult rehabilitation.

The encouraging part is that many cases of hyperinsulinaemia-associated laminitis are preventable.

The goal is not to find one miracle solution. It is to recognise the horse’s individual risks early and consistently manage the factors that can be controlled.

Small, sensible decisions made every day can prevent the crisis that otherwise appears to happen overnight.