Recognising the Early Signs of Laminitis

Key Message

Laminitis does not always begin with a horse standing rocked back in the classic founder stance.

Often the first signs are much more subtle. A horse may become a little reluctant to move, uncomfortable turning, tender on hard ground or simply quieter than usual.

Changes in the hoof itself may also tell us that the laminae have been under stress for some time.

Learning what is normal for your horse makes these early changes much easier to recognise.

At a Glance

Possible early signs of laminitis include:

• A stronger or bounding digital pulse
• Tenderness on hard or stony ground
• A shorter, stiffer or shuffling stride
• Reluctance to make tight turns
• Reluctance to trot or move freely
• Less spontaneous movement around the paddock
• Shifting weight from one foot to another
• Lying down more than usual
• Difficulty comfortably holding up one hoof for the farrier or trimmer
• Tension through the shoulders, back or hindquarters
• Changes in behaviour, including becoming unusually quiet or less active within the herd
• Stretching or separation of the white line
• Bruising or haemorrhage in the white line
• Flat, thin or dropped soles
• Growth rings, particularly when they become wider towards the heels
• A change in the angle of the hoof wall, flaring or dishing
• Recurrent abscesses, seedy toe or hoof wall separation

At the more severe end, the horse may become obviously lame, repeatedly shift weight, lie down frequently or adopt the familiar founder stance.

The Full Lesson

One of the difficulties with laminitis is that the early stages may not look like obvious lameness.

In metabolic or endocrine laminitis, damage to the laminae can develop gradually. By the time the horse is dramatically sore, changes within the feet may have been occurring for some time.

Dr Eleanor Kellon describes this as occult or sub acute laminitis.

Because both front feet are often affected at the same time, the horse can simply look stiff, shortened in its stride or reluctant to move.

This means early laminitis is sometimes mistaken for general stiffness, arthritis, hock soreness, back pain, laziness or simply an older horse slowing down.

Watch how your horse moves. Some of the earliest clues appear in movement.

You may notice that your horse:

• Walks with a short or wooden looking stride
• Takes smaller steps than usual
• Is reluctant to trot
• Hesitates when asked to turn sharply
• Looks worse when turning in a small circle
• Is uncomfortable walking downhill
• Is hesitant on hard or stony ground
• Moves more comfortably on a soft surface
• Is less willing to walk around the paddock

A horse may also transfer more weight onto the hindquarters in an attempt to unload painful front feet.

In more advanced cases this eventually becomes the classic founder stance, with the front feet placed forward and the hind legs positioned further underneath the body.

But waiting for the founder stance means waiting for a very obvious sign.

Ideally, we want to recognise the problem much earlier.

Changes in behaviour can be important too, sometimes the first change is not obviously in the feet at all!

A horse experiencing low grade foot pain may:

• Spend more time standing still
• Lie down more often
• Stop wandering around the paddock
• Become reluctant to come when called
• Become quieter than usual
• Drop in social status within the herd
• Be reluctant to pick up a foot

A horse that has slowly developed pain may also become very good at disguising it.

A quiet horse can even be described as exceptionally well behaved when in reality it is avoiding unnecessary movement because its feet hurt.

Changes from that horse's normal behaviour are therefore particularly important.

The Digital Pulse

Learning to feel your horse's digital pulse is one of the most useful monitoring skills you can develop.

The digital arteries supply the hoof.

In a comfortable horse the pulse is usually soft and may be quite difficult to feel.

With hoof pain or pathology the pulse can become noticeably stronger and fuller, often described as a bounding digital pulse.

A strong digital pulse does not automatically mean laminitis. An abscess or another painful hoof problem can also increase it.

The important thing is to learn what is normal for your horse.

Check it when your horse is comfortable and healthy. Then you are much more likely to recognise when it changes.

The Writing Is on the Wall

The hoof wall can tell us a remarkable amount about what has been happening inside the foot.

Laminitis affects the connection between the hoof wall and the pedal bone. As that connection stretches or weakens, changes can gradually become visible in the hoof capsule.

Look for:

• Growth or stress rings
• Rings that diverge, becoming wider towards the heels than at the toe
• A change in the angle of the hoof wall
• Dishing through the front of the hoof
• Flaring around the hoof wall
• A long stretched toe
• White line stretching or separation
• Seedy toe
• Flat or dropped soles
• Thin soles
• Recurrent abscessing or bruising

One of the most useful clues is the change in hoof wall angle.

New hoof grows down from the coronary band. When the underlying problem is brought under control and a better laminar connection begins growing, the new hoof wall at the top may grow at a noticeably different angle from the older damaged wall below it.

Over time, that new wall grows towards the ground.

In that sense, the hoof wall really does provide a record of what has been happening.

Understanding hoof rings

Not every hoof ring means laminitis.

Hoof growth naturally changes with nutrition, season and other influences.

What is more concerning is a repeated pattern of rings combined with other changes, particularly rings that are closer together at the toe and spread wider apart towards the heel.

These divergent rings can be associated with previous laminitic change.

They should make us look more closely at the rest of the horse rather than being viewed in isolation.

Look at the white line

The white line is another valuable place to look.

When the laminar connection stretches, the white line can become wider than normal.

You may see:

• Stretching at the toe
• Separation
• Small areas of haemorrhage or bruising
• Seedy toe developing within the separation

A stretched white line is not something we should simply fill, cut out and forget.

It tells us that the hoof capsule and the structures inside it may no longer be tightly connected.

Flat or dropped sole

A healthy sole should have appropriate depth and shape around the pedal bone.

Laminitic horses may develop:

• Flat soles
• Thin soles
• Dropped soles

This can make walking on hard or stony surfaces particularly uncomfortable.

If the pedal bone has moved within the hoof capsule, radiographs become extremely useful for understanding what is happening internally and for guiding the trim.

Back and body soreness

Foot pain changes the way the horse stands and moves.

A horse trying to protect painful front feet may shift weight backwards, shorten the stride and brace through the body.

Over time this can create tension through:

• The shoulders
• The neck
• The lower back
• The hindquarters

This does not mean every sore backed horse has laminitis.

But if a horse develops unexplained stiffness or back soreness alongside foot tenderness, altered movement or hoof changes, the feet deserve careful attention.

Why laminitis can be mistaken for something else

Because metabolic laminitis commonly affects both front feet, horses often do not show the classic one sided lameness we associate with an injury.

Instead you may see:

• General stiffness
• A shortened stride
• Reluctance to turn
• Weight transferred towards the hindquarters
• Poor performance
• Reluctance to move forward

This is one reason low grade laminitis may be mistaken for problems higher up the limb or body.

Other conditions can also look like laminitis, including hoof abscesses, other causes of foot pain, tying up, neurological disease and, occasionally, other serious problems.

We therefore need to look at the whole picture.

Look at the whole horse

No single sign diagnoses laminitis.

Instead, put the clues together.

Ask yourself:

• Has my horse's movement changed?
• Is the horse less comfortable on hard ground?
• Is turning more difficult?
• Has the digital pulse changed?
• Is the horse moving less voluntarily?
• Has behaviour changed?
• Is there unusual body or back tension?
• What does the white line look like?
• Are there new hoof rings, flares or angle changes?
• Is the sole becoming flatter or thinner?
• Does this horse have known risk factors for EMS or PPID?

The more pieces of the picture that appear together, the more seriously the possibility of laminitis should be considered.

In endocrine laminitis, subtle changes may have been occurring within the feet well before the horse becomes obviously lame.

Early recognition gives us an opportunity to investigate the cause, reduce the laminitis trigger and protect the hoof before considerably more damage occurs.

Learn your horse's normal movement.

Learn the normal digital pulse.

Look at the feet regularly.

And listen when your horse starts telling you that something has changed.