Recovering from Laminitis: The Rehabilitation Phase

Key Message

Recovery from laminitis takes time.

A horse becoming comfortable again does not necessarily mean the hoof has completely recovered. The damaged hoof needs to grow out and be replaced by new, well connected growth, and this takes months, not weeks.

The rehabilitation phase is about keeping the underlying cause controlled, maintaining correct hoof alignment, protecting the feet while they heal, and gradually allowing the horse to return to normal movement when it is ready.

At a Glance

During rehabilitation:
• Keep the underlying cause of the laminitis controlled.
• Move from the temporary Emergency Diet to an appropriate long term diet.
• Continue regular, correctly aligned trimming as the new hoof grows.
• Use boots, pads and comfortable footing where needed.
• Watch the new hoof growth for improving connection and alignment.
• Remember that feeling better does not mean the hoof has completely healed.
• Do not rush exercise or ridden work.
• Expect recovery to take many months.

The Full Lesson

When does rehabilitation begin?

As the horse becomes more comfortable and the original trigger comes under control, the focus shifts from managing the immediate crisis to supporting the hoof while it repairs and regrows.

This is the rehabilitation phase.

A horse may become much more comfortable within days or weeks. Digital pulses may settle, movement may improve and the horse may appear much more like its normal self.

But the hoof can still be compromised.

Laminitis damages the connection between the hoof wall and the internal structures of the foot. That damaged hoof needs to grow out and gradually be replaced by new hoof with a stronger laminar connection.

So improvement in comfort is an excellent sign, but it is the beginning of rehabilitation, not the end.

Keep the underlying cause controlled

Whatever caused the laminitis still needs to be managed throughout recovery.
For a horse with EMS, that means continuing to control insulin. For a horse with PPID, appropriate medication and monitoring remain important. If the horse has both conditions, both need to be addressed.

The temporary Emergency Diet can also transition into a properly balanced long term diet based around appropriate forage.

We cover these areas in more detail in the individual lessons on EMS, PPID, long term diet and pasture management.

Grow a new, healthy hoof

One of the most useful ways to think about rehabilitation is that we are growing a new hoof.

As the underlying problem comes under control and the hoof is correctly trimmed, new growth begins at the coronary band. Ideally, this new wall grows down with a stronger connection and better alignment than the damaged hoof below it.

You may be able to see a change in the angle of the new growth at the top of the hoof.
Over the following months, the aim is for that healthier growth to continue down until the older, damaged hoof has gradually been replaced.

This process cannot be rushed.

Maintain the trim as the hoof grows

Correct hoof alignment remains extremely important throughout rehabilitation.

The hoof needs to be trimmed according to the internal structures, particularly where rotation, sinking or hoof capsule distortion has occurred. Radiographs can be very useful for guiding this process.

Early in rehabilitation, shorter trimming intervals may be necessary to prevent the toe and damaged hoof wall from becoming distorted again.

Boots, pads and comfortable footing can also help protect the recovering feet, but they support a correct trim rather than replacing one.

Watch the hoof tell the story

The growing hoof can provide useful clues about how rehabilitation is progressing.

Look for:
• New wall growing at a healthier angle from the coronary band
• A tighter white line and better laminar connection
• Less flare and distortion as the damaged wall grows out
• Improving sole depth and shape
• Increasing comfort

Regular photographs taken from the same angles can be a simple way to follow these changes over time.

Expect some bumps along the way

Laminitis can leave the hoof structurally compromised for many months. During that time, problems such as abscesses, white line separation, seedy toe, flares and cracks may occur.

These problems need to be managed, but they do not mean that rehabilitation has failed.

Some are consequences of the original damage and may continue until the affected hoof has grown out.

The important thing is to keep looking at the overall direction of recovery.

Don't rush movement and exercise

Movement is an important part of eventual recovery, particularly for horses with EMS, but a painful laminitic horse should never be forced to exercise.

As the horse becomes comfortable and the feet become appropriately aligned and supported, voluntary movement can gradually increase.

Formal exercise, hand walking and eventually returning to ridden work need more careful consideration, so we will cover those separately in Returning to Exercise After Laminitis.

How long does recovery take?

There is no single timeframe.

A very mild episode caught early may have a very different recovery from a horse with significant rotation, sinking or hoof capsule distortion.

What is important to remember is that even when the horse feels much better, growing a new hoof takes many months.

Recovery should therefore be judged by more than whether the horse looks sound today. We also need to consider the new hoof growth, laminar connection, hoof alignment and whether the original cause remains controlled.

The Most Important Thing to Remember

Feeling better is the beginning of rehabilitation, not the end.

Once the acute episode settles, recovery becomes a process of maintaining the conditions that allow the hoof to heal.

Keep the underlying cause controlled, maintain correct hoof alignment, protect the feet where necessary, watch the new hoof grow and give the horse time.

The aim is not simply to make the horse comfortable again.

It is to grow a healthy, well connected hoof and reduce the chance of laminitis happening again.