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((short description|Disease of the feet of hooved animals))
((Multiple issues|
((More citations needed|date=December 2021))
((One source|date=December 2021))
))
[[File:Laminitis radiograph with annotation.jpg|thumb|300px|[[Radiograph]] of a horse hoof showing rotation of the [[pedal bone|coffin bone]] and evidence of sinking, a condition often associated with laminitis. The annotation P2 stands for the [[Equine forelimb anatomy#Bones of the distal forelimb|middle phalanx]], or [[pastern]] bone, and P3 denotes the distal phalanx, or coffin bone. The yellow lines mark the distance between the top and bottom part of the coffin bone relative to the hoof wall, showing the distal (bottom) of the coffin bone is rotated away from the hoof wall.]]

'''Laminitis''' is a disease that affects the feet of [[ungulate]]s and is found mostly in [[horse]]s and [[cattle]]. Clinical signs include foot tenderness progressing to inability to walk, increased digital pulses, and increased temperature in the hooves. Severe cases with outwardly visible clinical signs are known by the colloquial term ''[[#Rotation, sinking, and founder|founder]]'', and progression of the disease will lead to perforation of the coffin bone through the sole of the hoof or being unable to stand up, requiring [[Animal euthanasia|euthanasia]].

==Laminae==
((Main|Horse hoof#Internal structures))
The bones of the hoof are suspended within the [[Anatomical terms of location#Other directional terms|axial]] hooves of ungulates by layers of modified skin cells, known as '''laminae''' or '''lamellae''', which act as shock absorbers during locomotion. In horses, there are about 550–600 pairs of primary [[epidermis (zoology)|epidermal]] laminae, each with 150–200 secondary laminae projecting from their surface.<ref name="Equine Emerg">((cite book | last1 = Orsini | first1 = James  | first2 = Thomas | last2 = Divers | name-list-style = vanc |title=Equine Emergencies|date=2014|publisher=Elsevier|location=St. Louis, MO|isbn=978-1-4557-0892-5|pages=697–712|edition=4th))</ref> These interdigitate with equivalent structures on the surface of the [[coffin bone]] (PIII, P3, the third [[Phalanx bones|phalanx]], pedal bone, or distal phalanx), known as [[dermal]] laminae.<ref>((cite book | first = Christopher C | last = Pollitt | name-list-style = vanc |year=1995 |title= Color Atlas of the Horse's Foot |publisher= Mosby |isbn= 978-0-7234-1765-1 ))</ref> The secondary laminae contain [[Stratum basale|basal cell]]s which attach via [[hemidesmosome]]s to the [[basement membrane]]. The basement membrane is then attached to the coffin bone via the connective tissue of the dermis.<ref name="Equine Emerg"/>

==Pathophysiology==
Laminitis literally means inflammation of the laminae, and while it remains controversial whether this is the primary mechanism of disease, evidence of inflammation occurs very early in some instances of the disease.<ref>((cite journal | vauthors = Loftus JP, Black SJ, Pettigrew A, Abrahamsen EJ, Belknap JK | title = Early laminar events involving endothelial activation in horses with black walnut- induced laminitis | journal = American Journal of Veterinary Research | volume = 68 | issue = 11 | pages = 1205–11 | date = November 2007 | pmid = 17975975 | doi = 10.2460/ajvr.68.11.1205 | doi-access = free ))</ref> A severe inflammatory event is thought to damage the basal epithelial cells, resulting in dysfunction of the [[hemidesmosome]]s and subsequent reduction in adherence between the epithelial cells and the [[basement membrane]].<ref name="Baxter"/> Normal forces placed on the hoof are then strong enough to tear the remaining laminae, resulting in a failure of the interdigitation of the epidermal and dermal laminae between the hoof wall and the coffin bone. When severe enough, this results in displacement of the coffin bone within the hoof capsule.<ref name="Baxter">((cite book|last1=Baxter|first1=Gary | name-list-style = vanc |title=Manual of Equine Lameness|date=2011|publisher=Wiley-Blackwell|location=Ames, Iowa|isbn=978-0-8138-1546-6|pages=257–262|edition=1st))</ref> Most cases of laminitis occur in both front feet, but laminitis may be seen in all four feet, both hind feet, or in cases of support limb laminitis, in a single foot.<ref name="Baxter"/>

===Mechanism===
The mechanism remains unclear and is the subject of much research. Three conditions are thought to cause secondary laminitis:
*[[Sepsis]]/[[endotoxemia]] or generalized inflammation
*[[Endocrinopathy]]
*Trauma: concussion or excessive weight-bearing

;Inflammation

Inflammatory events that are associated with laminitis include sepsis, endotoxemia, retained [[placenta]], [[carbohydrate]] overload (excessive grain or pasture), [[enterocolitis]], [[pleuropneumonia]], and contact with [[black walnut]] shavings.<ref name="KER">((cite journal | vauthors = Huntington P, Pollitt C, McGowan C | title = Recent research into laminitis. | journal = Advances in Equine Nutrition | volume = IV | date = September 2009 | page = 293 | url =  http://www.ker.com/library/Proceedings/08/5_Laminitis_p57.pdf | access-date=28 July 2014|url-status=dead |archive-url= https://web.archive.org/web/20130323045457/http://ker.com/library/Proceedings/08/5_Laminitis_p57.pdf |archive-date=23 March 2013 ))</ref> In these cases, there is an increase in blood flow to the hoof, bringing in damaging substances and inflammatory cells into the hoof.

;Endocrinopathy

Endocrinopathy is usually the result of improper [[insulin]] regulation, and is most commonly seen with [[pituitary pars intermedia dysfunction]] (also called equine Cushing's syndrome) and [[equine metabolic syndrome]] (EMS),<ref name="Baxter"/> as well as obesity and [[glucocorticoid]] administration.<ref name="KER"/> In cases of EMS, most episodes occur in the spring when the grass is lush.<ref name="Baxter"/>

;Trauma

Mechanical laminitis starts when the hoof wall is pulled away from the bone or lost, as a result of external influences. Mechanical laminitis can occur when a horse habitually paws, is ridden or driven on hard surfaces ("road founder"), or in cases of excessive weight-bearing due to compensation for the opposing limb, a process called ''support limb laminitis''. Support limb laminitis is most common in horses suffering from severe injury to one limb, such as fracture, resulting in a non-weight bearing state that forces them to take excessive load on the opposing limb. This causes decreased blood flow to the cells, decreasing oxygen and nutrient delivery, and thus altering their metabolism which results in laminitis.<ref name="Equine Emerg"/>

===Theories of pathophysiology===
;Matrix metalloproteinases
One of the newest theories for the molecular basis of laminitis involves [[matrix metalloproteinase]]s (MMPs). [[Metalloproteinase]]s are enzymes that can degrade collagen, growth factors, and cytokines to remodel the extracellular matrix of tissues. To prevent tissue damage, they are regulated by [[Tissue inhibitor of metalloproteinase|tissue inhibitors of metalloproteinases]] (TIMPs). In cases of laminitis, an underlying cause is thought to cause an imbalance of MMPs and TIMPs, favoring MMPs, so that they may cleave substances within the extracellular matrix and therefore break down the basement membrane.<ref name="pmid21333362">((cite journal | vauthors = de Laat MA, Kyaw-Tanner MT, Nourian AR, McGowan CM, Sillence MN, Pollitt CC | title = The developmental and acute phases of insulin-induced laminitis involve minimal metalloproteinase activity | journal = Veterinary Immunology and Immunopathology | volume = 140 | issue = 3–4 | pages = 275–81 | date = April 2011 | pmid = 21333362 | doi = 10.1016/j.vetimm.2011.01.013 | url = https://eprints.qut.edu.au/52106/1/52106_Authors_Final_Version.pdf ))</ref> Since the basement membrane is the main link between the hoof wall and the connective tissue of P3, it is thought that its destruction results in their separation.<ref name="KER"/> MMP-2 and MMP-9 are the primary enzymes thought to be linked to laminitis.<ref name="KER"/>

;Theories for development
There are multiple theories as to how laminitis develops. These include:
*Enzymatic and inflammatory theories: The enzymatic theory postulates that increased blood flow to the foot brings in inflammatory cytokines or other substances to the hoof, where they increase production of MMPs, which subsequently break down the basement membrane. The inflammatory theory states that inflammatory mediators produce inflammation, but recognizes that MMP production occurs later. Therefore, this is possibly a 2-step process, beginning with inflammation and leading to MMP production and subsequent laminitis.<ref name="KER"/>
*Vascular theory: Postulates that increases in capillary pressure, constriction of veins, and shunting of blood through anastomoses to bypass the capillaries, causes decreased blood and therefore decreased oxygen and nutrient delivery to lamellae. The end-result would be ischemia, leading to cellular death and breakdown between the lamellae. Subsequently, increased vascular permeability leads to edema within the hoof, compression of small vessels, and ischemia. Vasoactive amines may be partially to blame for changes in hoof blood flow.<ref name="KER"/>
*Metabolic theory: Insulin affects multiple processes within the body, including inflammation, blood flow, and tissue remodeling. Change in insulin regulation may lead to laminitis.<ref name="KER"/> Hyperinsulinemia has been shown to cause increased length of the secondary lamellae and epidermal cell proliferation.<ref name="Equine Emerg"/> 
*Traumatic theory: Concussion is thought to directly damage lamellae, and increased weight-bearing is thought to decrease blood supply to the foot.<ref name="KER"/>

===Rotation, sinking, and founder===
[[File:Laminitis embedding hc biovision.jpg|thumb|250px|Hoof sagittal section with massive inflammation and rotation of third phalanx]]
Normally, the front of the third phalanx is parallel to the hoof wall and its lower surface should be roughly parallel to the ground surface.  A single severe laminitic episode or repeated, less severe episodes can, depending upon the degree of separation of dermal and epidermal laminae, lead to either rotation or sinking of the pedal bone, both of which result in anatomical changes in the position of the coffin bone with visible separation of the laminae, colloquially known as founder.  Rotation and distal displacement may occur in the same horse.<ref name="Baxter"/>  Both forms of displacement may lead to the coffin bone penetrating the sole.  Penetration of the sole is not inherently fatal; many horses have been returned to service by aggressive treatment by a veterinarian and farrier, but the treatment is time-consuming, difficult and expensive.

Rotation is the most common form of displacement, and, in this case, the tip of the coffin bone rotates downward.<ref name="Baxter"/>  The degree of rotation may be influenced by the severity of the initial attack and the time of initiation and aggressiveness of treatment.  A combination of forces (e.g. the tension of the deep digital flexor tendon and the weight of the horse) result in the deep digital flexor tendon literally pulling the dorsal face of the coffin bone away from the inside of the hoof wall, which allows the coffin bone to rotate.  Also, ligaments attaching the collateral cartilages to the digit, primarily in the palmar portion of the foot, possibly contribute to a difference in support from front to back.  The body weight of the animal probably contributes to rotation of the coffin bone.  Rotation results in an obvious misalignment between PII (the short pastern bone) and PIII (the coffin bone).  If rotation of the third phalanx continues, its tip can eventually penetrate the sole of the foot.

Sinking is less common and much more severe.  It results when a significant failure of the interdigitation between the sensitive and insensitive [[Horse hoof#Internal structures|laminae]] around a significant portion of the hoof occurs.  The destruction of the sensitive laminae results in the hoof wall becoming separated from the rest of the hoof, so that it drops within the hoof capsule.  Sinking may be symmetrical, i.e., the entire bone moves distally, or asymmetric, where the lateral or medial aspect of the bone displaces distally.<ref name="Baxter"/>  Pus may leak out at the white line or at the coronary band.  In extreme cases, this event allows the tip to eventually penetrate the sole of the foot.  A severe "sinker" usually warrants the gravest prognosis and may, depending upon many factors, including the quality of aftercare, age of the horse, diet and nutrition, skill, and knowledge and ability of the attending veterinarian and [[farrier]](s), lead to euthanasia of the patient.

==Phases of laminitis==
Treatment and prognosis depend on the phase of the disease, with horses treated in earlier stages often having a better prognosis.

;Developmental phase
The developmental phase is defined as the time between the initial exposure to the causative agent or incident, until the onset of clinical signs. It generally lasts 24–60 hours, and is the best time to treat a laminitis episode. Clinical laminitis may be prevented if cryotherapy (icing) is initiated during the developmental phase.<ref name="Equine Emerg"/>

;Acute phase
The acute phase is the first 72 hours following the initiation of clinical signs. Treatment response during this time determines if the horse will go into the subacute phase or chronic phase. Clinical signs at this time include bounding digital pulses, lameness, heat, and possibly response to hoof testing.<ref name="Equine Emerg"/>

;Subacute phase
The subacute phase occurs if there is minimal damage to the lamellae. Clinical signs seen in the acute phase resolve, and the horse becomes sound. The horse never shows radiographic changes, and there is no injury to the coffin bone.<ref name="Equine Emerg"/>

;Chronic phase
[[File:Founder severe rotation.JPG|thumb|250px|right|Hoof specimen, sagittal section. Severe P3 rotation and penetration into the sole. A lamellar wedge is evident.]]
The chronic phase occurs if damage to the lamellae is not controlled early in the process, so that the coffin bone displaces. Changes that may occur include separation of the dermal and epidermal lamellae, lengthening of the dermal lamellae, and compression of the coronary and solar dermis. If laminitis is allowed to continue, long-term changes such as remodeling of the apex and distal border of the coffin bone (so that a "lip" develops) and [[osteolysis]] of the coffin bone can occur.<ref name="Equine Emerg"/>

The chronic phase may be compensated or uncompensated. Compensated cases will have altered hoof structure, including founder rings, wide white lines, and decreased concavity to the sole. Horses will be relatively sound. On [[radiograph]]s, remodeling of the coffin bone and in cases of rotational displacement, the distal hoof wall will be thicker than that proximally. [[Venogram]]s will have relatively normal contrast distribution, including to the apex and distal border of the coffin bone, and the coronary band, but "feathering" may be present at the lamellar "scar."<ref name="Equine Emerg"/>

Uncompensated cases will develop a lamellar wedge (pathologic horn), leading to a poor bridge between P3 and the hoof capsule. This will lead to irregular horn growth and chronic lameness, and horses will suffer from laminitis "flares." Inappropriate hoof growth will occur: the dorsal horn will have a tendency to grow outward rather than down, the heels will grow faster than the toe, and the white line will widen, leading to a potential space for packing of debris. The solar dermis is often compressed enough to inhibit growth, leading to a soft, thin sole (<10&nbsp;mm) that may develop [[seroma]]s. In severe cases where collapse of the suspensory apparatus of P3 has occurred, the solar dermis or the tip of P3 may penetrate the sole. The horse will also be prone to recurrent [[abscess]]ation within the hoof capsule. Venogram will show "feathering" into the vascular bed beneath the lamellae, and there will be decreased or absent contrast material in the area distal to the apex of the coffin bone.<ref name="Equine Emerg"/>

== Causes ==
[[File:2015-09-07. Архипо-Осиповка 026.jpg|thumb|The front feet of this horse exhibit the rings and overgrowth typical of foundered horses.]]

Laminitis has various causes, some of which commonly occur together.  These include:

===Vasoactive amines===
The inflammatory molecule [[histamine]] has also been hypothesized as a causative agent of laminitis.<ref>((cite journal |last1=Nilsson |first1=Sture A. | name-list-style = vanc |year=1963 |title=Clinical, morphological and experimental studies of laminitis in cattle |journal=Acta Veterinaria Scandinavica |volume=4 |issue=Suppl. 1 |pages=188–222 |oclc=13816616 ))</ref><ref>((cite journal | vauthors = Takahashi K, Young BA | title = Effects of grain overfeeding and histamine injection on physiological responses related to acute bovine laminitis | journal = Nihon Juigaku Zasshi. The Japanese Journal of Veterinary Science | volume = 43 | issue = 3 | pages = 375–85 | date = June 1981 | pmid = 7321364 | doi = 10.1292/jvms1939.43.375 | doi-access = free ))</ref>  However, contradictory evidence indicates the role of histamine in laminitis has not been conclusively established.<ref>((cite journal | vauthors = Thoefner MB, Pollitt CC, Van Eps AW, Milinovich GJ, Trott DJ, Wattle O, Andersen PH | title = Acute bovine laminitis: a new induction model using alimentary oligofructose overload | journal = Journal of Dairy Science | volume = 87 | issue = 9 | pages = 2932–40 | date = September 2004 | pmid = 15375054 | doi = 10.3168/jds.s0022-0302(04)73424-4 | doi-access = free ))</ref>

===Mechanical separation===
((See also|#Mechanical laminitis))

Commonly known as '''road founder''', mechanical separation occurs when horses with long toes are worked extensively on hard ground.  The long toes and hard ground together contribute to delayed '''breakover''', hence mechanical separation of the laminae at the toe.  Historically, this was seen in [[carriage horse]]s bred for heavy bodies and long, slim legs with relatively small hooves; their hooves were trimmed for long toes (to make them lift their feet higher, enhancing their stylish "action"), and they were worked at speed on hard roads. Road founder is also seen in overweight animals, particularly when hooves are allowed to grow long; classic examples are ponies on [[pasture board]] in spring, and pregnant mares.<ref name=RooneyNL/>

===Poor blood circulation===

Normal blood circulation in the lower limbs of a horse depends in part on the horse moving about.  Lack of sufficient movement, alone or in combination with other factors, can cause '''stagnant [[Hypoxia (medical)|anoxia]]''', which in turn can cause laminitis.<ref name=RooneyNL/>

A horse favoring an injured leg will both severely limit its movement and place greater weight on the other legs.  This sometimes leads to '''static laminitis''', particularly if the animal is confined in a stall.<ref name=RooneyNL>((cite web | url = http://www.horseshoes.com/farrierssites/sites/rooney/nonclassicallaminitis/nonclassicallaminitis.htm  | title = Nonclassical laminitis | first = James | last = Rooney | name-list-style = vanc | archive-url = https://web.archive.org/web/20080124120909/http://www.horseshoes.com/farrierssites/sites/rooney/nonclassicallaminitis/nonclassicallaminitis.htm | archive-date = 2008-01-24 | url-status = dead ))</ref>  A notable example is the 2006 [[Kentucky Derby]] winner [[Barbaro (horse)|Barbaro]].<ref>
((cite news
 |title       = Transcript of Press Conference on the condition of Barbaro
 |publisher   = [[University of Pennsylvania]] School of Veterinary Medicine
 |date        = 13 July 2006
 |url         = http://www.vet.upenn.edu/newsandevents/news/Barbaro_Transcript7-13.pdf
 |url-status     = dead
 |archive-url  = https://web.archive.org/web/20070204100304/http://www.vet.upenn.edu/newsandevents/news/Barbaro_Transcript7-13.pdf
 |archive-date = 4 February 2007
))
</ref>

'''Transport laminitis''' sometimes occurs in horses confined in a trailer or other  transportation for long periods of time.  Historically, the most extreme instances were of horses shipped overseas on sailing ships.  However, the continual shifting of weight required to balance in a moving vehicle may enhance blood circulation, so some horsemen recommend trailering as an initial step in rehabilitation of a horse after long confinement.((Citation needed|date=February 2008))

Laminitis has been observed following an equine standing in extreme conditions of cold, especially in deep snow.((Citation needed|date=February 2008)) Laminitis has also followed prolonged heating such as may be experienced from prolonged contact with extremely hot soil or from incorrectly applied hot-shoeing.((Citation needed|date=February 2008))

===Complex causes===
*[[Pituitary pars intermedia dysfunction]], or Cushing's disease, is common in older horses and ponies and causes an increased predisposition to laminitis.
*[[Equine metabolic syndrome]] is a subject of much new research and is increasingly believed to have a major role in laminitis. It involves many factors such as [[cortisol]] metabolism and [[insulin]] resistance. It has some similarities to [[Diabetes mellitus type 2|type II diabetes]] in humans. In this syndrome, peripheral [[adipocytes|fat cells]] synthesise [[adipokines]] which are analogous to cortisol, resulting in Cushings-like symptoms.
*A retained [[placenta]], if not passed completely after the birth of a [[foal]], can cause mares to founder, whether through toxicity, bacterial fever, or both.
*Anecdotal reports of laminitis following the administration of drugs have been made, especially in the case of [[corticosteroid]]s.  The reaction may be an expression of idiosyncrasy in a particular patient, as many horses receive high dose [[glucocorticoid]] into their joints without showing any evidence of clinical laminitis.<ref>((cite journal |title=Clinical use of triamcinolone acetonide in the horse (205 cases) and the incidence of glucocorticoid‐induced laminitis associated with its use |journal=Equine Veterinary Education|volume=16|issue=2|pages=86–89|doi=10.1111/j.2042-3292.2004.tb00272.x|year=2010|last1=McCluskey|first1=M. J.|last2=Kavenagh|first2=P. B.))</ref>     <ref>((cite journal |title=No Evidence That Therapeutic Systemic Corticosteroid Administration is Associated With Laminitis in Adult Horses Without Underlying Endocrine or Severe Systemic Disease |year=2016|doi=10.18849/ve.v1i1.12|url=https://www.veterinaryevidence.org/index.php/ve/article/view/12/17|last1=McGowan|first1=Cathy|last2=Cooper|first2=Daniel|last3=Ireland|first3=Joanne|journal=Veterinary Evidence|volume=1|doi-access=free))</ref>
*Even horses not considered to be susceptible to laminitis can become laminitic when exposed to certain [[agrichemical]]s. The most commonly experienced examples are certain [[herbicide]]s and synthetic [[fertilizer|nitrate fertilizer]].

==Risk factors==
Whilst diet has long been known to be linked to laminitis, there is emerging evidence that breed and body condition also play a role.<ref>((cite journal |title=Laminitis: Risk Factors and Outcome in a Group of Danish Horses |journal=Journal of Equine Veterinary Science |volume=53 |pages=68–73 |year=2017 |last1=Luthersson |first1=Nanna |last2=Mannfalk |first2=Maria |last3=Parkin |first3=Tim D.H |last4=Harris |first4=Patricia | name-list-style = vanc | doi = 10.1016/j.jevs.2016.03.006 |s2cid=4493753 |url=http://eprints.gla.ac.uk/133906/7/133906.pdf ))</ref> Levels of hormones, particularly [[adiponectin]], and serum [[insulin]] are also implicated, opening up new possibilities for developing early prognostic tests and risk assessments.<ref>((cite journal | vauthors = Menzies-Gow NJ, Harris PA, Elliott J | title = Prospective cohort study evaluating risk factors for the development of pasture-associated laminitis in the United Kingdom | journal = Equine Veterinary Journal | volume = 49 | issue = 3 | pages = 300–306 | date = May 2017 | pmid = 27363591 | doi = 10.1111/evj.12606 | s2cid = 19954615 | url = https://researchonline.rvc.ac.uk/id/eprint/10493/1/10493.pdf ))</ref>

==Diagnosis==
Early diagnosis is essential to effective treatment.  However, early outward signs may be fairly nonspecific.  Careful physical examination typically is diagnostic, but [[radiograph]]s are also very useful.

===Clinical signs===
[[File:Laminitis plastinate hc biovision.jpg|thumb|250px|right|Cross-section of horse with severe laminitis, showing a dished dorsal hoof wall that grows in a more horizontal manner, and a sole that is convex due to pressure from the tip of P3 secondary to rotation.]]
* Increased temperature of the wall, sole and/or coronary band of the foot<ref name="Baxter"/>
* A pounding pulse in the digital [[Anatomical terms of location#Relative directions|palmar]] artery<ref name="Baxter"/>
* Anxiety and visible trembling
* Increased vital signs and body temperature
* Sweating
* Flared nostrils
* Walking very tenderly, as if walking on egg shells
* Repeated "easing" of affected feet, i.e. constant shifting of weight
* [[Lameness (equine)|Lameness]] with a positive response to hoof testers at the toe<ref name="Baxter"/>
* The horse stands in a "founder stance" in attempt to decrease the load on the affected feet. If it has laminitis in the front hooves, it will bring its hind legs underneath its body and put its fore legs out in front.<ref name="Baxter"/> In cases of sinking, the horse stands with all four feet close together, like a circus elephant.
* Tendency to lie down whenever possible, and recumbency in extreme cases<ref name="Baxter"/>
* Change in the outward appearance of the hoof in cases of chronic laminitis: dished (concave) dorsal hoof wall, "founder rings" (growth rings that are wider at the heel than the toe), a sole that is either flat or convex just dorsal to the apex of the frog which indicates P3 has displaced or penetrated, widening of the white line at the toe with or without bruising, "clubbing" of the foot.<ref name="Equine Emerg"/><ref name="Baxter"/> 
* Change in the appearance of the coronary band: hair that does not lie in a normal position (not against the hoof wall), indentation or rim just above the hoof capsule allowing palpation behind the coronary band.<ref name="Equine Emerg"/> 
* In cases of sinking, it may be possible to palpate a groove between the coronary band and the skin of the pastern.<ref name="Baxter"/>

===Lameness evaluation===
;Hoof testing
Laminitic horses are generally sore to pressure from hoof testers applied over the toe area. However, there is risk of a false negative if the horse naturally has a thick sole, or if the hoof capsule is about to slough.<ref name="Equine Emerg"/>

;Obel grading system
The severity of lameness is qualified using the Obel grading system:<ref>((cite web|last1=Anderson|first1=Michelle | name-list-style = vanc |title=The Obel Grading System for Describing Laminitis |url= http://www.thehorse.com/articles/31062/the-obel-grading-system-for-describing-laminitis |website=www.thehorse.com |date=16 December 2012 |publisher=The Horse|access-date=30 July 2014 |url-status=live |archive-url=https://web.archive.org/web/20140815041620/http://www.thehorse.com/articles/31062/the-obel-grading-system-for-describing-laminitis |archive-date=15 August 2014 ))</ref>
* Obel grade 1: Horse shifts weight between affected feet or continuously lifts feet up. It is sound at the walk but displays a shortened stride at the trot.
* Obel grade 2: Horse displays a stilted, stiff gait, although is willing to walk. It is possible to easily lift a front foot and have the horse take all of its weight on the contralateral limb.
* Obel grade 3: Horse displays a stilted, stiff gait, but is reluctant to walk and is difficult when asked to lift a front foot.
* Obel grade 4: Horse is very reluctant to move, or is recumbent.

;Nerve blocks
Horses suffering from the disease usually require an abaxial sesamoid block to relieve them of pain, since the majority of pain comes from the hoof wall. However, chronic cases may respond to a palmar digital block since they usually have primarily sole pain.<ref name="Baxter"/> Severe cases may not respond fully to nerve blocks.<ref name="Equine Emerg"/>

===Radiographs===
Radiographs are an important part of evaluating the laminitic horse. They not only allow the practitioner to determine the severity of the episode, which does not always correlate with degree of pain,<ref name="Equine Emerg"/>  but also to gauge improvement and response to treatment. Several measurements are made to predict severity. Additionally, radiographs also allow the visualization and evaluation of the hoof capsule, and can help detect the presence of a lamellar wedge or seromas.<ref name="Equine Emerg"/> The lateral view provides the majority of the information regarding degree of rotation, sole depth, dorsal hoof wall thickness, and vertical deviation.<ref name="Equine Emerg"/><ref name="Ramey">((cite book | first1 = Pete | last1 = Ramey | first2 = Robert M | last2 = Bowker | name-list-style = vanc | title = Care and Rehabilitation of the Equine Foot |publisher= Hoof Rehabilitation Publisher |year= 2011 |isbn= 978-0-615-52453-5 |pages= 234–253))</ref>  A 65-degree dorsopalmar view is useful in the case of chronic laminitis to evaluate the rim of the coffin bone for pathology.<ref name="Equine Emerg"/>

;Radiographic measurements
[[File:LaminiticRadiographicMeasurements.jpg|right|300px|thumb|Radiographic measurements, including coronary extensor distance (CE), horn:lamellar distance (HL), sole depth (SD), digital breakover (DB), and palmar angle (PA)]]
Several radiographic measurements, made on the lateral view, allow for objective evaluation of the episode.
# ''Coronary extensor distance (CE)'': the vertical distance from the level of the proximal coronary band to the extensor process of P3. It is often used to compare progression of the disease over time, rather than as a stand-alone value. A rapidly increasing CE value can indicate distal displacement (sinking) of the coffin bone, while a more gradual increase in CE can occur with foot collapse. Normal values range from 0–30&nbsp;mm, with most horses >12–15&nbsp;mm.<ref name="Equine Emerg"/> 
# ''Sole depth (SD)'': the distance from the tip of P3 to the ground.
# ''Digital breakover (DB)'': distance from the tip of P3 to the breakover of the hoof (dorsal toe).<ref name="Equine Emerg"/> 
# ''Palmar angle (PA)'': the angle between a line perpendicular to the ground, and a line at the angle of the palmar surface of P3. 
# ''Horn:lamellar distance (HL)'': the measurement from the most superficial aspect of the dorsal hoof wall to the face of P3. 2 distances are compared: a proximal measurement made just distal to the extensor process of P3, and a distal measurement made toward the tip of P3. These two values should be similar. In cases of rotation, the distal measurement will be higher than the proximal. In cases of distal displacement, both values will increase, but may remain equal. Therefore, it is ideal to have baseline radiographs for horses, especially for those at high-risk for laminitis, to compare to should laminitis ever be suspected. Normal HL values vary by breed and age:<ref name="Equine Emerg"/> 
::* Weanlings will have a greater proximal HL compared to distal HL
::* Yearlings will have approximately equal proximal and distal HL
::* Thoroughbreds are usually 17mm proximally, and 19mm distally
::* Standardbreds have been shown to have a similar proximal and distal HL, around 16&nbsp;mm at 2 years old, and 20&nbsp;mm at 4 years old
::* Warmbloods have similar proximal and distal values, up to 20&nbsp;mm each
::* HL tends to increase with age, up to 17&nbsp;mm in most light breeds, or higher, especially in very old animals

;Venograms
[[venography|Venograms]] can help determine the prognosis for the animal, particularly in horses where the degree of pain does not match the radiographic changes. In venography, a contrast agent, visible on radiographs, is injected into the palmar digital vein to delineate the [[vasculature]] of the foot.<ref name="Equine Emerg"/> The venogram can assess the severity and location of tissue compromise and monitor effectiveness of the current therapy.<ref name="Ramey"/> Compression of veins within the hoof will be seen as sections that do not contain contrast material. Poor or improper blood flow to different regions of the hoof help determine the severity of the laminitic episode. Venography is especially useful for early detection of support limb laminitis, as changes will be seen on venograph (and MRI) within 1–2 weeks, whereas clinical signs and radiographic changes do not manifest until 4–6 weeks.<ref name="Equine Emerg"/>

Horses undergoing venography have plain radiographs taken beforehand to allow for comparison. The feet are blocked to allow the sedated horse to stand comfortably during the procedure. Prior to injection, a tourniquet is placed around the fetlock to help keep the contrast material within the foot during radiography. Diffusion of contrast may make some areas appear hypoperfused, falsely increasing the apparent severity of the laminitic episode. After injection of the contrast material, films are taken within 45 seconds to avoid artifact caused by diffusion. Evaluation of blood supply to several areas of the foot allows the practitioner to distinguish mild, moderate, and severe compromise of the hoof, chronic laminitis, and sinking.<ref name="Equine Emerg"/>

===Other diagnostics===
Other imaging tools have been used to show mechanical deviations in laminitis cases include [[computed tomography]], as well as [[MRI]], which also provides some physiologic information.((Citation needed|date=April 2008))  [[Scintigraphy|Nuclear scintigraphy]] may also be useful in certain situations. [[Ultrasonography]] has been explored as a way to quantify changes in bloodflow to the foot.<ref>((cite journal | vauthors = Wongaumnuaykul S, Siedler C, Schobesberger H, Stanek C | title = Doppler sonographic evaluation of the digital blood flow in horses with laminitis or septic pododermatitis | journal = Veterinary Radiology & Ultrasound | volume = 47 | issue = 2 | pages = 199–205 | date = 2006 | pmid = 16553154 | doi = 10.1111/j.1740-8261.2006.00128.x ))</ref>

==Prognosis==
The sooner the diagnosis is made, the faster the treatment and the recovery process can begin. Rapid diagnosis of laminitis is often difficult, since the general problem often starts somewhere else in the horse's body. With modern therapies, most laminitics will be able to bear a rider or completely recover, if treated quickly, and if the laminitis was not severe or complicated (e.g. by equine metabolic syndrome or [[Cushing's disease]]). Even in these cases, a clinical cure can often be achieved. [[Endotoxic]] laminitis (e.g. after foaling) tends to be more difficult to treat. Successful treatment requires a competent [[farrier]] and [[veterinarian]], and success is not guaranteed. A horse can live with laminitis for many years, and although a single episode of laminitis predisposes to further episodes, with good management and prompt treatment it is by no means the catastrophe sometimes supposed: most horses suffering an [[acute (medicine)|acute]] episode without pedal bone displacement make a complete functional recovery. Some countermeasures can be adopted for pasture based animals.<ref name="pmid16772514">((cite journal | vauthors = Harris P, Bailey SR, Elliott J, Longland A | title = Countermeasures for pasture-associated laminitis in ponies and horses | journal = The Journal of Nutrition | volume = 136 | issue = 7 Suppl | pages = 2114S–2121S | date = July 2006 | pmid = 16772514 | doi = 10.1093/jn/136.7.2114S | doi-access = free ))</ref><ref>((cite book | last1 = Colahan | first1 = Patrick | first2 = Alfred | last2 = Merritt | first3 = James | last3 = Moore | first4 = I | last4 = Mayhew | name-list-style = vanc | title = Equine Medicine and Surgery| edition = Fifth| publisher = Mosby|date=December 1998 |page=408 |url=http://www.elsevier.com/wps/find/bookdescription.cws_home/694822/description#description | isbn = 978-0-8151-1743-8))</ref> Discovery of laminitis, either active or relatively stabilized, on an [[equine prepurchase exam]] typically downgrades the horse's value, as the possibility of recurrence is a significant risk factor for the future performance of the horse.

Several radiographic abnormalities can be judged to correlate with a worsened prognosis:
* Increased degree of rotation of P3 relative to the dorsal hoof wall (rotation greater than 11.5 degrees has a poorer prognosis)<ref name="Baxter"/> 
* Increased founder distance, the vertical distance from the coronary band (seen with a radio-opaque marker) to the dorsoproximal aspect of P3 (distance greater than 15.2mm has a poorer prognosis)<ref name="Baxter"/> 
* Decreased sole depth<ref name="Baxter"/> 
* Sole penetration by P3

== Treatment ==
In laminitis cases, a clear distinction must be made between the acute onset of a laminitis attack and a chronic situation.<ref>((Cite web |title=Laminitis in Horses - Musculoskeletal System |url=https://www.msdvetmanual.com/musculoskeletal-system/lameness-in-horses/laminitis-in-horses |access-date=2023-11-30 |website=MSD Veterinary Manual |language=en))</ref> A chronic situation can be either stable or unstable. The difference between acute, chronic, stable, and unstable is of vital importance when choosing a treatment protocol. There is no cure for a laminitic episode and many go undetected.<ref>((Cite web |last=Director |first=Stephanie L. Church, Editorial |date=2020-02-05 |title=How to Support Horses With Acute or Chronic Laminitis |url=https://thehorse.com/184663/how-to-support-the-horse-with-acute-or-chronic-laminitis/ |access-date=2023-11-30 |website=The Horse |language=en-US))</ref> Initial treatment with [[cryotherapy]] and anti-inflammatory drugs may prevent mechanical breakdown if instituted immediately, but many cases are only detected after the initial microscopic damage has been done.<ref>((Cite journal |last1=Van Eps |first1=A. W. |last2=Pollitt |first2=C. C. |date=2004 |title=Equine laminitis: cryotherapy reduces the severity of the acute lesion |url=https://beva.onlinelibrary.wiley.com/doi/10.2746/0425164044877107 |journal=Equine Veterinary Journal |language=en |volume=36 |issue=3 |pages=255–260 |doi=10.2746/0425164044877107 |issn=0425-1644))</ref><ref>((Cite journal |last1=Jacobs |first1=Carrie C. |last2=Schnabel |first2=Lauren V. |last3=McIlwraith |first3=C. Wayne |last4=Blikslager |first4=Anthony T. |date=2022 |title=Non‐steroidal anti‐inflammatory drugs in equine orthopaedics |journal=Equine Veterinary Journal |language=en |volume=54 |issue=4 |pages=636–648 |doi=10.1111/evj.13561 |issn=0425-1644 |pmc=9304133 |pmid=35076950))</ref> In cases of sepsis or endotoxemia, the underlying cause should be addressed concurrently with laminitis treatment.<ref name="Baxter"/> There are various methods for treating laminitis, and opinions vary on which are most useful. Additionally, each horse and affected hoof should be evaluated individually to determine the best treatment plan, which may change with time.<ref name="Equine Emerg"/> Ideally, affected hooves are re-evaluated on a regular basis once treatment commences to track progress.<ref name="Equine Emerg"/>

===Management===
Initial management usually includes stall rest to minimize movement, and deeply bedding the stall with shavings, straw, or sand. Exercise is slowly increased once the horse has improved, ideally in an area with good (soft) footing, beginning with hand-walking, then turn-out, and finally riding under saddle.<ref name="Equine Emerg"/> This process may take months to complete.<ref name="Equine Emerg"/>

===Cryotherapy===
Cooling of the hoof in the developmental stages of laminitis has been shown to have a protective effect when horses are experimentally exposed to carbohydrate overload. Feet placed in ice slurries were less likely to experience laminitis than "uniced" feet.<ref name="Pollitt 2003">((cite journal |last=Pollitt |first=Christopher | name-list-style = vanc |date=November 2003 |title=Equine Laminitis |journal=Proceedings of the AAEP |volume=49 |url=http://www.ivis.org/proceedings/AAEP/2003/pollitt/IVIS.pdf |access-date=2008-04-19 |url-status=live |archive-url=https://web.archive.org/web/20080308174343/http://www.ivis.org/proceedings/AAEP/2003/pollitt/IVIS.pdf |archive-date=2008-03-08 ))</ref> Cryotherapy reduces inflammatory events in the lamellae. Ideally, limbs should be placed in an ice bath up to the level of the knee or hock. Hooves need to be maintained at a temperature less than 10 degrees Celsius at the hoof wall, for 24–72 hours.<ref name="Equine Emerg"/>

In the case of a full-blown case of laminitis, use of a cold water spa proved effective in the treatment of [[Bal a Bali]]. For the first three days, Bal a Bali was kept in the spa for eight hours at a time. Once his condition stabilized, he continued to be put in the spa twice a day over the next few months.<ref name=Miracle>((cite web |last1=Shulman |first1=Lenny | name-list-style = vanc |title=Making of a Miracle |url= https://vet.osu.edu/sites/vet.osu.edu/files/legacy/userimages/u89/BH29-BalABali.pdf |website=vet.osu.edu (reprint from The Blood-Horse)|access-date=20 March 2017|url-status=live|archive-url=https://web.archive.org/web/20161217150726/http://www.vet.osu.edu/sites/vet.osu.edu/files/legacy/userimages/u89/BH29-BalABali.pdf|archive-date=17 December 2016))</ref>

===Drug therapies===
;Anti-inflammatories and analgesics
Anti-inflammatories are always used when treating acute case of laminitis, and include Nonsteroidal anti-inflammatory medications ([[NSAIDS]]), DMSO, pentoxpfylline, and cryotherapy.<ref name="Baxter"/> For analgesia, NSAIDs are often the first line of defense. [[Phenylbutazone]] is commonly used for its strong effect and relatively low cost. [[Flunixin]] (Banamine), ketofen, and others are also used.  Nonspecific NSAIDs such as [[suxibuzone]], or [[COX-2 selective inhibitor|COX-2]]-specific drugs, such as [[firocoxib]] and [[diclofenac]], may be somewhat safer than phenylbutazone in preventing NSAID toxicity such as [[Horse colic#Right dorsal colitis|right dorsal colitis]], [[Equine gastric ulcer syndrome|gastric ulcers]], and kidney damage.<ref name="pmid8420909">((cite journal | vauthors = MacAllister CG, Morgan SJ, Borne AT, Pollet RA | title = Comparison of adverse effects of phenylbutazone, flunixin meglumine, and ketoprofen in horses | journal = Journal of the American Veterinary Medical Association | volume = 202 | issue = 1 | pages = 71–7 | date = January 1993 | pmid = 8420909 ))</ref><ref>((cite conference |first1=David |last1=Sabaté  | first2 = Josep | last2 = Homedes | first3 = I | last3 = Mayós | first4 = R | last4 = Calonge | name-list-style = vanc | date = January 2005 | conference = 11th SIVE Congress | location = Pisa |title=Suxibuzone as a Therapeutical Alternative to Phenylbutazone in the Treatment of Lameness in Horses |url=http://www.ivis.org/proceedings/SIVE/2005/free_com/Sabate.pdf |access-date=2008-04-19 |display-authors=etal |url-status=live |archive-url=https://web.archive.org/web/20050529051837/http://www.ivis.org/proceedings/SIVE/2005/free_com/Sabate.pdf |archive-date=2005-05-29 ))</ref><ref name="pmid18167116">((cite journal | vauthors = Doucet MY, Bertone AL, Hendrickson D, Hughes F, Macallister C, McClure S, Reinemeyer C, Rossier Y, Sifferman R, Vrins AA, White G, Kunkle B, Alva R, Romano D, Hanson PD | display-authors = 6 | title = Comparison of efficacy and safety of paste formulations of firocoxib and phenylbutazone in horses with naturally occurring osteoarthritis | journal = Journal of the American Veterinary Medical Association | volume = 232 | issue = 1 | pages = 91–7 | date = January 2008 | pmid = 18167116 | doi = 10.2460/javma.232.1.91 ))</ref> However, firocoxib provides less pain relief than phenylbutazone or flunixin.<ref name="Equine Emerg"/> Care must be taken that pain is not totally eliminated, since this will encourage the horse to stand and move around, which increases mechanical separation of the laminae.<ref name="Equine Emerg"/>

Pentafusion, or the administration of [[ketamine]], [[lidocaine]], [[morphine]], [[detomidine]], and [[acepromazine]] at a constant rate of infusion, may be of particular benefit to horses suffering from laminitis.<ref name="Baxter"/> Epidurals may also be used in hind-limb laminitis.<ref name="Baxter"/>

;Vasodilators
[[Vasodilator]]s are often used with the goal of improving laminar blood flow. However, during the developmental phases of laminitis, vasodilation is [[contraindicated]], either through hot water or vasodilatory drugs.<ref>((cite book | vauthors = Pollitt CC |veditors=Ross MW, Dyson SJ |title=Diagnosis and Management of Lameness in the Horse|year=2003 |publisher=[[Saunders (imprint)|Saunders]] |location=St. Louis, MO |isbn=0-7216-8342-8 |chapter=Medical Therapy of Laminitis |page=330  ))</ref>  Systemic [[acepromazine]] as a vasodilator with the fringe benefit of mild [[sedation]] which reduces the horse/pony's movements and thus reduces [[concussion]] on the hooves, may be beneficial after lamellar damage has occurred, although no effects on laminar blood flow with this medication have been shown.<ref>((cite journal | vauthors = Adair HS, Schmidhammer JL, Goble DO |year=1997 |title=Effects of acepromazine maleate, isoxsuprine hydrochloride and prazosin hydrochloride on laminar blood flow in healthy horses |journal=Journal of Equine Veterinary Science |volume=17|pages=599–603|doi=10.1016/S0737-0806(97)80186-4 |display-authors=etal))</ref> [[Nitroglycerine]] has also been applied topically in an attempt to increase blood flow, but this treatment does not appear to be an effective way to increase blood flow in the equine digit.<ref>((cite journal | vauthors = Belknap JK, Black SJ |year=2005|title=Review of the Pathophysiology of the Developmental Stages of Equine Laminitis|journal=Proceedings American Association of Equine Practitioners |volume=51))</ref>

===Trimming and shoeing===
Besides pain management and control of any predisposing factors, mechanical stabilization is a primary treatment goal once the initial inflammatory and metabolic issues have resolved. No approach has been shown to be effective in all situations, and debate is ongoing about the merits and faults of the numerous techniques. Once the distal phalanx rotates, it is essential to derotate and re-establish its proper spatial orientation within the hoof capsule, to ensure the best long-term prospects for the horse. With correct trimming and, as necessary, the application of [[orthotic]]s, one can effect this reorientation. However, this is not always completely effective.<ref>((Cite journal |last1=Parks |first1=Andrew |last2=O'Grady |first2=Stephen E |date=2003-08-01 |title=Chronic laminitis: current treatment strategies |url=https://www.sciencedirect.com/science/article/pii/S0749073903000191 |journal=Veterinary Clinics of North America: Equine Practice |series=Podiatry |volume=19 |issue=2 |pages=393–416 |doi=10.1016/S0749-0739(03)00019-1 |issn=0749-0739))</ref><ref>((Cite web |title=Tenotomy as a treatment for Laminitis |url=https://www.equipodiatry.com/news/articles/tenotomyhtm |access-date=2023-11-30 |website=www.equipodiatry.com))</ref><ref>((Cite journal |last=Baxter |first=Gary M. |date=1994-12-01 |title=Acute Laminitis |url=https://www.sciencedirect.com/science/article/pii/S0749073917303516 |journal=Veterinary Clinics of North America: Equine Practice |series=Emergency Treatment in the Adult Horse |volume=10 |issue=3 |pages=627–642 |doi=10.1016/S0749-0739(17)30351-6 |issn=0749-0739))</ref>

;Trimming
Successful treatment for any type of founder must necessarily involve stabilization of the bony column by some means. Correct trimming can help improve stabilization. This usually includes bringing the "break over" back to decrease the fulcrum-effect that stresses the laminae. Trimming the heels helps to ensure [[Horse hoof#The frog|frog]] pressure and increases surface area for weight-bearing on the back half of the hoof.<ref>((Cite web |title=Realigning Trim |url=https://www.thelaminitissite.org/realigning-trim.html |access-date=2023-11-30 |website=The Laminitis Site |language=en))</ref> While horses may stabilize if left barefooted, some veterinarians believe the most successful methods of treating founder involve positive stabilisation of the distal phalanx, by mechanical means, e.g., shoes, pads, polymeric support, etc. Pour-in pads or putty is sometimes placed on the sole to increase surface area for weight-bearing, so that the sole in the area of the quarters, and the bars, will take some of the weight.<ref>((Cite journal |last1=Reilly |first1=Patrick T. |last2=Dean |first2=Emily K. |last3=Orsini |first3=James A. |date=2010-08-01 |title=First Aid for the Laminitic Foot: Therapeutic and Mechanical Support |url=https://www.sciencedirect.com/science/article/pii/S0749073910000490 |journal=Veterinary Clinics of North America: Equine Practice |series=Advances in Laminitis, Part II |volume=26 |issue=2 |pages=451–458 |doi=10.1016/j.cveq.2010.06.004 |issn=0749-0739))</ref><ref>((Cite web |date=2016-02-14 |title=Managing the Laminitic and Foundered Horse with Sole Support |url=https://www.horsejournals.com/horse-care/hoof-care/managing-laminitic-and-foundered-horse-sole-support |access-date=2023-11-30 |website=Horse Journals |language=en))</ref>

;Altering the palmar angle
The deep digital flexor tendon places a constant pull on the back of the coffin bone. This is sometimes counteracted by decreasing the palmar angle of the hoof by raising the heels, often with the use of special shoes which have a wedge in the heel of approximately 20 degrees.<ref>((Cite journal |last1=Ramsey |first1=G. D. |last2=Hunter |first2=P. J. |last3=Nash |first3=M. P. |date=2011 |title=The effect of hoof angle variations on dorsal lamellar load in the equine hoof |url=https://beva.onlinelibrary.wiley.com/doi/10.1111/j.2042-3306.2010.00319.x |journal=Equine Veterinary Journal |language=en |volume=43 |issue=5 |pages=536–542 |doi=10.1111/j.2042-3306.2010.00319.x |issn=0425-1644))</ref><ref>((Cite web |last=MA |first=Christa Lesté-Lasserre |date=2023-10-10 |title=Researchers Compare Therapeutic Shoes for Horses with Laminitis |url=https://thehorse.com/1123873/researchers-compare-therapeutic-shoes-for-horses-with-laminitis/ |access-date=2023-11-30 |website=The Horse |language=en-US))</ref> Shoes are usually glued or cast onto the foot so painful nailing does not have to take place.<ref>((Cite web |title=Gluing Shoes To Hoof Boots To Treat Chronic Laminitis |url=https://www.americanfarriers.com/articles/8129-gluing-shoes-to-hoof-boots-to-treat-chronic-laminitis |access-date=2023-11-30 |website=www.americanfarriers.com |language=en))</ref> The position of P3 within the hoof is monitored with radiographs. Once the horse has improved, the wedge of the shoe must be slowly reduced back to normal.<ref>((Cite web |last=CF |first=Craig Lesser, DVM |date=2022-09-13 |title=Managing Laminitic Horses Using Radiographs |url=https://thehorse.com/1115635/managing-laminitic-horses-using-radiographs/ |access-date=2023-11-30 |website=The Horse |language=en-US))</ref>

;Use of orthotics
The application of external orthotic devices to the foot in a horse with undisplaced laminitis and once displacement has occurred is widespread.  Most approaches attempt to shift weight away from the laminae and onto secondary weight-bearing structures, while sparing the sole.<ref>((Cite web |title=Laminitis in Horses |url=https://www.acvs.org/large-animal/laminitis-in-horses/ |access-date=2023-11-30 |website=American College of Veterinary Surgeons |language=en-US))</ref><ref>((Cite journal |last1=Reilly |first1=Patrick T. |last2=Dean |first2=Emily K. |last3=Orsini |first3=James A. |date=2010-08-01 |title=First Aid for the Laminitic Foot: Therapeutic and Mechanical Support |url=https://www.sciencedirect.com/science/article/pii/S0749073910000490 |journal=Veterinary Clinics of North America: Equine Practice |series=Advances in Laminitis, Part II |volume=26 |issue=2 |pages=451–458 |doi=10.1016/j.cveq.2010.06.004 |issn=0749-0739))</ref>

;Corrective hoof trimming
Corrective hoof trimming will restore proper hoof form and function. Corrective trimming will allow the hooves to be healthy again.<ref>((Cite web |title=Disorders of the Foot in Horses - Horse Owners |url=https://www.merckvetmanual.com/horse-owners/bone,-joint,-and-muscle-disorders-in-horses/disorders-of-the-foot-in-horses |access-date=2023-11-30 |website=Merck Veterinary Manual |language=en-US))</ref>

;Realigning trimming
Realigning trimming trims back the toe so that it is in line with the coffin bone. Realigning trimming pushes the coffin bone back into the correct position. The process of a new hoof capsule totally growing out to replace the old one takes up to a year.<ref>((Cite journal |last1=Aoun |first1=Rita |last2=Charles |first2=Iyana |last3=DeRouen |first3=Abigail |last4=Takawira |first4=Catherine |last5=Lopez |first5=Mandi J. |date=2023 |title=Shoe configuration effects on third phalanx and capsule motion of unaffected and laminitic equine hooves in-situ |journal=PLOS ONE |volume=18 |issue=5 |pages=e0285475 |doi=10.1371/journal.pone.0285475 |issn=1932-6203 |pmid=37155654 |pmc=10166494 |doi-access=free ))</ref>

==== Alternative horseshoeing methods ====
New non-invasive horseshoeing methods are available for farriers to take advantage of. They encapsulate the damaged hoof, protecting and supporting the sensitive internal structures. This prevents further deterioration, whilst also immediately reducing pain and improving the horse’s ability to move. The resulting comfort also reduces overall stress levels, leading to a faster recovery as the horse can quickly return to a regular routine.<ref>((Cite web |title=Laminitis In Horses - Non-Invasive, Supportive Treatment |url=https://formahoof.com/laminitis |access-date=2022-09-14 |website=FormaHoof |language=en-US))</ref>

===Aggressive therapies===
;Dorsal hoof wall resection
A dorsal hoof wall resection may help in certain conditions after consultation with an experienced veterinarian and farrier team. If decreased bloodflow distal to the [[coronary plexus]] is seen on a venogram, or when a laminar wedge forms between P3 and the hoof wall, preventing the proper reattachment ([[interdigitation]]) of the laminae, this procedure may be beneficial. When the coffin bone is pulled away from the hoof wall, the remaining laminae will tear. This may lead to abscesses within the hoof capsule that can be severe and very painful, as well as a mass of disorganized tissue called a laminar (or lamellar) wedge.<ref>((cite book | first = Robert A | last = Eustace | name-list-style = vanc | title = Explaining Laminitis and its Prevention | location = Cherokee, Ala. | publisher = Life Data Labs | year = 1996 |isbn= 978-0-9518974-0-9 |pages= 29–31))</ref>

;Coronary grooving
Coronary grooving involves removing a groove of hoof wall just distal to the coronary band. It is thought to encourage dorsal hoof wall growth and improve alignment of the wall.<ref name="Baxter"/>

;Deep digital flexor tenotomy
((Main|Treatment of equine lameness#Deep digital flexor tendon tenotomy))
Because the rotation of P3 is exacerbated by continued pull on the deep digital flexor tendon, one approach to therapy has been to cut this tendon, either in the cannon region (mid-metacarpus)<ref name="Baxter"/> or in the [[pastern]] region. Over a time period of 6 weeks, tenotomy is thought to allow P3 to realign with the ground surface.<ref name="Baxter"/> Critics claim that this technique is unsuccessful and invasive, with advocates making counter-arguments that it is often used in cases which are too far advanced for treatment to help.<ref name="pmid10029854">((cite journal | vauthors = Eastman TG, Honnas CM, Hague BA, Moyer W, von der Rosen HD | title = Deep digital flexor tenotomy as a treatment for chronic laminitis in horses: 35 cases (1988-1997) | journal = Journal of the American Veterinary Medical Association | volume = 214 | issue = 4 | pages = 517–9 | date = February 1999 | pmid = 10029854 | url = http://www.ivis.org/proceedings/AAEP/1998/Eastman.pdf ))</ref> Tenotomy does risk subluxation of the distal interphalangeal joint (coffin joint),<ref name="Baxter"/> which may be avoided with the use of heel extensions on the shoe.<ref name="Equine Emerg"/> Horses may return to work after the surgery.<ref name="Equine Emerg"/> This treatment is often recommended for severe cases of laminitis, and requires proper trimming and shoeing to be successful.<ref name="Equine Emerg"/>

;Botulinum toxin infusion
As an alternative to the deep digital flexor tenotomy, [[Botulinum toxin|''Clostridium botulinum'' type A toxin]] has been infused into the body of the deep digital flexor muscle.  This theoretically allows for the same derotation as a [[#Deep Digital flexor tenotomy|tenotomy]], but without the potential for scarring or [[contracture]] associated with that procedure.  A recent study used this technique in seven laminitic horses. Significant improvement was seen in six of the horses, with moderate improvement in the seventh.<ref>((cite journal | vauthors = Carter DW, Renfroe JB | title = A novel approach to the treatment and prevention of laminitis: botulinum toxin type A for the treatment of laminitis | journal = Journal of Equine Veterinary Science | date = July 2009 | volume = 29 | issue = 7 | pages = 595–600 | doi = 10.1016/j.jevs.2009.05.008 ))</ref>

==Complications==
Complications to laminitis include recurrent hoof abscesses, which are sometimes secondary to pedal osteitis,<ref name="Equine Emerg"/> [[seroma]]s, and fractures to the solar margin of the coffin bone.<ref name="Baxter"/>

==((anchor|Founder))Informal use of the word "founder"==
Informally, particularly in the United States, "founder" has come to mean any chronic changes in the structure of the foot that can be linked to laminitis. In some texts, the term is even used synonymously with laminitis, though such usage is technically incorrect.  Put simply, not all horses that experience laminitis will founder, but all horses that founder will first experience laminitis.

== See also ==
*[[Barefoot horses]]
*[[Farrier]]
*[[Horse hoof]]
*[[Horseshoe]]
*[[Lameness (equine)]]

== References ==
((Reflist))

== Further reading ==
((refbegin|32em))
* ((cite book | title = Adams and Stashak's Lameness in Horses | edition =  6th | date = March 2011 | publisher = Wiley-Blackwell| editor-first = Gary M. | editor-last = Baxter | name-list-style = vanc  | isbn = 978-0-813-81549-7 ))
* ((cite book | title = The Lame Horse | first = James R. | last = Rooney | name-list-style = vanc | publisher = Russell Meerdink Company | date = 1998 | isbn = 978-0-929346-55-7 ))
* ((cite book | title = The Illustrated Veterinary Encyclopedia for Horsemen | editor-first =  Don M. | editor-last = Wagoner | name-list-style = vanc | publisher = Equine Research Inc. | isbn = 978-0-935842-03-6 | year = 1977 ))
* ((cite book | title = Veterinary Medications and Treatments for Horsemen | veditors = Adams HR, Chalkley LW, Buchanan TM, Wagoner DM | publisher = Equine Research Inc. | date = 1977 | isbn = 978-0-935842-01-2 ))
* ((cite book | first1 = James M. | last1 = Giffin | first2 = Tom | last2 = Gore | name-list-style = vanc | title = Horse Owner's Veterinary Handbook | publisher = Howell Book House | edition = Third | date = July 2008 | isbn = 978-0-470-12679-0 | url-access = registration | url = https://archive.org/details/horseownersveter00gore ))
* ((cite book | first = Jaime | last = Jackson | name-list-style = vanc | title = Founder: Prevention & Cure the Natural Way | publisher = Star Ridge Company | isbn = 978-0-9658007-3-0 | date = March 2001 ))
*((cite book | title = Who's Afraid of Founder. Laminitis Demystified: Causes, Prevention and Holistic Rehabilitation | first = Hiltrud | last = Strasser | name-list-style = vanc | author-link = Hiltrud Strasser | publisher =  Sabine Kells | date = 2003 | isbn = 978-0-9685988-4-9 ))
* ((cite book | first = Simon | last = Curtis | name-list-style = vanc | title = Corrective Farriery, a textbook of remedial horseshoeing  | publisher =  R & W Publications (Newmarket) Ltd | date = June 2006 | isbn = 978-1-899772-13-1 ))
* ((cite book | first = Doug | last = Butler | name-list-style = vanc | title = The Principles of Horseshoeing II and The Principles of Horseshoeing III | isbn = 978-0-916992-26-2 | year = 2004 | publisher = Doug Butler Enterprises ))
* ((cite book | first1 = Ronald J. | last1 = Riegel | first2 = Susan E. | last2 = Hakola | name-list-style = vanc| title = Illustrated Atlas of Clinical Equine Anatomy and Common Disorders of the Horse | volume = One  | publisher =  Equistar Publications | date = 1999 | asin = B000Z4DW38 ))
* ((cite journal | vauthors = Redden RF | title = Understanding Laminitis | journal = The Horse | date = Apr 15, 2004 | url = https://thehorse.com/152248/understanding-laminitis/ ))
* ((cite book | first =  Jaime | last = Jackson | name-list-style = vanc | title = Founder: Prevention & Cure the Natural Way | publisher = Star Ridge Publishing | year = 2001 | isbn = 978-0-9658007-3-0 ))
((refend))

[[Category:Equine injury and lameness]]
[[Category:Equine hoof]]
[[Category:Horse diseases]]

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