If your horse is showing signs of acute laminitis, they require emergency veterinary attention and prompt treatment.
Laminitis affects the soft structures of the equine hoof, known as the laminae, and can cause significant pain and lameness.
An episode of laminitis can result in permanent damage to the internal structures of the hooves if left untreated.  Although the condition can be life-threatening, many horses recover with proper management.
At the first sign of a laminitis attack, there are steps you can take to slow the progression of laminar damage and improve your horse’s prognosis. This includes immediately calling your veterinarian, removing your horse from pasture and grains, and applying ice water to your horse’s feet.
This article will discuss emergency steps to take if you think your horse is experiencing a flare-up of acute laminitis. Once the lamnitic emergency has been managed, follow these steps to support your horse’s recovery.
Laminitis Emergency Treatment Protocol
Laminitis should be treated promptly to minimize damage to the laminae and prevent permanent disability, founder or death.
Step 1) Assess Your Horse for Signs of Laminitis
Observe your horse’s ability to move. Determine if he is willing and able to move at the walk and turn his body. Don’t force the horse to move if he is not able to as this could cause additional damage to the laminae and increase pain.
Look for signs of pain. Horses with laminitis may be unwilling to stand on hard surfaces. They may also shift their weight frequently and lift their feet alternately. A glazed facial expression can also be a sign of pain.
Take your horse’s heart rate. An elevated heart rate may be present in horses with laminitis a few days in advance of other symptoms of the condition. At rest, a normal heart rate is between 30 and 40 beats a minute. A slight increase of only a few beats per minute can indicate the onset of laminitis.
Check your horse’s digital pulse. An unusually strong pulse in your horse’s digital artery can be caused by inflammation in the hoof and could potentially indicate the presence of laminitis. Use your fingers to check the pulse of the digital artery which can be felt above the fetlock and in the upper and mid pastern.
Step 2) Contact Your Veterinarian
Laminitis is a veterinary emergency that requires prompt treatment. A veterinarian can determine the extent of damage that has occurred in the hooves and what treatment is required.
A veterinarian will perform a medical assessment including a lameness exam to diagnose your horse and determine a treatment plan for laminitis. Be prepared to provide your veterinarian with your horse’s medical history and current diet.
Radiographs may need to be taken to detect if there have been any changes to the coffin bone. These images can also be very helpful for the farrier to determine how the horse should be trimmed to properly balance the foot and if therapeutic shoeing would be beneficial.
Step 3) Move Your Horse to a Small Area with Soft Bedding
Horses with laminitis should move as little as possible until they are assessed by a veterinarian. Until the extent of the damage to the laminae is known, restrict unnecessary movement to avoid causing further injury.
If your horse shows signs of laminitis while at pasture and is unable to move, it may be necessary to use a trailer to transport him from the field to the stable. If it is not possible to remove the horse from the pasture, an alternative would be to place him in a very small area where movement can be restricted and there is little to no grass.
If moving the horse from one area to another is necessary, try to stay on soft ground or create a path using a soft footing such as sand or sawdust. Materials such as rubber mats or carpets can also be used to make a pathway for the horse to walk on.
A stall or small area with soft bedding is ideal for your horse to stand on. Beddings such as shavings, sawdust, or soaked wood pellets are helpful for supporting the hooves and maximizing weight distribution.
Step 4) Administer Cold Water Therapy
Cryotherapy involves the controlled cooling of a horse’s hooves, preferably prior to or at the onset of lameness. This therapy can be administered using either ice water or commercial systems.
Experts recommend cooling the hoof wall to 5 to 10 degrees Celsius (41 to 50 Fahrenheit) for a period of 48 to 72 hours.  Cryotherapy is widely accepted as an effective therapy to prevent and treat sepsis-related laminitis. It can also help prevent oligofructose-induced or pasture-associated laminitis. 
Cryotherapy induces vasoconstriction, decreases inflammatory damage and decreases metabolic activity in the area. This reduces the activity of enzymes that break down the laminae. 
The benefits of cold water therapy for resolving other forms of laminitis are unclear, but given the relative ease of this treatment it is still worth trying.
Step 4) Identify the Cause of Laminitis
Laminitis can occur due to a range of causes.  Determining the cause of laminitis in your horse is important as this will influence what type of treatment is necessary.
There are three main types of laminitis including:
- Endocrinopathic laminitis: Occurs in horses that have equine metabolic syndrome and or Pituitary Pars Intermedia Dysfunction (PPID).  Cases of pasture-associated laminitis (also known as grass laminitis) make up most incidences of endocrinopathic laminitis.
- Sepsis-associated laminitis: Occurs as a secondary effect of illness such as pneumonia or colic, or when mares retain the placenta after giving birth. 
- Supporting limb laminitis (SLL): The least common type of laminitis, SLL occurs in horses with a serious non-weight-bearing lameness. In cases of SLL, laminitis develops in a supporting limb. 
Endocrinopathic laminitis is the most common form of this condition. It typically affects horses with metabolic disease including PPID or insulin resistance.
This condition may develop in horses with chronically elevated insulin levels. It may also be triggered by a horse consuming a large amount of grain or grass containing high levels of non-structural carbohydrates (NSCs) including sugar, starch, and fructans. 
In these cases, horses should be removed from pasture immediately and not fed grain or concentrates.
Horses with sepsis-related laminitis are typically very ill with conditions such as colitis (inflammation of the colon), enteritis (intestinal inflammation), intestinal obstructions, metritis (toxic uterine inflammation following a retained placenta), or pneumonia.
These horses require treatment of their underlying illness to stop the progression of laminitis.
Horses unable to bear weight on a lame limb cannot shift their weight between their legs normally. These horses are at risk of developing supporting limb laminitis due to decreased blood flow to the lamellae. Management of horses with tendon or ligament injuries can prevent this condition.
Laminitis can also be caused by NSAIDs or corticosteroid administration. NSAIDs interfere with healthy gut function and corticosteroids may temporarily reduce insulin sensitivity. Ask your veterinarian if you should stop these medications during the acute phase of laminitis.
Although rare, traumatic laminitis can also result from excessive concussion to the hooves that causes tissue damage (sometimes known as road founder).
Step 5) Provide Medications
Under the guidance of a veterinarian, provide medications to help relieve your horse’s pain and combat inflammation.
Medications may also be required to treat any underlying causes of your horse’s laminitis.
Anti-inflammatory medications have proven beneficial for horses being treated for acute laminitis by reducing inflammation and laminar damage.
Common anti-inflammatory medications used in the emergency treatment of laminitis include Phenylbutazone (bute), Firocoxid, Flunixin Meglumine, and Dimethyl sulfoxide (DMSO).
In some cases of acute laminitis, medications are administered to inhibit the destruction of laminar connections due enzymes known as matrix metalloproteinases (MMPs). Types of MMP inhibitors commonly used in the treatment of laminitis include Pentoxifylline and Doxycycline.
Horses suffering from laminitis are typically prescribed pain-relieving drugs such as Phenylbutazone, Gabapentin, Morphine, Lidocaine, Ketamine, and Butorphanol.
Medications for Underlying Conditions
Metformin: Used to treat horses with severe insulin dysregulation, this drug prevents blood glucose and insulin levels from increasing after a meal. 
Levothyroxine: This synthetic form of thyroid hormone is beneficial in horses that are resistant to weight loss.
Pergolide: Used in horses with PPID, this drug helps to minimize the overproduction of endocrine hormones by the pars intermedia. 
Polymyxin B: A type of antibiotic used in the treatment of sepsis in horses.
Step 6) Surgical Intervention
In severe cases of laminitis that have progressed to founder, tenotomy of the deep flexor tendon may be used to reduce the pulling forces exerted by the DDFT on the coffin bone.
A tenotomy may enable the coffin bone to return to a normal position in the hoof capsule.
Step 7) Consult a Farrier for Therapeutic Hoof Care
An experienced farrier can provide corrective trimming and shoeing to assist in the treatment of laminitis by preventing further stress on the laminae.
Horses with laminitis benefit from trimming and shoeing strategies that shift the forces of weight-bearing to the rear of affected hooves. The body weight should be distributed over hoof structures including the frog, heels, bars, and sole.
Trimming and shoeing techniques help to reduce the damaging leverage forces on the toe region of the hoof and reduce the point of break-over. They also aim to restore a healthy angle of the coffin bone relative to the hoof capsule.
EVA foam, styrofoam, and various types of impression materials are commonly applied to the bottom of the hooves to help treat laminitis. The goal of these materials is to relieve pressure on the laminae to prevent further damage and reduce pain.
For some horses, hoof boots can facilitate healing after laminitis. Available in a range of sizes, hoof boots provide cushioning to the sole of the hoof and are often used in combination with padded inserts.
Some horses benefit from being shod with heart bar or egg bar shoes. Therapeutic components such as pads and wedges may be used in addition to shoes. Barefoot trimming is beneficial for some horses recovering from laminitis, whereas others require the support of shoes and padding materials to be comfortable during their recovery process.
Laminitic horses require farrier care more frequently than horses with healthy hooves. Farrier care should be provided every four weeks for horses recovering from laminitis.
Step 8) Feed an Appropriate Recovery Diet
Once a horse has experienced an episode of laminitis for any reason, the risk for future episodes increases.  Feeding a proper diet is essential for helping horses recover from this condition and to prevent future attacks.
After a flare-up of acute laminitis, horses should be fed a forage-based diet containing less than 10 percent NSCs (starch and Ethanol Soluble Carbohydrates (ESCs) including glucose, fructose, and sucrose). Hay can be soaked to reduce the sugar content.
Hay should be fed at the rate of between 1.5 and 2% of the horse’s body weight. Never feed less than 1.5% of the horse’s body weight without supervision from a veterinarian.
Using a slow feeder or hay net can extend the time it takes for horses to consume forage and helps to reduce the risk of stomach ulcers and