Laminitis is a common but serious condition that involves separation of the laminae, which connect the coffin bone to the hoof wall.
A bout of laminitis can cause mild to severe pain in affected horses and result in lasting damage to the hooves. In extreme cases, the condition can result in permanent lameness and lead to the horse being euthanized.
With prompt treatment and appropriate rehabilitation, the majority of horses recover from laminitis and can return to light work within two to three months.
However, once a horse has experienced laminitis as a result of elevated insulin in metabolic syndrome or PPID, the chance of recurrence increases. Mares that have pregnancy-induced insulin resistance and laminitis may also experience it again on subsequent pregnancies.
Damage to the laminae and alterations in the circulatory mechanisms in the hooves leave the horse vulnerable to future attacks.
Careful management of your horse’s nutrition and health is critical to preventing laminitis from recurring. This article will discuss how to best support the recovery of a laminitic horse to help them return to soundness.
The prognosis for horses with laminitis varies widely depending on the cause, the extent of damage to the laminae and the severity of pain experienced by the horse.
Horses with a mild case generally have a good prognosis and a high recovery rate. Treating laminitis promptly increases the chance of recovery for affected horses. Eliminating the cause and immediate attention to a realigning trim are critical to recovery.
Some horses are not able to recover completely if the laminae are severely compromised and the condition progresses to founder. Founder occurs when the coffin bone (also known as the pedal bone or the distal phalanx) has rotated and/or sunk within the hoof capsule.
However, if the cause is quickly and properly addressed and correct hoof care is maintained, even horses that have penetrated or sloughed their entire hooves have survived with a long period of intensive nursing.
While laminitis itself is not fatal, if the pain of the condition cannot be adequately managed, horse owners may make the decision to euthanize the animal.
In one review of veterinary case records for 216 horses and ponies with laminitis, 77% were able to return to soundness and resume their athletic careers.
Three percent of the animals did not regain athletic soundness but were kept as companions or breeding animals. 20% of the affected horses either died or were euthanized, with only a small number surviving for longer than 1 year. 
However, it should be noted that article was written before equine metabolic syndrome was well recognized and the role of insulin was known. Today, addressing hyperinsulinemia is a core component of laminitis recovery.
Laminitis Recovery Plan
Knowing what caused laminitis in your horse and how much weakening of laminar structures in the hooves has occurred is important when implementing a recovery plan for your horse.
Recovery from acute laminitis aims to achieve the following therapeutic targets:
- Resolving the underlying causes or predisposing factors that led to your horse’s laminitic episode.
- Addressing pain by resolving the cause and with medications as needed.
- Rehabilitating the hoof to support the coffin bone and reducing the weight bearing forces exerted on the laminae.
- Providing adequate rest and restricting the horse’s movement to prevent further injury and enable healing.
- Promoting blood flow to the hooves using vasodilatory medications or supplements that increase peripheral circulation.
- Enabling a gradual return to movement once the horse is no longer lame and can be maintained comfortably without pain medications.
Closely follow the advice provided by your veterinarian and work with an experienced farrier to increase the chances of a successful recovery.
Addressing Underlying Causes
The first step to helping your horse recover from laminitis is to remove the influence of any predisposing factors that triggered the laminitic episode.
A familiar scenario is laminitis caused by spring pasture. It used to be thought that any horse could develop pasture-associated laminitis and that there was a component of hindgut disturbance from fermentation of fructan in the grass.
Laminitis can also occur due to high fever, illnesses or a retained placenta that causes sepsis. The condition may also occur from trauma or excessive weight-bearing forces on the hoof.
Other factors such as corticosteroid or cephalosporin drug use, exposure to black walnut shavings, Hoary alyssum ingestion, selenium toxicity, pregnancy-induced insulin resistance, severe colic and certain other hoof disorders can also contribute to the development of laminitis.
Work with your veterinarian to address underlying health problems or treat illnesses that contributed to laminitis, such as PPID or equine metabolic syndrome.
Horses recovering from laminitis require confinement to a stall or small area with deep bedding to restrict their movement and encourage them to lay down. Deep sand is best for conforming to the hoof while supporting the frog and sole. 
Laminitis weakens the connection of the laminae between the coffin bone and hoof. Your horse will need time with limited movement for these structures to heal and regain full strength.
A significant factor in achieving recovery after laminitis is how horses are managed after lameness resolves. Dr. Andrew van Eps from the University of Pennsylvania’s School of Veterinary Medicine recommends stall rest (with limited hand-walking) for a period of one week for every day the horse was lame. 
However, prolonged stall confinement worsens the poor circulation that is part of laminitis pathology. This can be seen when horses that are on stall confinement improve in their comfort level after walking for a few minutes.
Horses with an appropriate realigning trim and protective boots and pads may be allowed access to a sand or dirt paddock as long as their pain is not being blocked by medications and there are no horses or dogs to chase them.
In most cases riding should not be resumed until the hoof has gone through a complete growth cycle and radiographs show good alignment.
Post-Laminitis Veterinary Assessment
Veterinary follow-up care is essential to track the progress of your horse’s recovery from laminitis.
Radiographs are valuable for monitoring the effects of laminitis inside the hooves. This type of imaging can detect bone remodelling, bone rotation, and damage to the laminar structures.
Because laminitis can result in changes to the hooves after weeks or months, it is helpful to take radiographs throughout the recovery process. Your veterinarian may recommend that radiographs be taken multiple times during the recovery process to ensure healing is complete.
These conditions may involve high insulin and glucose levels, insulin resistance, and increased levels of adrenocorticotropic hormone (ACTH). Treating endocrine disease is critical for helping your horse recover from laminitis. 
General blood tests may be used to assess the health of the kidneys or gastrointestinal tract when horses are being treated with anti-inflammatory and analgesic medications. Some of these medications can cause side effects.
NSAID medications are not meant to be used for prolonged periods of time and carry significant risks. They are also not very helpful in most laminitis cases that involved elevated insulin as the root cause, not inflammation.
Return to Movement
When a horse should be encouraged to move depends on how well he has recovered from laminitis. You should have your veterinarian’s approval before allowing your horse to move beyond his recovery space.
After having laminitis, horses should only be permitted to move freely when they meet the following criteria:
- The cause of laminitis has been identified and removed or treated.