Interview Questions for Laminitis Management

Laminitis, or founder, is a debilitating condition affecting the hoof of equines. Its pathophysiology is complex and not fully understood, but it fundamentally involves inflammation of the laminae – the sensitive and insensitive tissues that interlock to suspend the coffin bone within the hoof capsule. This inflammation leads to a breakdown of the bond between these laminae, potentially resulting in rotation or sinking of the coffin bone.

The process often begins with an initiating event, such as excessive carbohydrate intake, sepsis, or hormonal imbalances. This triggers a cascade of inflammatory mediators, including cytokines and prostaglandins, leading to increased vascular permeability and swelling within the hoof. The resulting increased pressure compromises blood flow to the laminae, causing further damage and pain. Endotoxins, often released from gut bacteria in cases of colic or other systemic diseases, can also play a crucial role in initiating the inflammatory response. Essentially, imagine it like a severe and painful swelling within the hoof, disrupting the delicate structure that supports the horse’s weight.

Clinical signs of laminitis vary depending on the severity and stage of the disease. Early signs can be subtle, including subtle lameness, shifting weight, reluctance to move, and increased digital pulse. As the condition progresses, more pronounced signs become evident:

• Lameness: Often characterized by a characteristic stance with weight shifted to the heels, and reluctance to bear weight on the affected limb.
• Increased digital pulse: A strong, bounding pulse felt in the pastern area.
• Heat in the hoof: The hoof may feel warmer than the surrounding tissues.
• Pain on hoof manipulation: The horse may react painfully when the hoof is squeezed or flexed.
• Laminar separation (in advanced cases): This can lead to visible rotation or sinking of the coffin bone, resulting in severe lameness and potentially hoof deformation.

It’s crucial to remember that subtle signs can easily be overlooked; early detection is vital for effective management.

While not strictly defined stages, laminitis progression is typically described as acute and chronic phases, with further distinctions within these phases to aid management.

Acute Laminitis: This is the initial, often rapidly developing phase. It’s characterized by severe pain, inflammation, and a high risk of coffin bone rotation or sinking. Immediate intervention is crucial to prevent permanent damage. Sub-stages might refer to the severity of pain and the extent of laminar damage.

Chronic Laminitis: This is the long-term consequence of acute laminitis or recurrent episodes. It involves persistent inflammation, remodeling of the hoof, and often permanent structural changes, including chronic lameness, hoof distortion, and the potential for eventual loss of the hoof.

The transition between acute and chronic phases is gradual, and the severity of the chronic phase depends largely on the effectiveness of acute management.

Diagnosing laminitis relies on a combination of clinical examination and imaging techniques.

• Clinical Examination: This involves a thorough assessment of the horse’s gait, stance, digital pulse, and response to hoof manipulation. The veterinarian will look for signs of lameness, heat, and pain.
• Radiography (X-rays): This is the most common imaging technique used to evaluate the position of the coffin bone, assess the extent of laminar separation, and identify any bone changes. It provides clear evidence of coffin bone rotation or sinking.
• Ultrasound: Provides higher resolution images of the soft tissues within the hoof, allowing visualization of the laminae and assessing the extent of inflammation and damage.

A detailed history is also crucial, as understanding potential predisposing factors, such as recent diet changes or underlying diseases, can contribute to a correct diagnosis. For example, a horse recently consuming a large amount of lush pasture could be suspected of laminitis.

Immediate management of acute laminitis focuses on pain relief, reducing inflammation, and supporting the coffin bone. This often requires a multi-faceted approach.

• Pain Management: Strong analgesics (pain killers) are essential to provide comfort. This may involve NSAIDs (non-steroidal anti-inflammatory drugs) and potentially opioid analgesics in severe cases.
• Anti-inflammatory Therapy: NSAIDs help reduce inflammation and pain. Other anti-inflammatory medications might be considered depending on the underlying cause.
• Support for the Coffin Bone: This is crucial to prevent further rotation or sinking. This may involve providing supportive bedding, such as deep shavings or mats to distribute weight and reduce stress. Special supportive shoes or other hoof support may be used.
• Treatment of Underlying Causes: If an underlying condition, like endotoxemia, is suspected, treatment will be directed at that.
• Minimize Movement: Restricting movement to absolute minimum is important, reducing any further stress on the sensitive structures of the hoof.

In some acute cases, more aggressive interventions such as intravenous fluids or other supportive care will be necessary.

Long-term management of chronic laminitis focuses on preventing further damage, managing pain, and maintaining hoof function. This is an ongoing process and requires careful management of multiple factors.

• Pain Management: Chronic pain management is often achieved with long-term use of NSAIDs under veterinary guidance. Other therapeutic options may also be needed.
• Farrier Care: Regular farrier visits are essential to trim and shoe the hoof appropriately, to support the coffin bone and minimize stress. This might involve specialized corrective trimming techniques and custom shoes.
• Lifestyle Management: Providing a safe, well-drained environment reduces stress on the hooves. Limiting turnout on hard surfaces and providing supportive bedding are important aspects of long-term management.
• Nutritional Management: Carefully controlled diet is crucial (detailed in the next question).
• Regular Veterinary Monitoring: Regular check-ups are essential to monitor the horse’s progress, assess hoof health, and adjust the management plan as needed. This may involve regular radiographs to monitor coffin bone position and potential progression of the condition.

The goal in chronic laminitis is to optimize comfort and maintain the quality of life for the horse, recognizing that a complete cure is generally not possible.

Nutrition plays a pivotal role in both the prevention and management of laminitis. The primary focus is to avoid excessive intake of non-structural carbohydrates (NSCs), such as sugars and starch, which are readily fermented in the hindgut and can lead to an increase in lactic acid and endotoxins, initiating or exacerbating the inflammatory cascade responsible for laminitis.

Dietary Recommendations:

• Low NSC Diet: This is crucial. The diet should be formulated to minimize sugar and starch intake. This might involve selecting hay varieties with low NSC content and avoiding sugary treats or high-starch feeds.
• High Fiber Diet: A diet high in fiber, such as long-stem hay and chaff, promotes healthy gut function and helps prevent rapid fermentation.
• Controlled Grazing Management: For horses grazing on pasture, controlled grazing strategies, such as limited turnout times or grazing muzzles, may be needed to restrict NSC intake, particularly in the spring when grass is lush and high in sugars.
• Regular Monitoring: Regular monitoring of the horse’s weight and body condition score is important to ensure adequate nutrition. Blood tests can also measure insulin and glucose levels that can be important indicators of underlying metabolic issues that predispose a horse to laminitis.

Remember, nutritional management is an essential long-term commitment in laminitis management and should be guided by veterinary and nutritional expertise. Individual diets should be tailored to the specific needs and metabolic profile of the affected horse.

Supportive therapies in laminitis aim to alleviate pain, reduce inflammation, and improve blood flow to the hoof. These are crucial because they don’t directly address the underlying cause but significantly impact the horse’s comfort and chances of recovery. They work best in conjunction with addressing the primary cause of the laminitis.

• Rest: Complete box rest is often the first and most critical step. This prevents further stress on the already compromised laminae. The level of restriction depends on the severity – from strict stall rest to limited turnout in a small paddock.
• Pain Management: Analgesics (pain relievers) and NSAIDs (non-steroidal anti-inflammatory drugs) are vital to manage pain and inflammation. Careful selection and dosage are crucial, guided by veterinary assessment.
• Cold Therapy: Applying ice packs or cold water soaks to the hooves can help reduce inflammation and swelling, particularly in the acute phase. This should be done under veterinary supervision to avoid excessive cooling.
• Elevation: Raising the horse’s legs slightly can help reduce swelling and improve blood circulation to the hooves.
• Supportive Bandaging: In severe cases, supportive bandages can provide additional support to the hoof and reduce the risk of further damage. The technique needs to be appropriate to avoid compromising circulation.
• Nutritional Support: A balanced diet is crucial. This might involve adjustments in feed to reduce the intake of sugars and starches, known to trigger or exacerbate laminitis. This often necessitates consultation with an equine nutritionist.

For example, a horse suffering from acute laminitis might begin with complete box rest, ice therapy, and powerful pain relief medication. As the inflammation subsides, the treatment plan may progress to controlled exercise and adjustments to their diet.

Assessing laminitis severity involves a combination of clinical examination and diagnostic imaging. It’s a dynamic process, and the severity can change rapidly. We use a grading system to help standardize assessment, but each case is unique.

• Clinical Examination: This includes assessing the horse’s posture (often shifting weight, reluctance to move), digital pulse (increased intensity indicates inflammation), hoof temperature (increased temperature indicates inflammation), and lameness (severity varies greatly). We also check for digital swelling and pain response to hoof pressure.
• Digital Radiography: X-rays provide crucial information about the extent of the laminar damage. They show the position of the coffin bone within the hoof capsule. Rotation and sinking of the coffin bone are key indicators of severity.
• Ultrasound: This can help visualize the soft tissues, detecting the extent of inflammation and providing further information about the condition of the laminae. This can help assess the viability of the laminae.

A horse showing only mild digital pulse and minimal lameness might be graded as having mild laminitis. Conversely, a horse exhibiting severe lameness, significant rotation of the coffin bone on X-ray, and intense digital pulse is considered to have severe laminitis, requiring intensive management. Regular assessments and imaging are needed to monitor progression and response to treatment.

Hoof trimming and shoeing are crucial in laminitis management, aiming to support the coffin bone, relieve pressure, and promote healthy hoof growth. The principles rely on distributing weight evenly and reducing stress on the compromised laminae.

• Trimming: The goal is to create a wide, flat bearing surface to distribute weight away from the sensitive compromised areas. This often includes removing excess heel and sole, and ensuring a level sole for weight distribution. We also aim to reduce breakover (the point at which the foot leaves the ground), making it easier for the horse to move.
• Shoeing: Shoe selection and application vary depending on the severity and stage of laminitis. Options include therapeutic shoes designed to support the coffin bone, such as heart bar shoes, egg bar shoes, or rocker-bottom shoes. These shoes provide a wider support base and adjust the breakover to minimize stress.
• Importance of Expertise: Proper hoof trimming and shoeing in laminitis cases require significant expertise. An experienced farrier specializing in laminitis management is essential to ensure the correct approach for each individual horse, avoiding potential complications such as increased pressure in the wrong areas.

For example, a horse with a rotated coffin bone might require a heart bar shoe to support the displaced bone and distribute weight evenly. The farrier’s skill in custom fitting and adjusting the shoe is key to success.

Laminitis carries several serious potential complications. These complications often arise from the severe inflammation and damage to the laminae, leading to structural compromise of the hoof.

• Coffin Bone Rotation and Displacement: The coffin bone can rotate downwards or sink into the sole of the foot, causing severe lameness and potentially requiring surgical intervention.
• Foundering: In severe cases, the coffin bone can penetrate the sole of the hoof. This is a catastrophic complication.
• Infection: Damage to the hoof tissues can make it susceptible to infection. This often necessitates specific antimicrobial therapy and, in severe cases, surgical intervention.
• Chronic Lameness: Even with successful treatment, many horses experience residual lameness which may impact their quality of life.
• Deformation of the Hoof: The hoof can become deformed, affecting the horse’s ability to bear weight and potentially requiring ongoing farriery support.

Imagine a horse with severe laminitis. The coffin bone could rotate to an angle where it causes considerable pressure and pain in the foot. This could result in further damage to the delicate structures, leading to infection or even foundering.

Monitoring the progress of laminitis treatment is a continuous process that involves regular clinical assessment and, in many cases, repeated diagnostic imaging. The goal is to detect any worsening of the condition or complications and adjust treatment accordingly.

• Clinical Examination: Regular assessment of the horse’s posture, lameness, digital pulse, hoof temperature, and the presence of any pain is crucial. Changes in any of these parameters can indicate worsening or improvement.
• Digital Radiography: Repeat radiographs are taken at intervals to track the position of the coffin bone. This helps assess the success of treatment in preventing further rotation or sinking.
• Ultrasound: This can provide additional information about the healing process in the soft tissues. This helps gauge if the inflammation is reducing.
• Lameness Scoring: We may use standardized lameness scales to objectively track changes in the degree of lameness over time.

For instance, if a horse initially has severe rotation of the coffin bone, we would monitor this with repeated X-rays to ensure that it isn’t progressing further and ideally observe movement towards improved alignment. Regular clinical examination ensures that any new issues like infection can be identified promptly.

The prognosis for laminitis is variable and depends on several factors, with the severity of initial damage being most influential. Early intervention and appropriate management greatly improve the chances of a favorable outcome.

• Severity of Laminar Damage: The extent of coffin bone rotation, sinking, and laminar damage shown on radiographs is a strong predictor of the prognosis. Severe damage significantly reduces the likelihood of a complete recovery.
• Response to Treatment: How well the horse responds to initial treatment, including pain management, rest, and hoof care, is crucial. A lack of response or worsening of the condition is a poor prognostic indicator.
• Underlying Cause: Successfully addressing the underlying cause of the laminitis is essential for preventing recurrence. If the underlying cause persists, the prognosis may be worse.
• Horse’s Overall Health: The horse’s age, overall health, and body condition play a role. Older horses or those with pre-existing health problems might have a reduced capacity for recovery.

A horse with mild laminitis that responds well to treatment and has the underlying cause addressed has an excellent chance of returning to near-normal function. However, a horse with severe coffin bone rotation and little improvement despite intensive therapy will likely have a poor prognosis, with persistent lameness and the potential for chronic management needs.

Analgesics play a critical role in laminitis management, primarily by controlling pain and reducing inflammation. Effective pain management significantly improves the horse’s comfort and facilitates better overall treatment adherence.

• Pain Relief: Laminitis is extremely painful. Analgesics help alleviate this pain, allowing the horse to rest comfortably and reducing stress on the affected tissues. This often leads to quicker recovery.
• Reducing Inflammation: Many analgesics, particularly NSAIDs, also possess anti-inflammatory properties. This helps reduce the underlying inflammation that contributes to the severity of the condition. This reduces tissue damage and swelling.
• Drug Selection: The choice of analgesic depends on the severity of the laminitis and the horse’s overall health. NSAIDs are commonly used, but opioids might be necessary in severe cases for breakthrough pain. Careful selection and monitoring are essential to minimize potential side effects.
• Importance of Veterinary Guidance: Analgesics should only be administered under the strict guidance of a veterinarian. Improper use can have serious consequences and potentially mask crucial signs of worsening condition.

For example, a horse in acute pain might receive a combination of NSAIDs and a short course of opioids to provide effective pain relief. As the acute phase passes, the horse may transition to a lower dose or a different analgesic under the veterinary guidance.

Addressing the underlying cause of laminitis is paramount because it’s not just about treating the symptoms; it’s about preventing recurrence and improving long-term prognosis. Laminitis is a complex condition, often a consequence of another issue. Treating only the pain and inflammation, without addressing the root cause, is like treating a fever without addressing the underlying infection – it might temporarily alleviate the symptoms, but the problem persists, potentially worsening.

For example, if laminitis stems from excessive carbohydrate intake, simply managing pain won’t prevent future episodes. Dietary changes are crucial. Similarly, if it’s caused by endocrine problems like Cushing’s disease, targeted medication to manage the hormone imbalance is essential. Identifying and treating the root cause dramatically increases the chances of a successful outcome and prevents future laminitis episodes.

• Example 1: A horse with laminitis due to carbohydrate overload needs a strict dietary change to low-sugar, low-starch hay and controlled grain intake.
• Example 2: A horse with laminitis secondary to sepsis requires aggressive treatment of the infection using antibiotics.

Anti-inflammatory drugs play a vital role in laminitis management by reducing pain and inflammation in the sensitive laminae. Non-steroidal anti-inflammatory drugs (NSAIDs) like phenylbutazone (bute) and flunixin meglumine (Banamine) are commonly used. These drugs work by inhibiting the production of prostaglandins, chemicals responsible for pain and inflammation. They help manage the acute phase of laminitis, providing crucial comfort to the horse.

However, it’s crucial to remember that NSAIDs only address the symptoms, not the underlying cause. Long-term NSAID use can have side effects, so they should be used judiciously under veterinary guidance. Regular bloodwork monitoring is important to assess kidney and liver function. The goal is to find the balance between managing pain and minimizing potential side effects.

Important Note: Always consult with a veterinarian before administering any medication to your horse. They will assess the individual situation and determine the appropriate dosage and duration of treatment.

Hoof casts are supportive devices used to help stabilize the hoof and reduce the stress on the sensitive laminae during the acute phase of laminitis. There are various types, each with specific applications:

• Foam padding and supportive bandages: These provide gentle support and cushioning, preventing further damage to the sensitive structures of the hoof. They are ideal for early stages or less severe cases.
• Custom-made hoof casts (often fiberglass): These are more rigid and offer stronger support for severe cases of laminitis where rotation or sinking of the coffin bone is a concern. They provide better stability and reduce the impact of weight-bearing.
• Standing bandages: Applied to the lower leg, these help support the limb and reduce swelling. They are often used in conjunction with hoof casts.

The type of cast used depends on the severity of the laminitis, the stage of the disease, and the individual horse’s needs. Proper application is critical to prevent further injury. Improperly applied casts can cause more harm than good. A veterinarian or farrier experienced in laminitis management should always apply and monitor these casts.

Pain management in laminitis is crucial for the horse’s comfort and well-being. It’s a multifaceted approach combining medication, supportive therapies, and careful management of the environment.

• NSAIDs: As mentioned earlier, these are the mainstay of pain relief, reducing inflammation and pain.
• Opioids: In severe cases, opioids may be used for stronger pain relief. These are usually reserved for acute, severe pain when NSAIDs are insufficient.
• Local nerve blocks: These injections can provide temporary pain relief by numbing specific nerves in the hoof. They are useful for diagnostic purposes and to manage severe pain.
• Cryotherapy: Ice packs can help reduce inflammation and pain in the early stages.
• Rest and proper bedding: Providing a clean, comfortable, and well-bedded stall helps minimize pain and prevents further injury.

The approach to pain management depends on the severity and stage of laminitis. Regular veterinary assessments are necessary to adjust the treatment plan as needed.

Laminitis has diverse causes, and understanding these is key to effective management. They can be broadly categorized:

• Endocrine diseases: Cushing’s disease and Equine Metabolic Syndrome (EMS) are significant risk factors. These conditions lead to insulin resistance and imbalances in carbohydrate metabolism.
• Dietary indiscretions: Overconsumption of grain, lush pasture, or other high-carbohydrate foods can trigger laminitis. The rapid influx of sugars and starches overwhelms the system.
• Infections and toxins: Sepsis, retained placenta, and certain toxins (like endotoxins from bacterial infections in the gut) can contribute to laminitis.
• Retained placenta: The failure to expel the placenta after foaling leads to infection and can cause laminitis.
• Concussion: Severe concussion to the limbs, especially the front legs, can damage the laminae.

Often, laminitis is multifactorial. One underlying cause can initiate the process, while other factors contribute to its severity and progression.

Supportive bandaging in laminitis aims to reduce stress on the hoof and alleviate pain. Properly applied bandages support the hoof capsule, reducing the force exerted on the weakened laminae. This is particularly important in acute cases where the coffin bone is at risk of rotation or sinking. They also help to minimize swelling and reduce discomfort.

Bandages should be carefully applied by a veterinarian or experienced farrier to ensure proper support without constricting blood flow. The type of bandage material, its tightness, and the overall support structure need to be tailored to the individual case. Regular checks are necessary to ensure the bandage remains in place and doesn’t cause any unintended complications like sores or pressure points.

The purpose isn’t to restrict movement entirely, but rather to provide cushioned support to the affected hoof. It’s a crucial part of the overall laminitis management plan, enhancing comfort and aiding healing.

Differentiating laminitis from other hoof conditions requires a careful clinical examination, including observing gait, assessing hoof temperature, palpating the hoof for pain, and using radiography to visualize bone structures. Here are some key differences:

• Navicular syndrome: Often presents with subtle lameness, especially at the walk. Pain is localized to the palmar aspect of the hoof. Radiography may reveal navicular bone changes.
• Founder: A term often used synonymously with laminitis, but founder specifically refers to the visible sinking or rotation of the coffin bone, a late-stage complication of laminitis.
• Abscesses: Characterized by localized swelling, heat, and intense lameness, usually with a palpable fluctuant area in the hoof. Abscesses are often easier to pinpoint.
• Sole bruising: Pain is localized to the sole. There might be a history of trauma to the sole.

A veterinarian skilled in equine lameness can diagnose laminitis by assessing these factors and ruling out other conditions. Early and accurate diagnosis is critical for timely and effective treatment.

Regular hoof care is paramount in laminitis prevention because it addresses the foundation of the problem: the laminar tissues connecting the hoof wall to the coffin bone. Think of it like this: if the foundation of a building is weak, the entire structure is at risk. Similarly, poorly maintained hooves create imbalances that stress the laminae, increasing susceptibility to laminitis.

• Proper trimming: Regular trimming by a qualified farrier ensures balanced hoof conformation, reducing strain on the laminae. Improper trimming, especially long toes and low heels, creates excessive downward pressure on the coffin bone.

• Consistent hoof balance: A balanced hoof distributes weight evenly, minimizing stress on any single area. This is crucial because uneven weight distribution can cause inflammation and damage to the laminae.

• Early detection of hoof problems: Regular hoof inspections allow for early detection of cracks, abscesses, or other issues that could predispose a horse to laminitis. Early intervention can significantly improve outcomes.

Farriers play a vital role in both preventing and managing laminitis. They are the front-line defense in maintaining hoof health. Their skills are critical in mitigating the effects of the disease and supporting the healing process.

• Therapeutic trimming: In cases of laminitis, farriers perform specialized trimming to relieve pressure on the sensitive laminae. This might involve techniques like lowering the heels, adjusting the breakover point, and creating a supportive hoof shape.

• Shoe application: Specific shoeing techniques can be employed to redistribute weight and provide support to the coffin bone. This could include various types of therapeutic shoes, such as egg-bar shoes or heart-bar shoes, depending on the severity and type of laminitis.

• Monitoring hoof health: Farriers regularly assess the horse’s hooves, monitoring for any changes that could indicate a relapse or worsening of the condition.

Laminitis isn’t a single disease but a clinical syndrome with various underlying causes. We generally categorize it into two main types:

• Endotoxemic laminitis: This is often triggered by problems in the gastrointestinal tract, such as colic or ingestion of toxic plants. Bacteria in the gut release endotoxins that enter the bloodstream, causing widespread inflammation, including in the laminae.

• Non-endotoxemic laminitis: This type results from factors not related to bacterial toxins. Causes can include mechanical overload, hormonal imbalances (like in pregnant mares), and certain systemic diseases. These cases are often associated with chronic hoof issues.

Further sub-classification can be based on the severity and location of the laminar damage, helping guide treatment strategies. It’s crucial to identify the underlying cause to effectively manage the condition.

Untreated laminitis can have devastating long-term consequences. The damage to the laminar tissues can lead to:

• Rotation or sinking of the coffin bone: This is a severe complication where the coffin bone rotates within the hoof capsule or descends, causing significant pain and lameness.

• Chronic lameness: Even with treatment, some horses experience persistent lameness that limits their ability to perform activities.

• Hoof deformities: The hoof capsule may become distorted and misshapen, making it difficult to maintain hoof health and soundness.

• Euthanasia: In severe and untreatable cases, euthanasia may be necessary due to the persistent pain and suffering.

The severity of these consequences depends on various factors including the underlying cause, the promptness of treatment, and the individual horse’s response.

Counseling owners on the long-term care of a horse with laminitis involves a multifaceted approach focused on prevention and management. It’s a marathon, not a sprint.

• Dietary management: A low-carbohydrate, high-fiber diet is crucial to prevent future episodes. This reduces the risk of excessive insulin release that can trigger laminitis.

• Regular hoof care: Consistent professional trimming and shoeing are essential to maintain hoof balance and support. This often involves ongoing therapeutic shoeing.

• Exercise management: Controlled and appropriate exercise helps maintain hoof health, but overexertion can worsen the condition. We need to strike a balance.

• Monitoring for signs of recurrence: Owners need to be vigilant about monitoring their horse for signs of lameness, heat in the hooves, or other symptoms of a laminitis flare-up.

• Emotional support: This is a challenging condition for both the horse and the owner. Providing support and realistic expectations can make a big difference in the long run.

A multidisciplinary approach is critical to effective laminitis management. No single professional can provide all necessary expertise.

• Veterinarian: Diagnoses the underlying cause, provides medical management (e.g., pain relief, anti-inflammatory medication), and monitors the horse’s overall health.

• Farrier: Provides specialized trimming and shoeing to support the coffin bone and promote healing.

• Nutritionist: Develops a tailored dietary plan to control insulin levels and support healing.

• Physiotherapist (Equine): May provide therapeutic exercises and modalities to improve blood flow and reduce inflammation.

This collaborative approach ensures the horse receives comprehensive and coordinated care, maximizing the chances of a positive outcome.

I once managed a case of a 15-year-old mare with severe endotoxemic laminitis secondary to a severe bout of colic. Upon initial examination, she was severely lame, exhibiting significant digital pulses and heat in her hooves. Radiographs confirmed significant rotation of her coffin bones.

My key decisions included:

• Immediate pain management: We used systemic analgesics and regional nerve blocks to alleviate her suffering.

• Aggressive intravenous fluid therapy: To support her circulatory system and flush out endotoxins.

• Specialized hoof care: A farrier fabricated custom heart-bar shoes to redistribute weight and provide maximum support to the coffin bones.

• Dietary modification: We implemented a strict low-sugar, high-fiber diet to prevent future episodes.

• Regular monitoring and adjustments: We closely monitored her progress, adjusting her treatment plan as needed. This included regular radiographs to assess the coffin bone position.

After several months of intensive treatment and meticulous care, the mare’s condition improved significantly. While she retained some degree of lameness, she was able to live a comfortable life with ongoing hoof care and dietary management. This case highlighted the importance of a coordinated and responsive approach to managing severe laminitis.