Equine Laminitis: Practical Clinical Considerations

Over the past 20 yr, extensive research efforts as well as clinical experience has greatly increased our knowledge base of equine laminitis. Our present understanding of the disease is that there is failure of the lamellar attachment between the distal phalanx and hoof wall. This, in turn, initiates a sequence of events ranging from no permanent structural damage to loss of the hoof capsule. Affected individuals are often plagued with chronic pain, and they may suffer chronic hoof abscessation or abnormal hoof-wall development with recurring bouts of laminitis. The preponderance of laminitis research has been aimed at defining the events that occur systemically and locally within the digit that result in clinical laminitis. Although we have identified many early events that occur, we have yet to determine a specific triggering mechanism that initiates the pathological sequence. Importantly, there is a disconnect between research and clinical medicine in that much of our acquired research information is not used clinically. This is partly because of the narrow time frame of the prodromal and acute stage of laminitis compared with the relatively late clinical presentation and relative long-standing nature of the disease. Also, because of the variation in clinical case presentation and response, our treatments are anecdotal, based on clinical signs, and in the long run, often ineffective. Numerous treatments have, therefore, phased in and out of vogue over the years with only a few, such as the non-steroidal anti-inflammatory drugs, withstanding the test of time. The objective of this discussion is to review the salient features of laminitis and provide a realistic view point for the practitioner to consider when managing the patient and the client.