Prevention and treatment of acute laminitis

Laminitis treatment has been fraught with controversy and a plethora of failed therapies, primarily due to a lack of understanding of the disease process that we are treating. We have made a great deal of progress in the past 10–20 years, but still have a long way to go in detailing the pathophysiology, and therefore the treatment targets, for the different types of laminitis. When we think of acute laminitis, we primarily think of 2 types. The first is the horse with some type of systemic infection/sepsis (i.e. bacterial enterocolitis, grain overload, acute endometritis, pleuropneumonia), in which, similar to humans suffering from organ failure with these types of diseases, horses suffer from lamellar failure. The second scenario is commonly placed under ‘endocrinopathic laminitis’ in which the (possibly fat) horse or pony suffers an acute bout of laminitis when put out on lush pasture (pasture-associated laminitis). The 2 groups of horses are very different from each other; in sepsis-related laminitis, the horses usually had normal lamellae prior to the disease process that triggered the laminitis, but undergo catastrophic failure of the lamellae (with displacement of the distal phalanx) whereas, in pasture-associated laminitis, the animals are commonly animals at risk of laminitis (probably a combination of genetics and obesity) and may already have undergone an insidious displacement of the distal phalanx from previous laminitic episodes which may or may not have been noticed by the owner. […]