Q&A with Pete Ramey: Rehabbing Laminitis Cases
I’ve been a big fan of Pete Ramey for over a decade now. His book, Making Natural Hoof Care Work for You, was extremely instrumental in helping me get started with trimming my own horses. Then, a few years ago, I had the opportunity to host one of Pete’s clinics (you can read more about that here) which was a great experience. I knew I wanted to interview him for my blog eventually, and I’m happy to say it’s finally happened! The following is a Q&A we recently did, focusing on rehabbing horses with laminitis.
What are the first steps you typically take when called in to help with a laminitic case?
1.) Call the vet. I generally need radiographs, diagnosis, sometimes meds, sometimes PPID (Equine Cushings) and Insulin Resistance testing. The need for a cohesive vet/trimmer (or farrier) team cannot be overstated.
Immediately remove acute laminitis triggers – usually green grass, grain, treats (basically everything in the diet that has more than 10% sugar and starch combined or is more than 6% starch) and replace them with a diet of appropriate fiber, protein, fat and calories. The cornerstone of this diet is grass hay. Feed a daily mineral mix customized to the hay or, at minimum, a mineral mix that balances the local average hay per the NRC guidelines (hint – you won’t find such a supplement at Tractor Supply – yet) Details here.
2.) Encourage the horse owner to allow the vet latitude to diagnose and treat additional potential laminitis triggers (assorted diseases, GI ulcers, IR, PPID, etc.).
3.) Remove any emotional stress if possible (avoid stall confinement, keep with a companion horse, freedom to move, etc.)
4.) Once an appropriate trim has been done, I encourage hand walking and other light exercise in hoof boots with ½”-thick soft padded insoles.
See the protocol used here.
Should laminitic hooves be trimmed differently than healthy hooves?
The mechanical work varies greatly for each individual case, but the very short kindergarten version for this is:
- Prioritize heel-first loading with everything you do, particularly with hoof protection selection and heel height trimming. Details here.
- Optimize breakover and unload the hoof walls. Details here.
- Pad the sole. Make absolutely sure that there is a 100% release of all sole pressure whenever the foot is in flight or otherwise unloaded. Details here and here.
- Preserve and optimize sole thickness. Details here.
- Optimize mediolateral balance.
- If wholesale wall separation and flare is present, consider the discussions here and here.
- 4-week maximum trim cycle.
You mention in your article Laminitis Update that shoeing a laminitic horse only works for a little while and actually brings the hooves farther out of normal function. Assuming you still stand by this statement, can you explain how shoes affect hoof function in this case?
With hoof protection on (acute or chronic) laminitic hooves, it is critical that the shoe not be attached to the ground surface of the hoof wall or cause the sole to be unloaded. Such methods cause the horse’s entire weight to “hang” from the laminae and cause too much movement and stress of the laminae to re-grow new, well-attached laminae from the coronet, down.
A perimeter-attached shoe (primary load on the hoof wall) often gives temporary pain relief to laminitic horses because it helps all of the weakened, damaged laminae work together as a team. But eventually, the fact that this type of shoeing hangs all of the horses’ weight from the laminae leads to further lamellar damage and leaves room for vertical sinking. Details here and here.
It is possible to shoe a horse with most of the shear stress removed from the laminae – namely with hoof boots with padded insoles combined with the trimming detailed above and/or with the shoeing method detailed here.
How important are hoof boots in the process of healing from laminitis and what are your recommendations for using boots in these cases?
Critical. See above.
Have you dealt with any cases where the horse simply did not heal, despite dietary and trimming changes? If so, what do you believe contributed to this?
Usually, failure to heal or incomplete healing is caused by internal damage to P3 and more importantly, damage to the corium (dermal laminae, coronary papillae, solar corium… ). P3 remodeling seen on radiograph is usually indicative of corium damage, thus incomplete healing potential (perpetually weak laminae, reduced capacity to grow sole, etc.). The cause of this is usually a long duration of undiagnosed, untreated acute laminitis. In other cases, such damage may be caused by the severity of one event (SIRS [Systemic Inflammatory Response Syndrome] cases).
I have also seen a lot of laminitis cases fail to heal because the owner would not remove the laminitis triggers from the diet (grass, grain, treats…) and because contributing diseases were undiagnosed and/or untreated (PPID, GI ulcers, really any ailment that affects horses).
Assuming all proper dietary and trimming changes are in place, how long does it typically take to return a laminitic horse to soundness?
This varies with each individual case and depends on your definition of soundness.
Horses that suffer minimal mechanical damage and just go through acute laminitis, usually feel good 36 hours after the laminitis triggers are removed.
Even chronic cases with hoof capsule rotation can usually be made comfortable immediately with the trimming and padding discussed above.
But it may take a year or more to grow a well-attached hoof wall from the top, down. Until this is achieved, plus optimal sole thickness, the horse could not technically be considered sound.
And of course, failure with any of the factors discussed above can cause a perpetual “3 steps forward, 2 steps back” type of progress (or worse) – the most common such scenario for me is dealing with seasonally laminitic horses living on green grass.
All this said, my personal measure of success is “comfortable turned out barefoot and rideable anywhere in padded boots.” I achieve this within 3 months with a vast majority of cases (over 90%) regardless of the contributing factors and variances in pre-existing damage.
To read more from Pete Ramey or to sign up for one of his clinics, visit his website.