PPID/IR horse or not, laminitis is still the real danger

When horse owners hear the word laminitis, many immediately think of PPID, EMS or insulin resistance, and the horse with the cresty neck or fat pads all over. It’s almost as if laminitis has become shorthand for “a PPID/IR horse”. But here’s the uncomfortable truth: most laminitis cases actually happen in horses that do not have PPID, EMS or IR. And this misunderstanding is one of the biggest reasons so many horses continue to suffer needlessly.

EMS is a catch all umbrella - remember that horses are not born insulin resistant, and it is not a genetic defect; it is something that develops though inappropriate diet and lifestyle.

Laminitis occurs on a scale

Laminitis isn’t a black-and-white diagnosis. It happens on a scale, from the subtle, “slightly elevated digital pulse from mild inflammation”, all the way to full-blown founder where the horse is in severe pain and the internal hoof structures are badly damaged.

Every horse on that scale does have laminitis, and all those horses are accruing damage. However, not every one of those horses will progress to full blown founder. The vast majority of horses live somewhere in that middle ground: not “perfectly healthy” but not “crippled with founder” either. These horses often never get recognised as laminitic, and yet their hooves are quietly (or not so quietly when you learn what to look for!) showing the signs.

Severely laminitic yearling Thoroughbred, who is definitely not PPID/IR!

Why laminitis isn’t just a PPID horse problem

It’s a common mistake to only look for PPID/IR or EMS when laminitis shows up. If blood tests come back clear, many owners (and professionals) dismiss laminitis altogether. But that’s a huge error.

A PPID horse should eat the same way as a horse without it: a species-appropriate, low-sugar, high-fibre diet. That’s the diet that keeps all horses healthy. PPID /IR horses don’t have a special menu — they simply can’t afford the dietary mistakes that many non-PPID/IR horses manage to “get away with” for a while.

Horses that need extra calories to maintain condition, can still be fed with ingredients that don't cause laminitis, sugar is not nutrition!

Below is another highly laminitic thoroughbred horse who is definitely not PPID or IR.

The sad reality is that the severe PPID/IR cases — the ones who eventually crash with founder — have spent years, even decades, living on unsuitable, unnatural diets long before their diagnosis. The founder didn’t come out of nowhere. It was building up while no one noticed, and the PPID/IR diagnosis was just the final straw.

This horse BECAME IR, with a cresty neck and obesity over time because she was kept in a large paddock full of green grass, and eventually foundered. IR is 100% preventable, and also reversible.

Diet really is the deciding factor

Show me a horse that has lived their whole life on a well-managed, grass-free track system with a low-sugar diet, and then developed founder purely from PPID/EMS. I am willing to be proven wrong but I'm afraid that isn't going to happen!

Diet is the deciding factor in whether a horse tips over into laminitis, regardless of a PPID or EMS label.

This is why every horse should be managed as if they’re at risk — because they are.

The trim is always important, and for any horse that has gone over the edge and foundered, it can be the matter between life and death - so choose wisely, trim weekly and do it correctly.

Healthy hoof before its weekly trim, which is always important but imperative for laminitis cases.

Low-grade laminitis: the problem hiding in plain sight

One of the biggest issues is low(er)-grade laminitis. It affects far more horses than people realise, but it’s often ignored. Why? Because these horses are usually still “sort of rideable”. (Read on to see how most horse owners do not recognise signs of lameness in their horse.)

These horses might feel a bit or a lot footy on hard ground or gravel, but not lame enough in their paddocks or fields to set off alarms. And if they’re shod, they don't feel their feet properly, so they keep going despite the damage underneath. Almost always, it's these horses that get shod, because they seem to "do better with some shoes on" - which is actually a tell tale sign that the hooves are not healthy!

The signs of low-grade laminitis are easily seen in the hoof capsule:

• thin soles

• flares

• hoof wall cracks

• thrush

• "event" lines

• abscesses

• even pedal bone damage and chronic rotation can be seen in the hoof capsule itself

Owners are often told these issues are just “bad breeding”, “flat Thoroughbred feet”, or “normal wear and tear”, and the all time classic: "wet weather", which covers pretty much every problem under the sun while letting everyone off the hook in terms of responsibility: there's not much we can do about the weather is there!?

But those are excuses, not reasons. The hoof is telling the truth - and it’s telling us inflammation is present.

All the horses below have normal metabolism, yet they are displaying very significant inflammation aka laminitis. Including a yearling TB!

Why many professionals still miss it

This isn’t just a problem with vets or farriers who for the most part are traditionally unaware of how a healthy hoof should really look. Even among barefoot trimmers, laminitis is routinely overlooked.

In addition, there are barefoot trimmers who don’t fit and supply hoof boots — but once we truly understand how diet and inflammation affect hoof health, it's clear that most horses need that protection to be fully comfortable under saddle. Barefoot isn't just about not using steel shoes, and simply not using steel shoes isn't enough; barefoot should be a commitment to holistic welfare.

Hoof boots are an often underused piece of kit causing horses to miss out on comfort.

The reality is, that not that many horses today have hooves healthy enough to be ridden barefoot. Many horses could only go on soft grass comfortably yet they are asked to ride in the sand arena, on asphalt roads and gravel tracks without any hoof protection at all, or boots that are unsuitable for the level of damage the horse has. That doesn’t mean barefoot isn’t possible - it means we need to acknowledge the connection between diet, inflammation and hoof health if we want to achieve it.

Contrary to general belief that sand is a nice soft surface, when it comes to riding horses on it, it's not actually that comfortable. If you watch enough horses riding on sand arenas barefoot vs booted, the difference in quality of movement is clear as day.

A severely damaged hoof from chronic laminitis, that should never be asked to do anything for a human, unprotected. This horse is still on a grass diet because the exact nature of the problem is not fully accepted, even though the hoof never lies.

Relying on owners to recognise signs of discomfort is not reliable; research by Sue Dyson (The Ridden Horse Pain Ethogram) shows us that 73% of horses in a study showed signs of lameness, even though all their owners thought the horses were sound. Of the horses used in the study, 50% also were ridden in a saddle that did not fit. This points to a significant lack of proper education, rather than carelessness, but nevertheless, it leaves horses in pain and I would agree that the percentages are accurate, conservative even.

All horses are susceptible to laminitis

Laminitis doesn’t discriminate. Thoroughbreds are particularly prone - in fact we could argue that they’re the most laminitic breed on the planet - but every horse is susceptible. In our herd, all horses show signs of inflammation if they get access to green, actively growing grass. That’s why diet and management are everything, whether or not there’s a PPID/IR diagnosis on the table - because that diagnosis only comes later.

Laminitic TB before and after rehab, which included removing grass from the diet, living on a track and weekly trimming.

Where to go from here

If there’s one takeaway, it’s this: don’t wait for a PPID/IR diagnosis, or only use the horse's body score for assessment before you take laminitis seriously. Hooves don’t lie, and the earlier you act, the more soundness you can preserve for your horse. Even if your horse never founders, damage is still occurring.

At Hoof School, our Tier 1 course is designed to give owners the knowledge to spot these signs early, understand what’s really happening in the hoof, and make the right choices for their horse. Because when you understand the truth about laminitis, you can stop managing problems with excuses - and start building real, lasting hoof health.