80 Causes,

P re d i s p o s i t i o n s ,
and Pathways
of Laminitis
Henry W. Heymering, CJF, RMF

KEYWORDS
 Laminitis  History  Founder  Equine

For most of history, the causes of laminitis have been based on observations. In the
last 30 years or so, however, the number of theories has exploded, with only a few
being confirmed by experiments. This article highlights these theories. Box 1 lists
these theories. Please note that included are simple theories, observations, disproved
causes, and proved causes. Further information regarding these theories may be
found elsewhere. The citations may speak for, or against, or both.
Of the dozens of suspected causes of laminitis, only five have been shown to reliably
create laminitis for the purposes of research (starch,52 black walnut,37 oligofructose,52
fructose,53 and insulin22). Laminitis also has been caused experimentally by subcuta-
neous injection, or repeated intravenous injection, of histamine, and by lactic acid
injected into the rumen of sheep.

8621A Hunters Drive, Frederick, MD 21701, USA

E-mail address: horseu@earthlink.net

Vet Clin Equine 26 (2010) 13–19

doi:10.1016/j.cveq.2009.12.003 vetequine.theclinics.com
0749-0739/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.
14 Heymering

Box 1
Possible causes of laminitis

Circulation
Theory only
AVA shunts1
Coagulopathy2,3
Reperfusion4,5
Starling forces—edema6–8
Vasoconstriction9
Vasodilation8,10,11
Observations
Mechanical damage
Road founder12,13
Lack of circulation from inactivity, including supporting leg,3 ship travel,3 being kept in
slings13
Trauma to the hoof—crushed under a wheel13
Over-rehydration6
Endocrine
Theory only
Equine Cushing disease14
Equine metabolic syndrome15
Estrogen (from plants16 or pregnancy17)
Hyperadrenocorticism/cortisol18
Insulin resistance19
Disproved causes
Hypothyroidism20,21
Proved causes
Insulin22
Observations
Mares that do not come into heat23
Mares that are in continual heat23
Testosterone24,25
Enzymes
Theory only
MMP2 & MMP98
Hoof nutrients (lack)
Theory only
Glucose26
Methionine keratin synthesis blocked27,28
 Pathways of Laminitis 15

Inflammation/edema
Theory only
Allergy29
Iron excess30,31
Stress
Observations
Colic3
Cold snaps (John Arkley, Palmer AK, personal communication, June 2002)
Draft/chill13
Drinking cold water when hot12
Heat13,32
Theory only
Hypertension33,34
Parturition35
Standing in cold water after hard riding12
Superpurgation13
Toxins
Theory only
Avacado36
Mercury36
Rattlesnake venom36
Red oak36
Selenuim36
Observations
Bee stings in great number (eg, 100 [Henry W. Heymering, CJF, RMF, personal observation, 1981])
Endophytes16,37
Endotoxins38
Exotoxins4,39
Histamine29,40–42
Hoary alyssum (Berteroa incana)43
Toxic amines5,40
Infections
Allisonella histiminiformans44
Balantidium coli40
Bacterial lung infections28
Intestinal infections36
Lyme disease45
Potomac horse fever46
Retained placenta21
Streptococcus equi36
Streptococcus bovis47
Viral respiratory infections23
16 Heymering

Proved causes
Black walnut (Juglans nigra)48
Disproved causes
Endotoxins49
Overeating
Proved causes
Acidosis41,50
Carbohydrates (starch)51
Fructans52
Observations
Beet tops53
Barley12
Grain42
Lactic acid54,55
Pasture49
Theory
Protein40,56
Miscellaneous
Observations
Abdominal surgery57
Colic6
Corticosteroid administration58,59
Deworming/anthelmintics53,58
Genetics60
High nerving43
Kidney disease (Burney Chapman, personal communication, 1992)
Phenylbutazone53
Strasser trim61
Vaccinations36,62
Theory
Fatty liver63
Tumor necrosis factor54

REFERENCES

1. Robinson NE. Digital blood flow, arteriovenous anastomoses and laminitis.

Equine Vet J 1990;22(6):381–3.
2. Hood DM, Gremmel SM, Amoss MS, et al. Equine laminitis III: coagulation
dysfunction in the developmental and acute disease. J Equine Med Surg 1979;
39:355–60.
 Pathways of Laminitis 17

3. Rooney JR, Robinson JL. Laminitis. In: Rooney JR, Robinson JL, editors. Equine
pathology. Ames (IA): Iowa State University Press; 1996. p. 188–93.
4. Hood DM, Grosenbaugh DA, Mostafa MB, et al. The role of vascular mecha-
nisms in the development of acute equine laminitis. J Vet Intern Med 1993;
7(4):228–34.
5. Bailey SR. The pathogenesis of acute laminitis: fitting more pieces into the puzzle.
Equine Vet J 2004;36:199–203.
6. West C. Bluegrass laminitis symposium: what we know about laminitis. Available
at: http://www.thehorse.com/ViewArticle.aspx?ID59247. Accessed December
20, 2009.
7. Butler KD, Gravlee F. Laminitis & founder: prevention and treatment for the great-
est chance of success. Cherokee (AL): Life Data Labs, Incorporated; 2007.
8. Pollitt CC. Equine laminitis: a revised pathophysiology. AAEP Proceedings 1999;
45:188–92.
9. Coffman JR, Johnson JH, Guffy MM, et al. Hoof circulation in equine laminitis.
J Am Vet Med Assoc 1970;156:76–83.
10. Trout DR, Horndoff WJ, Linford RL, et al. Scintigraphic evaluation of digital circula-
tion during the developmental and acute phases of equine laminitis. Equine Vet J
1990;22:416–21.
11. Robinson NE, Scott JB, Dabney JM, et al. Digital vascular responses and perme-
ability in equine alimentary laminitis. Am J Vet Res 1976;37:1171–4.
12. Smith F. The early history of veterinary literature. London: J.A. Allen; 1976. p. 27,48.
13. Zundel A. The horse’s foot and its diseases. New York: Wm. R. Jenkins; 1886.
p.172–3.
14. Donaldson MT. Equine Cushing’s disease and laminitis. In: Proceedings of North
American Veterinary Conference, vol. 18. Orlando (FL), January 17–21, 2004.
p.118–20.
15. Johnson PJ. The equine metabolic syndrome (peripheral Cushing’s syndrome).
Vet Clin North Am Equine Pract 2002;18:271–93.
16. Rohrbach BW, Green EM, Oliver JW, et al. Aggregate risk study of exposure to
endophyte-infected (Acremonium coenophialum) tall fescue as a risk factor for
laminitis in horses. Am J Vet Res 1995;56(1):22–6.
17. Johnson PJ, Messer Iv NT, Ganjam SK, et al. Laminitis during pregnancy patho-
physiological and practical considerations. In: Proceedings of the Fourth Interna-
tional Equine Conference on Laminitis and Diseases of the Foot. 2007.
p. 1–11.
18. Johnson PJ, Messer NT, Wiedmeyer C, et al. Endocrinopathic laminitis in the
horse. Clinical Techn Equine Pract 2004;3(1):45–56.
19. Coffman JR, Colles CM. Insulin tolerance in laminitic ponies. Can J Comp Med
1983;3:347–51.
20. Lowe JE, Baldwin BH, Foote RH, et al. Equine hypothyroidism: the long-term
effects of thyroidectomy on metabolism and growth in mares and stallions.
Cornell Vet 1974;64:276–95.
21. Stashak TS. Lameness. In: Stashak TS, editor. Adams’ lameness in horses. 4th
edition. Philadelphia: Lea & Febiger; 1987. p. 486–99.
22. Asplin KE, Sillence MN, Pollitt CC, et al. Induction of laminitis by prolonged hyper-
insulinaemia in clinically normal ponies. Vet J 2007;174(3):530–5.
23. Stashak TS. Adam’s lameness in horses. 4th edition. Philadelphia: Lea & Febiger;
1987. p. 487.
24. Dorn RC, Garner HE, Coffman JR, et al. Castration and other factors affecting the
risk of equine laminitis. Cornell Vet 1975;65:57–64.
18 Heymering

25. Amoss MS, Hood DM, Miller WG, et al. Equine laminitis: II. Elevation in serum
testosterone associated with induced and naturally occurring laminitis. J Equine
Med Surg 1979;3:171–5.
26. Pass MA, Pollitt S, Pollitt CC. Decreased glucose metabolism causes separation
of hoof lamellae in vitro: a trigger for laminitis? Equine Vet J Suppl 1998;26:133–8.
27. Larsson B, Obel N, Aberg B. On the biochemistry of keratinization on the matrix of
the horse’s hoof in normal conditions and in laminitis. Nord Vet Med 1956;8:
761–76.
28. Adams OR. Lameness in horses. 3rd edition. Philadelphia: Lea & Febiger; 1974.
p. 250.
29. Nilsson SA. Clinical morphological and experimental studies of laminitis in cattle.
Acta Vet 1963;4(Suppl 1):1–304.
30. Pitzen D. Some laminitis problems in horses may be caused by excessive iron
intake. Available at: http://74.125.93.132/search?q=cache:qztgQFipCN8J:
www.naturalhorsetrim.com/Dan%2520Pitzen%2520on%2520excess%2520iron%
2520and%2520laminitis.doc+Pitzen+iron&cd=4&hl=en&ct=clnk&gl=us&client=
safari. Accessed December 21, 2009.
31. Pitzen D. The trouble with iron. Feed management 1993;44(6):9–10.
32. Jenkins D. Hot flash: laminitis. Am Farriers J 2004;30(4):86–9.
33. Merillat LA. The treatment of acute laminitis. Am J Vet Med 1920;15:535–7.
34. Hood DM. Current concepts of the physiopathology of laminitis. Proc Annu Conv
Am Assoc Equine Pract 1980;25:13–20.
35. Martin WJ. Equine laminitis. Am J Vet Med 1916;11:297–302, 332–3.
36. Kellon E. Diseases leading to laminitis and the medical management of the lam-
initic horse. In: Floyd AE, Mansmann RA, editors. Equine podiatry. St. Louis (MO):
Saunder Elsevier; 2007. p. 370–7.
37. Vanselow RU. Laminitis due to poisonous resistance factors in grass. The Farriers
Journal 2009;137:6–10.
38. Hood DM, Stephens KA. Physiopathology of equine laminitis. Comp Cont Ed
1981;3(12):S455.
39. Mungall BA, Kyaw-Tanner M, Pollitt CC. In vitro evidence for a bacterial patho-
genesis of equine laminitis. Vet Microbiol 2001;79:209–23.
40. Turner AW. The etiology of laminitis. Aust Vet J 1937;13:254–6.
41. Takahashi K, Young BA. Effects of grain overfeeding and histamine injection on
physiological responses related to acute bovine laminitis. Jpn J Vet Sci 1981;
43:375–85.
42. Goetz TE. The treatment of laminitis in horses. Vet Clin North Am Equine Pract
1989;5(1):73–108.
43. Rooney JR, Roberston JL. Equine pathology. Ames (IA): Iowa University Press;
1996.
44. Garner MR, Flint JF, Russell JB. Allisonella histaminiformans gen. nov., sp. nov.
a novel bacterium that produces histamine, utilizes histidine as its sole energy
source, and could play a role in bovine and equine laminitis. Syst Appl Microbiol
2002;25:498–506.
45. Reilly F. Lyme disease laminitis—why it happens. Available at: http://
equinemedsurg.com/Heiro%20article.html#lyme. Accessed December 21, 2009.
46. Mulville P. Equine monocytic ehrlichoisis (Potomac horse fever): a review. Equine
Vet J 1991;23(6):400–4.
47. Rowe JB, Lees DW, Pethick DW, et al. Prevention of laminitis resulting from carbo-
hydrate overload in horses. Australian Equine Vet 1994;12(1):29.
 Pathways of Laminitis 19

48. Galey FD, Whiteley HE, Goetz TE, et al. Black walnut (Juglans nigra) toxicosis:
a model for equine laminitis. J Comp Pathol 1991;104(3):313–26.
49. Aristotle. History of animals books VII-X edited and translated by D.M. Balme.
Cambridge (MA): Harvard University Press; 1927.
50. Butler D, Gravlee F. Laminitis and founder: prevention and treatment for the great-
est chance of success. Cherokee (AL): Life Data Labs; 2007.
51. Garner HE, Coffman JR, Hahn AW, et al. Equine laminitis of alimentary origin: an
experimental model. Am J Vet Res 1975;36:441–4.
52. van Eps AW, Pollitt CC. Equine laminitis induced with oligofructose. Equine Vet J
2006;38(3):203–9.
53. Adams OR. Lameness in horses. 2nd edition. Philadelphia: Lea & Febiger; 1966.
54. Hood DM, Brumbaugh GW, Wagner IP. Effectiveness of a unique dihydropyridine
(BAY TG 1000) for prevention of laminitis in horses. Am J Vet Res 2002;63:443–7.
55. Morrow LL, Tumbleson ME, Kintner LD, et al. Laminitis in lambs injected with
lactic acid. Am J Vet Res 1973;34:1305–7.
56. Frederick MF, Frederick S. Treating refractory laminitis: a field study of refractory
laminitic cases that resolved on pergolide mesylate. In: 14th Annual Bluegrass
Laminitis Symposium. Louisville (KY); 2001. p. 159–80.
57. Parsons CS, Orsini JA, Krafty R, et al. Risk factors for development of acute lami-
nitis in horses during hospitalization: 73 cases (1997–2004). J Am Vet Med Assoc
2007;230(6):885–9.
58. Peremans K, Verschooten F, DeMoor A, et al. Laminitis in the pony: conservative
treatment vs. dorsal hoof wall resection. Equine Vet J 1991;23(4):243.
59. Bailey SR, Elliott J. The corticosteroid laminitis story: 2. Science of if, when, and
how. Equine Vet J 2007;39(1):7–11.
60. Hood DM, Beckham AS, Walker MA, et al. Genetic predisposition to chronic lami-
nitis in horses. Proc Annu Conv Am Assoc Equine Pract 1994;40:45–6.
61. Heymering H. The Strasser method trim reconsidered. 2009, no.141 (December).
p. 16–20.
62. Thomas EF. Autogenous blood therapy in laminitis. No Am Vet 1945;26:278–9.
63. Coffman JR. Chronic laminitis—fatty liver syndrome. Proc Annu Conv Am Assoc
Equine Pract 1996;12:275–81.