Treatment and Recovery of Founder in Horses

Many factors contribute to whether a horse can recover from a bout of laminitis. Find out ways to prevent and treat this devastating ailment.

A horse with severe laminitis or founder rocking back
Severe laminitis is easily identified as the horse rocks back to alleviate pain on the front feet, known as the “sawhorse stance.” Photo by Bob Langrish

Plenty has been written about the prevention, causes, and treatment of founder, but less information is available on whether or not afflicted horses will “successfully” recover. The answer, despite the availability of clinical exams to guide prognosis, is not as straightforward as it may seem. Here, two leading experts in their fields, as well as the owner of two horses stricken with founder, weigh in.

Diet & Equine Metabolic Syndrome

Raul Bras, DVM, CJF, APF, a shareholder and practicing veterinarian at Rood & Riddle Equine Hospital in Wellington, Fla., has extensive experience treating horses experiencing laminitis and founder. He says that diet and its relationship to equine metabolic syndrome (EMS) is likely the most common contributing factor.

“A very high percentage of laminitis and foundering of horses is due to equine metabolic syndrome,” he explains. And changing the diet, once EMS has been identified as the cause, can be one factor that contributes to whether or not your horse will recover.

“If the owner is not willing to put the horse on a weight loss plan, there is nothing you can do to the foot that is going to fix it or stop it,” says Travis Burns, M.S., CJF, TE, EE, FWCF, and associate professor of practice and chief of farrier services at the Virginia-Maryland College of Veterinary Medicine in Blacksburg, Va.

A sorrel grazing in a field
There is nothing the vet or farrier can do to the feet of a horse with EMS to fix or stop laminitis if the owner is unwilling to put him on a weight loss plan. Photo by Jeanma85/Adobe Stock

Since it is very easy to slip back into old habits and patterns, you should continue to diligently manage your horse’s diet going forward after receiving such a diagnosis.

“You have to keep the horse at an appropriate body condition score and have his metabolic profile within normal limits, or you are just fighting an uphill battle,” Burns adds.

Laminitis or Founder?

Raul Bras, DVM, CJF, APF, a shareholder and practicing veterinarian at Rood & Riddle Equine Hospital in Wellington, Fla., describes laminitis as inflammation of the laminae. He further explains that with laminitis, displacement or rotation of the coffin bone have not necessarily occurred. However, a “foundered” horse is one that had laminitis and ended up having some degree of coffin bone displacement.


Identifying Problems Early

While most horse owners are vigilant about having their veterinarians out to administer yearly vaccinations and dental exams, fewer have diagnostic tests, such as annual X-rays and barn-side insulin testing completed. This is particularly important with horses and ponies that are genetically or otherwise predisposed, in order to seek out possible problems before they arise.

Regarding insulin testing, Bras initially likes to test as much as possible to achieve a baseline.

“You have four seasons of the year. If you [test] in the winter, spring, summer, and fall, you can see how [insulin levels] fluctuate,” he says. Once the baseline has been noted, your vet can monitor for increases to it on an annual basis and make changes to the horse’s diet well before he experiences laminitis or founder.

A gelding eating from a feed tub
Monitoring insulin levels can help your vet recommend changes to your horse’s diet before laminitis occurs. Photo by Pimmimemom/Adobe Stock

Knowing if your horse is predisposed to a condition such as EMS goes well beyond making dietary changes. It can also help guide you in avoiding over-supplementation and in the treatment of other medical conditions your horse may develop.

For example, in some instances treating with steroids can trigger the development of laminitis. Bras advises that rather than helping, both over-supplementation and over-medicating can make laminitis and founder more difficult to treat.

Using a Venogram

Venograms, a type of contrast radiograph study, play a critical role in assessment, as early identification is a top contributing factor as to whether or not your horse will make a successful recovery.

“It all comes down to blood supply,” says Bras. “That’s why I am a proponent of the venogram.”

He likens venograms to weather reports because they give you time to prepare and potentially even prevent problems before they arise. By knowing that the blood supply to the foot has been compromised before a problem has already presented itself, you can take a proactive rather than a reactive approach to certain elements (such as farrier and dietary modifications) of your management plan.

Corrective shoeing, for example, can work to counteract mechanical failure, while dietary changes can address weight and metabolic issues before problems occur.

Aggressive Treatment

Should your horse experience laminitis or founder, immediate, bold treatment can play a key contributing factor in whether or not your horse will recover. Bras advises avoiding a “wait and see” approach. Instead, he recommends assessing the damage and determining how much blood supply is present, and using that knowledge to make decisions as to how to proceed.

While it may seem logical to think that a horse who experiences a high degree of rotation will be unlikely to recover, Bras explains that this may not be the case.

“You might have a horse that has equine metabolic syndrome and has an acute foundering that doesn’t rotate much or another with a lot of rotation,” he says. “Even if you have a lot of rotation, if you have identified it right away, there’s a strong chance you can save a horse.” He emphasizes that each case is individual.

An X-ray depicting rotation of a horse's coffin bone, indicating founder or laminitis
Identifying coffin bone rotation (shown) right away is critical in order to have the best chance at saving the horse. Photo courtesy Travis Burns

Emergency Treatment

Should a horse experience laminitis but rotation has not yet occurred, Bras recommends the application of the NANRIC Ultimate cuff shoe as long as the bone alignment matches the shoe.

The NANRIC Ultimate cuff shoe
The NANRIC Ultimate cuff shoe gives the heel 18 to 20 degrees of elevation, which can help a horse that has experienced laminitis but no coffin bone rotation. The heel elevation allows blood flow to the foot for a better chance of a successful outcome. Photo courtesy Travis Burns

“That shoe gives the horse 18 to 20 degrees heel elevation,” he says. “The heel elevation helps to optimize the blood supply to the hoof, thereby increasing the chances for a successful outcome.”

Because it doesn’t have to be glued or nailed on, any veterinarian, farrier, or owner (under veterinary supervision) can apply it simply by wrapping it on to secure it to the hoof.

A NANRIC Ultimate cuff applied to the hoof of a horse with founder while an X-ray is performed
The NANRIC Ultimate cuff shoe can be applied without glue or nails by a farrier or owner (under veterinary supervision). Careful monitoring of sole depth and coffin bone angle will help guide your vet’s treatment plan. Photo by R.F. Redden, DVM of NANRIC

Monitoring sole depth, degree of rotation, and the amount of blood supply during this process are all factors that will guide your veterinarian in directing treatment options, including making the call in extreme cases as to whether or not the deep digital flexor tendon (DDFT) should be severed to relieve tension and prevent rotation of the coffin bone.

Signs Indicating Outcome

According to Burns, marked improvement in the horse’s comfort, the return of vascular perfusion and growth of the horse’s foot—specifically in terms of sole depth—are all signs that your horse may make a recovery and return to his previous level of performance, or at least a modified version of it.

As a referral farrier making recommendations to help achieve successful outcomes for farriers in the field, Burns recognizes the need to work within principles rather than methods. Understanding that varying methods can all reach the same goal, he says that the first and foremost guiding principle he would like to achieve is recruiting the frog and sole into load-bearing.

This can be accomplished by any number of methods preferred by the horse owner’s farrier, including pads, heart-bar shoes and clogs, all aimed at meeting the needs of both the horse and the owner’s management situation. No matter the method, Burns likes to see a shoe that relieves tension on the laminae when the horse is moving even when he is turning.

A heartbar shoe
Burns likes to use a shoe that alleviates tension on the laminae when the horse is moving and turning, such as a heartbar shoe. Photo courtesy Travis Burns

Burns also recommends principles to realign the hoof capsule around the distal phalanx (P3 or coffin bone).

“If a horse can’t or won’t show growth, particularly under the tip of P3 or sole depth region, that is a bad sign,” he says.

As treatment progresses, Burns recommends lowering the heel to an appropriate palmar angle for the individual horse without causing increased tension on the DDFT, which results in increased tension on the laminae.

Finally, he advises dressing the hoof wall back to match the dorsal surface of the coffin bone. He says that if the bone stays healthy, you’ve got a much better prognosis for a return to athletic performance.

In the end, both Bras and Burns recommend the combined efforts of a veterinarian/farrier team.

“It’s not a good idea to think that your farrier can handle it on their own,” says Burns.

An Owner’s Perspective

Chriss Renier of Medina, Minn., has had two horses experience founder. The first case occurred approximately two decades ago when much less was known about the condition. Her second was ongoing for the past three years and ended in July 2022.

While multiple factors likely played a role, Renier feels that pituitary pars intermedia dysfunction (PPID, also known as Cushing’s disease) was a contributing condition with her first horse. The mare was treated by elevating her heels to increase blood perfusion and started on DMSO.

Renier credits the use of heel elevation with saving the horse’s life. Happily, the mare later made a successful return to her performance career.

Today, Renier is a huge proponent of venograms due to their ability to indicate the amount of blood perfusion present and the fact that they offer an early opportunity to correct it if deficient.

Renier’s second case came as a result of supporting-limb laminitis after the horse tore a superficial flexor tendon in a pasture accident. Despite awareness of the risk of founder and efforts on the part of the farrier to support the weight-bearing limb, two months after the initial injury to the left front leg, the mare foundered on her right front.

At that point, venograms showed that surgical intervention was necessary. While it is unknown if changing the mare’s footware immediately, even before founder occurred, would have changed the outcome, Renier stresses that this case makes it clear that owners must evaluate the risk of founder and the options for supportive footware immediately.

Throughout the ordeal, she hoped that the mare might one day be pasture sound. Unfortunately, euthanasia became necessary in July 2022.

This article about treatment and recovery of founder appeared in the April 2023 issue of Horse Illustrated magazine. Click here to subscribe!


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