Relevante trim guidelines

Lavinia Fiscaletti

Hi Lynn,

I've added the latest mark-ups to Relevante's album:,,,20,2,0,0

Things continue to improve - YAY! You're into more targeted trimming, focusing on the specific areas that need attention while leaving the others alone. Look at each foot before starting and really "see" what is/isn't there. Watch him move - you want those coveted heel-first landings from him. He's developing concavity all around, which is great. Some of the bars appear to need a bit of attention to tidy up the leading edges of the material that is letting loose. Taper them gently up into the heel buttresses. Roll all the toes under, esp. on the hinds. The heels are standing up straighter but need to have rockers added to all of them to assist in getting them all the way. Really assess the sole depth on both sides of each foot. Check the amount of wall that is proud of the sole at the perimeter - you don't want more than1/4" (6mm).

LF lateral: Orange line shows where we are looking to encourage the heels to eventually end up. The yellow lines are following several of the growth rings across the foot - note the undulating pattern and how all of them dip down at the back. That is due to the heel position, so keeping an eye on those gives you another marker of whether things are improving or not.

LF dorsal sole plane: Yellow  areas are along the tops of the bars where they can be tapered gently back toward the heels. The sole also appears to be flaking - you can gently scrape along those areas with the back of the hoof knife to flip off any that are ready to let go.

LF sole plane: Lime arrows indicate that the heel heights need to be checked, as it looks like the medial heel is longer. Assess the collateral groove depths and the calloused sole plane on each side to determine if that is true or not.

LF sole: Blue hashed areas are where to roll the toe aggressively and where to take the wall out of weight bearing in the heels, plus add those rockers to the heels. Orange rectangles are where the tallest part of the heel buttress should remain. Yellow hashes run along the leading edges of the bars that appear to be ready to do some shedding.

RF lateral: Orange ;ine is again where the heels will eventually be. Blue area is where to roll the toe.

RF dorsal sole plane: Yellow hashes are again along the bars where they appear ready to shed.

RF sole: Blue hashed areas are where the toe gets rolled aggressively and where to take the walls out of weight bearing in the heels. Orange rectangles are where the highest point of the heels remains. Yellow hashes run along the leading edges of the bars, where they can be gently tapered up to the heels.

LH sole plane: Blue line runs thru what appears to be a crack that is ready to snap off that portion of the medial heel, so need to finish what Mother Nature started.

LH sole: Same general idea as the fronts.

RH sole: Same general idea as the other three feet, but note that medial toe wall needs to be brought back inward as it has flared more in that area than the adjacent wall.

As long as he's comfortable and landing heel first, he doesn't need to wear boots. Start introducing formal exercise and listen to what he tells you.

Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR

Re: Candy Update: Invokana on board Questions and Concerns re. symptoms and diet


Hi Shawn,
We saw a huge improvement in Finn and Elliott’s foot soreness within 2 days. Finn was actively laminitic when he started invokana and he was out of his boots within a week and Elliott was out of his boots after just a few days.  Elliott seemed a little tender prior to invokana but not limpy, not laying down a lot and not in the classic laminitic stance like Finn was when started on invokana.  They both became happier and more playful. I did not see any improvement in other symptoms that quickly. Finn started to look quite sleek and lean after a few months. He’s never looked this good.  I think some of the symptoms just take time to resolve.  

Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
Joined 2019

Re: Managing hoof boots


We’ve used the cloud boots when needed. Spares are good to have when one is lost somewhere in the field. My boys play a lot when they are feeling good so we’ve had missing boots often. I always feel like I’ve found treasure when one has been found that was lost for a few weeks. 

I switched to corn starch instead of gold bond. It seems to be better for preventing rubs and it’s much cheaper. 

Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
Joined 2019

Re: Neurogan dosage


My old guys get 2 scoops once a day and are off of all NSAIDs. I have a gelding with navicular that just started so we will see how he does. I’ll get back to you on him. 
Terri Jennings with Teeny, Finn and Elliott
Arcata, CA
Joined 2019

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Re: Urine testing and grazing muzzle


I've used the Munch In Done - they work great!  Be careful for the fit and get them used to it before going out.
Sharon P, Elsa  April 2016


Courtenay, BC Canada

Elsa, Case History, Photo Album





Re: Urine testing and grazing muzzle

Cheryl Oickle

Oops correct spelling. Munch n done!

Cheryl and Jewel
Oct 2018
Port Alberni BC Canada

Flax/fat supplement

Bonnie Eddy

My IR mare had allergy testing done and she is allergic to flax and soy (among other things). She is a bit overweight but I believe she still needs some fat supplement. What can I give her? Chia seeds? Vet recommended rice bran but I believe that is inflammatory?
Thanks so much, 
Bonnie with Racham (over the rainbow) from Southern California, Nov/2016

Case History
Racham's Photos 


Re: Balance Cubes with Stabul 1 as complete feed?


Thank you for answering! I do hope he likes the Stabul mixed with his Triple Crown Balance cubes. It has been stressful worrying about him being hungry since he decided he's "over" the Balance Cubes.
Today I tried adding a small amount of Beet Root Powder and a small amount of dried peppermint leaves  the the soaked cubes. He went for it and ate a bit. He feels good I can tell, I think he is just protesting and missing the straight Timothy Pellets he used to get.

His weight is very good right now for him. He is a small pony, apparently "runt" sized based on the other American Shetlands he was rescued with at around 1 year old. He does have fat deposits( I jokingly refer to them as butt implants) but his neck is perfect now without the crest he had years ago. He is neither fat nor skinny.

I will try to figure out the amounts I should feed him of both the Balance cubes and the Stabul 1.
Any help with proper calculations on that would be greatly appreciated. Like I said I am planning to give him 50% Triple Crown Timothy Balance cubes and 50% Satbul 1.
Currently giving him 3.75 lbs. of Balance cubes per feeding, twice a day. But as I said he is now protesting and only eating a tiny bit of them. I don't want him to drop a lot of weight.  And it is awful when they won't eat their meal. Hopefully he will like the flavor of the Stabul mixed with the cubes and we will be good to go.
I am also giving him a bit less than 1/4 cup Chia Seeds(he refuses Flax), iodized salt and a very small amount of the Timothy pellets as a carrier and hiding his 1/2 Prascend inside. He gobbles it all up thank goodness.
As an afternoon treat I bring him diced celery, with a very small handful of roasted salted peanuts, sprinkled with stevia powder. He adores this treat.
I will look into the brewers yeast powder, and appreciate that tip.

I ordered a bag of the Fenugreek flavor Stabul 1 and a bag of the Peppermint flavor. I hope he likes them both so maybe I can mix it up during the week, or not....... We will see.
I am thankful that Triple Crown offers the Balance Cubes, and that the Stabul 1 is available and safe as well for the horses and ponies that are older and have lost the ability to chew/ break down hay!
Thanks so much.


Cris Bliss  California 2018

Re: Neurogan dosage

Bobbie Day

Thanks Nancy
i wish I could afford to give it everyone! Going to see if it will work on Desi and our nervous mare.
thx 😊
Bobbie and Desi
NRC Plus March 2020
Utah, Nov 2018

Re: Red Light Therapy

Nancy C

Hi Marsha

The blood supply in the foot is complicated, but the bottom line is that the sooner you get him on the right trim path less compromised it may ultimately be.

Please allow me to point out that even I can see new growth on the pics you just sent. Not sure why your trimmer does not.

There is work that can and should be done.

All the best for your blood draw.

Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2020-2021
Join us at the 2021 NO Laminitis! Conference, August 13-15, ECIR Virtual Conference Room

Re: Red Light Therapy


Absolutely, we have to get insulin down and it is number 1 priority.Good news is we are drawing blood on Wed. From there we can hopefully move forward  to getting the metformin. In looking at the realigning trim link,  does the vasculature become less compromised once the alignment  has improved? I think that is where the trimmer is concerned for him. She thinks blood supply is compromised as she  is not seeing new growth. Also, im thinking winter has slowed the growth and perhaps therapy can be an assist for blood supply even with proper trim. This is such a complex issue for getting it under control. I 'm confident his diet it tight. Thank you Nancy!!
Marsha and Dame - Buzzy TN 2019

Re: Urine testing and grazing muzzle

Cheryl Oickle

My horse is horrible on the trails with snacking and my arms take a beating. I found a lovely mesh type muzzle used only when riding. Does not obstruct their nose and can be used only when ridden.  Look up munch in done! The best 45 bucks you will ever spend! I never ride without it on. Fits on any bridle and 2 minute application

Cheryl and Jewel
Oct 2018
Port Alberni BC Canada

Re: Neurogan dosage

Nancy & Vinnie & Summer

Hi Bobbie, for Vinnie I give the upper end of the dose 1 scoop am and pm ans sometimes 2 scoops am and 1 pm.

Summer I give 1 scoop am and  occasionally 1 scoop pm depending on how she feels.
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018


Candy Update: Invokana on board Questions and Concerns re. symptoms and diet

Shawn Gould

Candy began Invokana on 1/25/21, 225mg due to insulin at 88 and sore feet. Increased to 300mg after one week. Retested insulin and ACTH after 3 weeks on Invokana. Insulin dropped to 23.1 Idexx norm 4.5-20. (Glucose strips consistently ay 30 range after 30 seconds and drug kept in barn at 40' for a week until I found out it is suppose to be kept ay 68'-77'!, So lucky efficacy was not effected in this case.)  This is the lowest Candy's insulin has been to my knowledge. ACTH 22 norm 9-35, after increase of Prascend in August to 2.25 even though ACTH tested normal then as well. So you would think everything might be good. It is not, we still have a long ways to go. Vet thrilled at response to Invokana, but Candy still has many symptoms. (I watch Candy eat all the pills so I know she is getting all of them consistently)

They include: Suborbital bulges, slightly gooey eye d/c, a crest (Body score 4-4+), coat changes (I had to clip her so much last year, I'm not sure where we are on this), heat intolerance, sore feet, (Although this has improved a lot and her weight shifting is much improved as well) with pulses in front, intermittent in back. Again vet said treat the symptoms. Prascend increased to 2.5 on 2/19/21. I don't completely understand how using Prascend and Invokana work in tandem. So even though Candy's insulin is almost normal all these symptoms persist. So does that mean the seemingly normal ACTH is not controlled and is fueling the the insulin levels? If that is the case, how could the insulin drop so much.  Or is it just too early to see symptoms dissipate? It seems like most people see an abatement of symptoms very quickly on Invokana.  
Another question is when treating with Prascend which comes first, symptom abatement or a drop in lab numbers? How long should I wait before testing again or do I just keep increasing the Prascend every 3 weeks until symptoms improve, since I'm treating those and not responding to the lab number?

I tested Candy's hay: 6.6 esc + starch and a protein of 15.9. Two different tests have been done on this hay, one by me and one by the grower. The grower's numbers were 7.8 e + s and 13.6 protein. I can only assume he had a much bigger sample than I did. I only could get to 8 bales. That being said, if protein was contributing to symptoms could that be mitigated by increasing TC Timothy Natural Balance cubes and decreasing the hay?

Another missing link is balancing this hay. I have not submitted it yet because I have so much trouble getting Candy to eat balancers. I was hoping to have a hint about a direction to go in. She eats around the pellets of U Balance and Grass Select. I need to have a fairly fool proof way to get minerals into her before I spend so much money on them. Candy is notoriously picky, hates flax and won't eat anything wet or damp. She tolerates Cocosoya. Taste tempters don't really apply to her unless it's TC Senior and I have decided to drop it all together in case it is contributing to her being foot sore. Plus it didn't work that well either. However, I do use one tablespoon, literally to give her all her pills. So far I have had the most luck is giving all supplements separately with high ratio of Timothy Pellets esc + starch 7.4. 

Thanks in advance for some guidance,

Shawn and Candy
Dec 2020, Santa Cruz, CA
Candy Case History:
Candy Photo Album:

Re: Gunkie eyes with swollen lids.


Welcome to the group Daune!
I think you were just sent the case history form that you need. I have attached our new member document below for you. It has many links (in blue) that will lead you to more information. We ask that you add your pony's name to your signature here. We ask members to always use their first name and their equines first name together. So your Case History Folder will be titled "Duane and (pony's name)". If you create a photo album (folder)for the pony it will be called Duane and pony's name. When you create you case history folder this will become a "container" for all documents that are pertinent to your pony. You can add sub-folders for hay tests, blood tests, etc.

Only documents can be stored within your Case History folder, pdf's, word documents, etc. All photos, jpegs, etc will need to go into a photos file. Helpful hint, if you have some type of test done like a blood test or hay test have it emailed to you as a document. Snail mail documents have to be scanned and stored in your photo folder. That is just slower and more awkward to upload.

The more information you provide about your pony the better. Our experienced moderators really need all info that you can provide. Please ask questions, do searches of files and messages. Our files and messages have a huge amount of information in them. Search on a key word. Nearly every page in our groups have a Search box at the top of the page. Just enter a word or term like "Safe Feeds". 

I'm happy you found this group!

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.


DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine. If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.


There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

Bonnie Snodgrass 07-2016

ECIR Group Primary Response 

White Cloud, Michigan, USA

Mouse Case History, Photo Album Deceased

Re: Managing hoof boots

Deb Walker

Hi Sue. My horse has been in boots (or other devices we tried that failed) basically 24/7 since the fall of 2017. I agree that a spare pair is essential to have something dry when they get wet. Scotty has a very large open barn area just for him, so if the snow is deep, or it's icy, I just lock him in. At first I was meticulous about thoroughly cleaning every single day...after over 3 years...I've become more lax when it's dry out. I have not had any problem with the Clouds rubbing, although I have changed the padding to a Soft Ride or other type of pad. Once recovery has moved along, I don't like the idea of the raised heel wedges in the Clouds. I too use a generic version of Gold Bond at times, and if his feet have gotten wet, I use No More Thrush powder. My farrier tried Stratus boots a couple of times, with strict instructions for me NOT to remove them in between trims. They were very difficult to get on...the Clouds are super easy. Right now his spare pair are Soft Rides, and although they work, I do not like them as well as the Clouds.
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:

Neurogan dosage

Bobbie Day

Ok girls I decided to jump on the Neurogan bandwagon, truthfully all my horses could stand to be on this but for pain is everyone just giving one scoop?

Excited to see if it will help my older ones.
Bobbie and Desi
NRC Plus March 2020
Utah, Nov 2018

Lavinia advice on Kodys trim


Hi Lavinia, our trimmer hasn't been available so we've been trying to get the feet in shape. He's walking better so I'm hoping we are on the right path. 

We are definitely getting into the laminar wedge when taking the toes back back but still a bit reticent to go to far so any advice would be good. I've added new photos to the album

Also, I am wondering if transitioning him to bare foot on the fronts just in deep sand could be an option. We are starting to get early rain and I don't want his feet to stay wet in boots. It could also be a way of starting to toughen his soles? Opinions please.

Cheers Debbie
Debbie Rainbow
Western Australia

Re: Giving Omeprazole To Horses Getting Phenylbutazone


Sara, my horse, Logo, had mild colics for awhile before he was tested for PPID.  My vet had me give him a small amount of cimetidine when he looked uncomfortable to see what his response was.  Within a short time, maybe 30-40 min, he would be back to his usual self.  I don’t recall the cimetidine dose but I can imagine you could do the same with GastroGard.  He invariably did this when I was away.  The first time he evidenced this discomfort, I had a vet out who felt it was an impaction and suggested I keep him away from hay and hand walk him where he could grab some grass.  He had no interest in grass at all and would drag me to the stacked hay.  At 17.2h, he generally won.  Looking back, I realized the issue was most likely the same.  I can’t say he had ulcers without scoping, and knowing how uncomfortable he was without hay in his stomach, I really did not want to do that but it might be an alternate means of checking.  I did not have insurance but gather you generally need to scope to get insurance to pay for the omeprazole.
Martha in Vermont
ECIR Group Primary Response
July 2012 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


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