Returning to work after a laminitis episode

Kirsten Rasmussen

Hi Louise,

If Nugget is comfortable in boots and has had a corrective trim you can start handwalking in straight lines.  We generally like to see trim photos and existing rads before we give the green light to exercise though since we've seen a lot of very poor trims.  If returning to exercise is driving work, it can be started earlier than ridden work in a larger equine.  Let his level of comfort dictate how much you do: don't force him to move, and if he is the type to overdo exercise hold him back to a walk.

In North America it's the "Karo" syrup test.  But as Maxine stated it is not necessary.  You need baseline non-fasting insulin, glucose and (if over the age of 15) ACTH, as detailed in the Diagnosis section of your welcome letter.  Adiponectin is nice to have but not as important as insulin.

Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album

Maxine McArthur

Louise, you don't have to do the sugar challenge test for insulin to check his IR. All you need is basal insulin which is done with one blood draw. The details are in the Diagnosis section of your welcome message below. Also via our website here: 

Adiponectin is not going to tell you what his insulin levels are, and you will need those levels to keep monitoring his condition into the future. There's a lot of information on how to manage IR equids via the links in your welcome message below, and also on our website:

Short version: IR is genetically programmed and is not a disease so cannot be "cured". It's a metabolic type. You can manage IR equids so that they lead completely normal lives, like many of the horses owned by our members. 
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response



Thank you so much. I'll go to the case history when I can.
As you say in a further response Danilon is an anti inflammatory in the UK... said to be kinder on the tummy than bute. He was on it for 12 days. He is now moving very  well without it.
The Kalo test is an IR test named after the sugar syrup called Kalo that you're supposed to give them after having no food and an hour before blood is taken.
If my vet offers an adopinectin test I'll have that. Thus far I have only been offered the Kalo test and will not have it again. Nugget is on no grass at all. He has Timothy hay which is tested and below 10% sugars (about 8%) and I soak it for him too. He was on poor grazing for five hours a day when he got this latest episode. He's fine now he's off the grass. He has thunderbrooks chaff with thunderbrooks daily essentials feed balancer. A horse feed designed by Dr Farley for IR horses prone to laminitis. He just had a trim after my Farrier studied the xrays. The vet suggested 3 months before returning to work but I see that you're advice us 6 to 9 months.
I'll fill out the case study info as soon as I can. Thank you for so much helpful information. I've been reading the letters on here for a while. I realise there's an awful lot to learn. I wish there were a way to reduce IR... is it reversible in any way? Like they can in people with good gut health and diet??
Signature; LouNCS
Name; Louise Seymour
Location; South East, UK
Year of joining; 2022

Bobbie Day

Louise, I apologize I didn't realize that danilon (in the UK) is a NSAID, please see the link below for more information on that.
Laminitis is not an inflammatory, so these drugs won't work, if your able to source Jiaogulan (if his trim is good) and devils claw for pain works best.
Pain Relief Alternatives to Bute and Banamine (
Jiaogulan and Laminitis.pdf (


Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response

Bobbie Day

Hello Louise,
Welcome to the group! Your first post here prompts a welcome message which I will include below, it will include a lot of valuable information and will help you with Nugget's care and the protocols we promote here. There are hyperlinks in the message that will take you even deeper into the subject line, we know all this information can be a little overwhelming at first but please keep it handy to refer back to as it will help you immensely. 
We're sorry that Nugget is having trouble but we're here to help. Firstly, I would ask you to complete a case history, we need a complete picture to better advise you. And any blood work and x-rays of his feet would be great, we have some very capable volunteers that can comment on his feet and his comfort level, or lack of.
We want the horse to exercise for sure but only if he is ready and able, if he is currently in a laminitic episode you would be better to let him move around at will until you're sure he's not going to do any additional damage by doing so.
If he has had three episodes, it's very obvious that something is driving his insulin up. Could you let us know what his diet is? Has he been on grass during these times? We suggest no grass at all for IR horses, if you let him out on pasture it needs to be with a sealed muzzle. Is he overweight?  You don't say if he was tested for IR, but if you haven't that would be my first step. There are drugs that can help with high insulin, you could talk to your vet about Metformin. 
EVJ 07-146 Durham (
Metformin 08.08.20 FINAL (

He had 6 days of 1 sachet of danilon a day and 6 days of half a sachet of danilon.
Are you meaning dandelion? 
I scheduled the kalo test recommended by my vet and they came to take blood while I was at work
I am assuming you mean Karo test? 

I would insist on the stimulation test, but again could you supply us with the test results that Nugget has had in the past? And if Nugget's diet is hay, I would suggest soaking it unless you have had it tested (again please provide) and you know the sugar and starch is below 10%. 
You need to find what's driving up the high insulin, ponies are already metabolically challenged so the more information you can give us the better. 
Please let us know if you have any additional questions.


Welcome to the 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 (look under the Hay Balancing file if you want professional help balancing). 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. 

Bobbie and Maggie 
Desi (over the rainbow bridge 7/21) 
Utah, Nov 2018
NRC Plus 2020, NAT, C&IR March 2021
ECIR Group Primary Response


My shetland, Nugget, had laminitis 3 wks ago. His third in three years, (March 2020, May 2021, May 2022. He was very sore. He had 6 days of 1 sachet of danilon a day and 6 days of half a sachet of danilon.
He was 14 days stabled and is now on a small bare patch. He is sound on boots and stomps happily about in his 12m x 10m enclosure. I am sure he has IR (he tested negative for PPID) I scheduled the kalo test recommended by my vet and they came to take blood while I was at work...apparently nugget wouldn't let them take the blood! (goodness knows what happened he is an angel) I do not like the test and have found that this group does not recommend it. I may try an adopinectin test next if my vet offers it. Nugget is a driving pony and loves to get out and about he likes to go fast!
How can I safely reintroduce him to work? This is my main concern, along with him never getting laminitis again! When will it be safe to walk him out in hand, and for how long? I imagine not back driving for 3 to 4 months?
He has 4° rotation on left and 5° rotation on right ...I don't know when he got the movement of course. He wears boots and special pads that I make for him with the farriers advice.
Signature; LouNCS
Name; Louise Seymour
Location; South East, UK
Year of joining; 2022