08/24/2025
Founder Rehab Case Study
Some of you may have seen the post from Lindsey Field over at The study of the equine hoof earlier today, including a case I’ve worked on for the last 7-ish years. I wanted to dive into this case a little bit, because I had some questions in her comment section about the case and the approach.
When I met this sweet and sassy little mini gelding (top photo/rad), he was very very sore and had difficulty walking even in boots. His owner had all kinds of special cut out pads and booting options, and was doing her best to figure him out.
When I met him, he had what APPEARED to be incredibly high heels coupled with a long lamellar wedge toe. I say “appeared” because when considering the radiographs, he had very thin soles- soles that were not trimmed- and much less heel depth radiographically than what appears externally. I remember noticing his collateral groove depth was not nearly as deep as I would have suspected.
When approaching any founder/laminitis case, the CAUSE is important to know, as the 3 main causes of laminitis are handled differently, and can result in different presentations of how fast rotation occurs and appearance of hoof breakdown. The main cause of laminitis is endocrinopathic, and this makes up about 90% of cases. This is diet/metabolic related, and usually (but not always) the most straight forward. Typically once the cause is found, whether that’s diet issues leading to hyperinsulinemia, or PPID causing high ACTH, and removed, the pain resides and the erroneous hoof growth returns to normal.
The other 10% of laminitis is caused by usually one of two things: supporting limb laminitis (a lack of perfusion in the opposing foot of a severe, non-weightbearing injury) or SIRS laminitis, Systemic Inflammatory Response Syndrome, which is caused by situations such as ingesting a toxic w**d, high fevers/illness, retained placenta, infections, a grain room break in leading to endotoxemia, etc.
With this case here, we had what we assume was a combination of metabolic laminitis and SIRS laminitis due to - as I remember it from a few years ago - a liver infection.
So what did we do? First and foremost I want to say that ECIR (the Equine Cushing’s and Insulin Resistance Group) is a godsend for difficult metabolic cases, and I often referred to them then and still now as I work on founder cases. REMOVING THE CAUSE mattered much more than the trim in this case- and all grain was removed from the diet, and he was placed on a tested bagged chopped hay initially (although not every batch was guaranteed), and then switched tested hay after that. He also was put on California Trace minerals.
The veterinarians were instrumental in diagnosing his infection, treating with appropriate medications for the infection as well as his metabolic issues, doing regular bloodwork for insulin and ACTH, and allowing me to tag along for radiograph appointments so we could work as a team!
Now, onto the trim, as there were a handful of comments on that as well. (Note- please do not take this trim information as prescriptive, I do not believe in giving trim advice online without seeing a horse in person).
When trimming this gelding, I would offer a forward stretch to see how his DDFT/check ligament and other soft tissue felt about the extension if I were to lower the heels. If he willingly stretched his leg and fully extended his carpus/knee, I was more willing to take more heel, which almost “forces” a stretch when standing. On days when he was less willing to extend, I was less assertive with the heels; either way, I trimmed them bit by bit and then would look at how he weighted his heel after. I would stop trimming the heels the second the heel just “kissed” the ground, to avoid check ligament injury or avoid him knuckling over from too much of a change. I was overly cautious based on his comfort level, as I have seen cases where too much too soon with foundered horses led to knuckling over which can be incredibly hard to rehab back from. Every trim, I also brought the toe back, and each cycle his new growth would grow down tighter, growing out his lamellar wedge.
We trimmed every few weeks, and the owner would use boots as needed (small Equine Fusions with pads).
This little guy has been doing wonderful for a few years now, is comfortable and happy, with a very attentive owner! The bottom photo in this collage is a more recent one, and he is now comfortable and back to trotting up for his trim and trotting back away after. Most of that lamellar wedge grew out well, and from the naked eye on rads (I don’t have measurements) his CE measurement looks to be less, so I would assume he has less distal descent. He has been very comfortable barefoot even with frozen ground this winter.
The biggest parts of his rehab were the diet (following ECIR), proper metabolic management, proper infection treatment, catering to his comfort level each and every trim, and listening to the horse.
Thank you Lindsey for sharing his story. And thank you to ECIR for your tireless efforts in sharing FREE information on managing metabolic horses and preventing and rehabbing laminitis, and thank you to Pete Ramey for teaching so generously on how to rehab these cases, and publishing peer reviewed research on his protocol (found here: https://www.sciencedirect.com/science/article/pii/S0737080613006370 )
And side note, if you’re hoof-obsessed like I am, we are doing a Podiatry Clinic here in October at our hoof rehab facility in MA, with Dr. Jenny Hagen, Celeste Lazaris , Ula Krzanowska, and Pat Reilly, where we are looking at some really interesting hoof rehab case studies and pathologies! In person participation is sold out, but we do have a wait list, and you can message to be added, or have a livestream/video recording option here:
https://thehumblehoof.com/product/october-25-26-2025-livestream/
If you have a laminitic horse, run - don’t walk - to ecirhorse.org and dive right in. It’s free!
