Innovative Equine Podiatry and Veterinary Services, PLLC

04/12/2026

We're not nutritionist but here are some guidelines we use. Working directly with an equine nutritionist is highly recommended!
🔬 Understanding NSC in Hay: What Every Horse Owner, Farrier, and Veterinarian Should Know
When we talk about metabolic horses, laminitis—or what I prefer to call lamellar structural failure (LSF)—nutrition becomes just as important as mechanics.
One of the most critical values in a hay analysis is NSC (Non-Structural Carbohydrates)
👉 Typically calculated as: WSC (water-soluble carbohydrates) + starch
Why does this matter?
Because elevated NSC = increased risk for insulin dysregulation, which directly contributes to lamellar damage.
📊 Average NSC Ranking of Common Hay Types (Lowest → Highest)
🟢 Teff Grass (~7–10%)
🟢 Warm-Season Grasses (Bermuda, Bahia) (~8–11%)
🟢 Alfalfa (~9–12%)
🟡 Mixed Hay (~10–13%)
🟡 Timothy (~10–14%)
🟠 Orchardgrass / Fescue / Bluegrass (~12–16%)
🔴 Ryegrass (~15–20%+)
🔴 Small Grain Hays (Oat, Wheat, Barley) (~15–20%+)
⚠️ Here’s the part most people miss:
❗ Hay type does NOT guarantee NSC
❗ The same hay can vary dramatically between cuttings
❗ Sunlight, stress, and harvest timing all matter
👉 A “safe” hay can test high
👉 A “risky” hay can test low
Testing is everything.
🧠 Clinical Takeaways
• Warm-season grasses → typically lower NSC
• Cool-season grasses → higher NSC risk
• Alfalfa → low NSC but calorie-dense
💡 Our Rule of Thumb at Innovative Equine Podiatry
For horses that need to lose weight or are metabolically challenged:
✔ Feed ~1.2% of body weight per day (forage only)
✔ Of that total forage:
👉 25% alfalfa
👉 75% coastal bermuda
👉 This approach helps balance:
• Lower NSC intake
• Adequate protein
• Controlled caloric intake
✔ Pair with a ration balancer to meet vitamin/mineral needs:
👉 Bluebonnet Feeds Limited Ration Balancer
👉 Purina Omega Match® Ration Balancer
⚠️ Important Notes
🔎 Hay must still be tested to confirm NSC
📉 This is a starting point—not a fixed prescription
🔁 Requires constant monitoring and adjustment based on:
• Body condition
• Insulin status
• Comfort and soundness
• Hoof growth and structural response
🔗 Bottom line:
You cannot manage lamellar structural failure mechanically if you are losing the metabolic battle nutritionally.


Creative Equine Solutions Sammy Pittman Horse Science Anatomyworks

02/22/2026

🚨 Steroids, Insulin, and Lamellar Structural Failure: What New Research Means for Our Horses 🚨
As many of you know, at our clinic we frequently discuss the risks associated with corticosteroid use—especially in horses with underlying metabolic risk. A large number of our lamellar structural failure cases each year are steroid-associated.
In many of these horses, the metabolic dysfunction was likely subclinical… until the steroid pushed them over the edge.
📚 Recent Research Adds Important Insight
A recent prospective, controlled crossover study evaluated the effect of the SGLT2 inhibitor ertugliflozin on insulin response after intra-articular corticosteroid administration.
Study Summary
8 metabolically normal geldings
Received intra-articular triamcinolone (18 mg)
Compared no treatment vs. 7 days of ertugliflozin before and after injection
Measured resting glucose, resting insulin, and oral sugar test (OST) responses
Key Findings:
✔ Insulin significantly lower 2 days after steroid injection with SGLT2 inhibitor
✔ Resting glucose significantly lower at 8–48 hours
✔ Resting insulin significantly lower at 12–72 hours
✔ Suggests reduced hyperinsulinemic response after steroid administration
Even in metabolically normal horses, insulin and glucose responses were blunted with SGLT2 inhibition.
The authors concluded that further investigation in insulin dysregulated horses is warranted — particularly regarding laminitis risk reduction.
🧬 Why This Matters Clinically
⚠ Hyperinsulinemia = Lamellar Risk
We now understand that hyperinsulinemia alone can induce lamellar pathology, even in the absence of systemic inflammation. Steroids can:
Increase insulin concentrations
Worsen underlying insulin dysregulation
Trigger lamellar structural failure
In horses with:
Equine metabolic syndrome
Regional adiposity (cresty neck, fat pads)
Obesity
Previous laminitis
Subclinical insulin dysregulation
…the addition of corticosteroids may be enough to initiate failure at the lamellar interface.
🐴 Equine Metabolic Syndrome (EMS)
Equine Metabolic Syndrome is characterized by:
Insulin dysregulation
Regional adiposity
Increased laminitis risk
Many performance horses today are:
Easy keepers
Over-conditioned
Fed high NSC diets
Exercised inconsistently
And importantly — some appear outwardly normal but have abnormal insulin dynamics.
💉 Steroids and the “Metabolic Push”
We use corticosteroids for:
Joint inflammation
Soft tissue injury
Respiratory disease
Allergic conditions
But steroids:
Increase insulin concentrations
Reduce peripheral glucose utilization
Can unmask latent metabolic dysfunction
In our practice, many steroid-associated lamellar structural failure cases are not classic “Cushing’s horses.”
They are subclinical metabolic horses that decompensate after steroid exposure.
💊 Where SGLT2 Inhibitors Fit
SGLT2 inhibitors:
Promote urinary glucose excretion
Reduce circulating glucose
Lower insulin concentrations
Improve insulin dynamics
Over the past few years, we have recommended SGLT2 inhibitors in suspect metabolic cases, particularly:
Prior to or surrounding steroid use
In known insulin dysregulated horses
In high-risk laminitis patients
This new research supports that strategy — showing measurable reduction in insulin and glucose changes even in metabolically normal horses.
🔎 Practical Take-Home Points
✔ Not all metabolic horses look obviously metabolic
✔ Steroids can induce hyperinsulinemia
✔ Hyperinsulinemia drives lamellar structural failure
✔ SGLT2 inhibitors may reduce steroid-associated insulin spikes
✔ Screening (resting insulin + oral sugar testing) matters
🧠 Our Philosophy
We are not anti-steroid.
We are anti-uninformed risk.
Every decision should be:
Mechanically informed
Metabolically informed
Individualized
If your horse requires corticosteroids, especially if:
Overweight
Previously laminitic
Cresty
Has regional adiposity
…let’s discuss metabolic screening and risk mitigation strategies.
Because when it comes to lamellar structural failure, prevention is always easier than rehabilitation.
— Dr. Sammy L. Pittman
Innovative Equine Podiatry & Veterinary Services
Helping Your Help Horses — From the Ground Up 🐴

02/17/2026

Cases like these make it hard to believe that there are folks taking care of horses hooves that do not believe that the deep flexor has anything to do with loads inside the hoof capsule. For those in the back row lets say it a little louder. The deep flexor tendon has to respected with regard to club feet and lamellar structural failure. You can use mechanics (here a deep flexor tentomy) to shift load to the heels and promote quicker healing and soundness. 4 months between image on the right and image on the left. Go out into the world an help horses! A tenotomy may be required in some case to offer maximum release but the majority will only require wedges or my preferred method a fully rockered wedge. Creative Equine Solutions Horse Science Anatomyworks

02/14/2026

Fun part of working on donkeys is there is nothing readily available and you get to fabricate it from scratch!Creative Equine Solutions

01/24/2026

01/24/2026

**edited to add** This will actually be a round table discussion Tuesday, March 17th in the Caraway 2 Room from 5 pm – 7 pm. American farriers convention in little rock Arkansas! This will actually be a roundtable discussion. I will bring this case to kick off some discussion. Bring your cases and questions and we can discuss them!I Many other good speakers and learning opportunities. March 16th-20th. We will have a booth with Creative Equine Solutions and Horse Science Anatomyworks in the trade show.

01/17/2026

Negative palmar angle, low bone angle and long toe lever aka low heel is one if the largest epidemics the horse world faces today. Combination of modern genetics and biomechanics that offer a challenge to the farrier. Out if the box methods have offered great success for better management and differ greatly mostly in the trim.

01/11/2026

AFA certifications. I had the opportunity some years back to take my certified farriers test.
The level of knowledge, hands-on skill, and forging ability required of candidates is significant. Even well into my career, I found the process sharpened my skill set, challenged my mechanics, and pushed my forging to a higher standard.

One of the biggest takeaways for me was the networking and camaraderie. Being surrounded by motivated professionals—regardless of background, discipline, or shoeing philosophy—was energizing and inspiring.

No matter your style or beliefs in shoeing, the certification journey is a valuable tool. It encourages growth, self-evaluation, and continued learning. I truly believe it can help advance your skills and confidence as a hoof-care professional.

Certification is not the destination—it’s a stepping stone in a long journey of successfully managing horses. If we want to provide the best care possible, we must continue to evolve, learn, and challenge ourselves.

Highly recommend the process.

01/01/2026

🎆🐎 Happy New Year from Creative Equine Solutions & Innovative Equine Podiatry 🐎🎆8
As we welcome a new year, we’re grateful for the horses, clients, colleagues, and collaborations that allow us to do what we love every day. Here’s to continued innovation, soundness, biomechanics, and helping horses perform at their best—from the ground up.
Wishing you and your horses a healthy, strong, and successful year ahead!

12/30/2025

Tried my firsr pair of Austin Edens COR Wedge shoes. Nice omnidirectional leverage reduction and a good host for a multiplanar/full rocker trim application. Nice shoe!

12/25/2025

Wishing you all a very Merry Christmas!