Clinical Case Review

Laminitis and Metabolic Syndrome

Image 1, Hospital for Large Animals at Tufts University

Image 1: View of the Hoof Wall and Coffin Bone. Image Copyright Tufts University.


While veterinary investigators from around the world improve our understanding of the causes of laminitis and its effective  management, the disease remains one of the most debilitating for horses as well as the most frustrating for clients, attending veterinarians and farriers alike. In a USDA study (pdf) specifically looking at laminitis in the U.S. horse population, 46% of owners perceived that their horses became laminitis because of introduction to lush pasture. Another 27% felt that the laminitis was secondary to feed problems, obesity pregnancy or injury. Less-common causes included diarrhea, grain overload and retained placenta.
The most common theme is thus related to feed management and body condition of the animals involved.  

The following two cases, presented to Tufts’ Hospital for Large Animals, represent one of the underlying conditions we see that predispose horses to laminitis, Equine Metabolic Syndrome. They also illustrate the strategies we use and the principles we follow to optimize long-term outcome. Continue reading

Clinicians and Staff

This Month’s Guest Editors

Dr. Carl Kirker-Head
Carl Kirker-Head

Dr. Carl Kirker-Head, Associate Professor of Clinical Sciences

Dr. Kirker-Head is the Marilyn M. Simpson Professor and Associate Professor of Surgery at Tufts Cummings School of Veterinary Medicine. He is also Director of the Orthopaedic Research Laboratory and an Adjunct Associate Professor in Tufts Department of Bio-Engineering. He is a Faculty Fellow at Tufts Center for Animals and Public Policy.  Dr. Kirker-Head graduated from the University of Cambridge, England in 1983 and completed his surgery residency at Tufts University in 1987, since which time he has been on faculty.  He is a Diplomate of the American and European Colleges of Veterinary Surgeons and he sits on the Academic Council and Board of Trustees of the AO Foundation. He and his wife own and operate an equine rehabilitation facility at their horse farm in Sturbridge, Massachusetts.

Dr. Nicholas Frank

Dr. Nicholas Frank, Chair of the Department of Clinical Sciences

Dr. Nicholas Frank

Dr. Nicholas Frank recently joined the faculty at Tufts University as Professor of Large Animal Internal Medicine and Chair of the Department of Clinical Sciences. Dr. Frank is a recognized expert in the areas of equine endocrine disorders, laminitis, geriatric medicine, nutrition, and internal medicine.  He comes to us from the University of Tennessee where he was a clinician and researcher, as well as Section Chief of Large Animal Medicine and Director of the Center for Equine Veterinary Research.  Research performed by Dr. Frank and his group helped to describe Equine Metabolic Syndrome and to assess medical treatments for this condition in horses. Dr. Frank will provide medicine consultations for the equine podiatry center and referring veterinarians.

Topics of Discussion

Cover of the Journal of Veterinary Internal Medicine

Equine Metabolic Syndrome (EMS), is explained in this Concensus Statement in the Journal of Veterinary Internal Medicine. Tufts' Dr. Nick Frank is the lead author.

 Equine Metabolic Syndrome, In Depth

While the two cases in this month’s Clinical Case Review are quite different in terms of severity of lameness at the time of presentation, as well as their current prognosis for soundness (good for case 1; poor-to-fair for case 2), they share common themes. First, both horses display the hallmarks of Equine Metabolic Syndrome (EMS) as a predisposing feature. They are both overweight; have crested necks; their body condition scores are higher than expected considering the low dietary intake being fed prior to laminitis; and they both lose weight reluctantly in spite of being fed meager rations. Additionally, both horses have elevated blood insulin but normal to high normal glucose. This is the case for most insulin resistant horses because pancreatic insulin secretion increases to normalize blood glucose levels.       

Equine Metabolic Syndrome                       

Equine Metabolic Syndrome, described by Dr. Nicholas Frank in this Concensus  Statement in the Journal of Veterinary Internal Medicine, should be suspected in any horse or pony that is predisposed to obesity. These animals are often described as “easy keepers” because weight gain occurs with pasture grazing and obesity persists after caloric restriction. Genetics are likely to play an important role Continue reading