Evidence-Based Treatment for Laminitis-What Works?

Acute or recurrent laminitis often results in marked structural or mechanical disruption of the hoof with rotation or sinkage of the coffin bone within the hoof capsule in affected horses or those predisposed to developing this complex and devastating disease. A complete knowledge and understanding of laminitis and its complex pathophysiologic cascade remains elusive despite the substantial time and effort that many scientists and clinicians have dedicated over the last few decades. As a result, preventive and therapeutic management strategies remain empirical and anecdotal, with little emphasis on evidence-based medicine. Evidence-based medicine involves integrating individual clinical expertise with external clinical evidence from systematic research to make the best possible decisions regarding patient management. Numerous and overlapping theories have been postulated for the pathophysiology of laminitis. Although beyond the scope of this discussion, the current most commonly discussed theories include vascular or ischemic, inflammatory, metabolic, enzymatic, and biomechanical. In reality, many of these pathways or others yet to be identified are likely involved in the complex cascade of acute laminitis. Substantial focused and relevant research is needed to advance our knowledge and understanding of this complex disease and to develop more effective preventive and therapeutic strategies based on sound scientific and clinical evidence.