Early diagnosis gains ground in laminitis care

Laminitis care is shifting further upstream, with early diagnosis and prompt treatment increasingly framed as the best chance to improve outcomes, particularly in endocrinopathic disease. The core message from Andrew van Eps’ review on endocrinopathic laminitis is straightforward: persistent hyperinsulinemia drives the condition, so insulin control is central to both prevention and treatment. Because many cases begin subclinically, he argues that metabolic screening and radiographic screening are needed before obvious clinical signs emerge. (pubmed.ncbi.nlm.nih.gov)

That message aligns with Penn Vet’s recent coverage, “Improving Laminitis Outcomes With Early Diagnosis and Treatment,” which emphasizes that faster recognition and appropriate intervention can improve prognosis and recovery. It also fits the long-running research agenda at New Bolton Center’s van Eps Laminitis and Endocrinology Laboratory, which focuses on prevention, early treatment, advanced imaging, and endocrine biomarker testing for horses and ponies at risk. (vet.upenn.edu)

The background here is a broader redefinition of laminitis over the past two decades. Rather than treating laminitis as a single disease process, clinicians now distinguish among endocrinopathic, sepsis-related, and supporting-limb forms, each with different mechanisms and management priorities. Endocrinopathic, or hyperinsulinemia-associated, laminitis is now widely described as the most common form, and it is closely linked to insulin dysregulation, equine metabolic syndrome, and pituitary pars intermedia dysfunction. (vettimes.com)

The practical implication is that early case finding has to go beyond visible lameness. Penn Vet’s assay service says insulin, ACTH, and adiponectin testing can help identify laminitis risk and guide treatment, while current equine endocrine recommendations support resting insulin assessment and, when needed, dynamic testing such as the oral sugar test. Recent reviews also note that relying only on phenotype, such as obesity or cresty neck score, will miss some horses with clinically important hyperinsulinemia. (vet.upenn.edu)

Expert commentary has pushed that point further. In industry reporting, van Eps has said horses can sustain microscopic lamellar damage before they show obvious lameness, and he has described early treatment as the point at which damage and tissue disorganization may still be minimal. Other commentary aimed at clinicians and hoof-care teams highlights subtle warning signs, including poor performance, hoof sensitivity, and widening of the white line, all of which can prompt earlier veterinary workup. (thehorse.com)

There is also evidence that practice patterns are changing. A survey of North American veterinary practitioners found clinicians had become more likely to incorporate endocrine testing into their approach to endocrinopathic laminitis, suggesting that research on insulin dysregulation is translating into field medicine. At the same time, Penn Vet’s research program continues to explore earlier identification tools, including digital radiographic measurements and sensor-based approaches to detect risk before catastrophic failure of the lamellae. (pubmed.ncbi.nlm.nih.gov)

Why it matters: For equine veterinarians, this is less about a new single treatment than about a different clinical workflow. Earlier insulin screening, ACTH testing where indicated, foot radiographs in at-risk horses, and faster intervention on diet, confinement, mechanical support, and medical management may offer the best chance to prevent progression. It also reinforces the need to frame laminitis as an endocrine and whole-horse problem, not just a hoof problem, and to work closely with farriers and pet parents on long-term risk reduction. (pubmed.ncbi.nlm.nih.gov)

What to watch: The next phase will likely center on better screening thresholds, wider use of subclinical imaging and biomarker testing, and more standardized early-intervention protocols for hyperinsulinemia-associated laminitis, including when to escalate medical therapy in high-risk horses. That’s an inference based on Penn Vet’s current research priorities, recent endocrine guidance, and continuing professional education in 2025 and 2026. (vet.upenn.edu)