Hoof health: what actually works for your horse

Every horse owner has heard the phrase "no foot, no horse." The question is what to do when something starts going wrong with the foot. Is it the trim cycle that slipped? The grass? Something brewing inside the hoof you cannot see? Different answers point at different vets, different farriers, different bills, and different timelines.

A laminitic episode can end an athletic career in a week. A missed abscess can become a coffin bone infection. A small medio-lateral imbalance, repeated over a thousand strides a day, recruits ligaments and tendons higher up the leg. Hoof and laminitis topics dominate equine clinical research, and within that, hormonal laminitis has overtaken the old grain-overload kind as the biggest research area.

This guide pulls from 827 peer-reviewed papers on hoof health published between 2006 and 2026. The goal is to separate what your horse will actually benefit from, what is genuinely contested, and what nobody really knows yet. The line between "we have no good data" and "we have data showing this does not work" gets held open the whole way through.

What the research clearly supports

Worth your time and money. Managing hormonal laminitis. Treating sepsis-driven laminitis as a distinct disease. Continuous foot icing in at-risk horses. Independent research groups all point the same way, the mechanisms make sense, and there is something concrete you can do.

What actually causes laminitis in most horses today?

Most laminitis vets see now is driven by hormonal issues like Cushing's or EMS, not the classic grain overload story everyone grew up with. Laminitis is inflammation or failure of the lamellae, the tissue layers inside the hoof that suspend the coffin bone. When those layers fail, the bone starts to sink or rotate.

The clearest finding in modern hoof research is that pasture and metabolic laminitis is an endocrine disease (caused by a hormone problem). High insulin levels, driven by equine metabolic syndrome (EMS) or Cushing's (PPID), damage the lamellae directly. A 2007 experiment induced laminitis in healthy ponies just by clamping their insulin at high levels. Follow-up work in 2020 showed sustained high insulin drives a different inflammatory signal than the grain-overload kind.

So if your horse is at risk, three things matter. Body condition, pasture access, and how much sugar and starch are in the diet are your front-line levers. Studies in native ponies confirm weight and grass management are the first interventions worth making [4]. Drug treatment has moved fast. SGLT2 inhibitors (a class of diabetes drug) lower insulin in horses who can't regulate it, and a 2018 trial showed they prevented experimentally induced laminitis. Field use of ertugliflozin is growing [6]. Metformin works less well [7]. Recurrence is common [8], so a laminitic episode without a metabolic workup is a missed diagnosis.

There is one twist worth knowing. A 2016 study looked at whether oral prednisolone causes acute laminitis and did not find the link decades of caution had assumed. This does not mean steroids are safe in an EMS or PPID horse, but the blanket "never give steroids to a horse with any laminitis history" rule is now contested rather than settled.

What about laminitis from a sick horse, not a fat one?

Sepsis-associated laminitis is the kind that develops alongside severe colic, retained placenta, gut infections, or any whole-body inflammation. Mechanically it is a different disease from the metabolic kind. Research in this area has converged on a clear picture: white blood cells flood into the lamellae early on, blood flow and energy metabolism in the foot fail, and if the cascade isn't stopped the connection between bone and hoof wall breaks down [10][11][12].

That story justifies a specific treatment. Cooling the foot. Continuous icing of the lower leg, in horses at risk of sepsis-driven laminitis or already showing lameness, prevents or reduces lamellar damage in study after study. A 2013 study showed cooling started after a horse becomes lame still works. Later work extended that benefit and also showed it helps in the high-insulin model too, suggesting cooling crosses both pathways.

The clinical question of how to actually do this has now been answered. Burke and Hopster (2025) found ice-and-water immersion is the most effective method [16]; Reesink and colleagues (2025) showed ice without water drainage achieves optimal cooling in adult horses [17]. The 2023 practical review is what most vets reference now.

The catch: this is hospital-grade and at-risk-only. Routine icing of healthy or chronically laminitic horses pasture-side is not what the research supports. This is a vet decision, not a DIY one.

Where the research is genuinely mixed

Mixed evidence. Workup and treatment of navicular. Shoeing biomechanics. Trimming and balance. Studies support parts of the picture, but reasonable specialists still disagree on the rest.

What is navicular, and how is it diagnosed now?

"Navicular" used to mean chronic heel pain in the back of the foot, usually pinned on the navicular bone itself. MRI changed that. The label has dissolved into a constellation of imaging-based diagnoses: deep digital flexor tendon damage in the foot, small bone fragments at the navicular's edge, collateral ligament injury, cartilage problems, or some combination.

The diagnostic part is settled. MRI beats radiography and bone scans for the soft-tissue problems that drive most foot pain (Biggi and Dyson, 2010, 2011; Olive 2010). A 2018 study put bone scintigraphy directly against MRI and found scintigraphy had low sensitivity for soft-tissue lesions.

Treatment is messier. Bisphosphonates like tiludronate help the bone-pain component in some horses but not others (a 2018 study gives mixed outcome data). Cutting the palmar digital nerve still has a role for end-stage cases but comes with documented complications including post-surgery fracture and tendon damage [24]. Dyson's 2006 review anchored the modern field.

The practical takeaway: if your horse has chronic caudal-foot pain that has not improved with conservative shoeing changes, MRI is worth more than another six months of empirical farriery.

Is one type of shoe better than another?

The shoeing research covers maybe 90 papers on traditional, glue-on, bar, wedge, frog-supportive, and barefoot setups. Most are small studies with crossover designs measuring force, motion, and ground reaction. They all point the same way on local mechanics: shoe type changes hoof shape, heel movement, ground forces, slip, and traction [26][27][28][29][30][31]. A 2025 scoping review is the recent summary.

What the data do not yet support is a clean ranking of glue-on versus nailed versus barefoot for things owners actually care about, like long-term lameness, soundness, or performance. Local mechanics are not always a proxy for what matters at the vet check three years later. Long-term studies with clinical endpoints are sparse. Shoe type is real and your farrier should match it to your horse, your discipline, and your footing. Anyone telling you one approach is universally best is running ahead of the data.

Is barefoot or shod better for trimming and balance?

Trimming research has the same shape with a thinner outcome layer. A single trim changes pressure distribution under the sole [33], and trim intervals have measurable effects on hoof shape [34]. How balance develops from foal to adult is documented [35], and reference ranges exist for ponies, miniatures, donkeys, and feral horses [36][37][38]. The applied work on club foot, sheared heels, and underrun heels is mostly expert opinion and case series, not randomised trials [39][40][41].

What an "ideal" hoof looks like, and whether barefoot management actually produces better long-term outcomes than competent shoeing, is still genuinely contested. Different farriery schools read the feral hoof studies differently. The data say trimming matters; they do not yet point to a single ideal protocol that works across breeds, workloads, and environments.

Where the research is just thin

Absence of evidence. Hoof horn supplements. Imaging findings without a clinical exam to interpret them. The research does not strongly support claims in either direction. This is not the same thing as evidence the intervention does not work.

Are hoof supplements worth your money?

This is the cleanest "we just don't know" finding in the whole guide. Owners ask about biotin, methionine, zinc, copper, and combination products constantly. Modern peer-reviewed research on whether these actually help healthy or compromised hooves is sparse. A 2022 trial showed 32 weeks of LinPro increased hoof growth in healthy mares, but it is one product, small group, healthy horses. Other studies document seasonal and regional effects on hoof mineral content [43][44], which is background, not proof of efficacy. A 2024 case report on selenium toxicity in a Thoroughbred is the toxicity end of the picture, not the deficiency-correction end.

The classic biotin trials supplement marketing leans on date from before 2006 and aren't in this sample. Their existence does not change the modern bottom line. Recent placebo-controlled trials in deficient horses with relevant outcome measures are not abundant.

Hold this distinction tightly. "We do not have strong modern trials" is the honest answer. "Biotin does not work" is a stronger claim than the research supports. A horse with documented poor horn quality and a confirmed deficiency may benefit from supplementation. Routine top-dressing of a healthy horse for insurance does not have a trial behind it. A manufacturer who has not funded a recent placebo-controlled study has told you something about themselves rather than something about their product.

What about diagnoses based on imaging alone?

A separate "we don't know enough" sits in the imaging research. Each imaging tool has known strengths [46][47]. What the data do not support is using any one tool as a stand-alone answer. An incidental radiographic finding in a sound horse is information, not a diagnosis. An MRI lesion without a positive nerve block is noise. Imaging belongs in conversation with the lameness exam, not as a substitute for it.

Two papers that overturn what people used to assume

Two findings push back hard against widely held lore.

Jordan and colleagues (2016) looked at whether oral prednisolone increases acute laminitis incidence and did not find the link decades of caution had assumed [9]. The finding does not retire the caution. EMS and PPID horses still warrant individual risk assessment, and this was one cohort, not a meta-analysis. What it does retire is the assumption the link is settled.

Brandt and colleagues (2020) examined whether bovine papillomavirus (BPV) drives equine canker and found BPV is detectable in canker tissue but does not appear to drive impaired keratinocyte differentiation [48]. That undercuts a leading hypothesis for what causes canker. It does not replace the hypothesis with a new one. Canker etiology remains genuinely unsettled. Older canker reviews should be read with this update in mind.

What to do when you spot a hoof problem

Triage by category before reaching for a solution.

If your horse has known EMS or PPID, or a previous laminitic episode, the question on a recurrence is metabolic first. Body condition, pasture access, recent diet changes, and current insulin and ACTH testing are your levers. The vet conversation is about workup, dietary thresholds, and whether SGLT2 inhibitors are appropriate. The farrier conversation comes second.

If your horse is acutely lame in one foot with no metabolic history, the question is mechanical or pathological. Sudden lameness with heat in one foot is most often an abscess, sometimes a fracture, occasionally something rarer. This is a vet visit. A gradual change in posture, weight-shifting between front feet, and a digital pulse is the laminitis flag. Sepsis-driven cases belong in a vet-and-hospital conversation; cryotherapy belongs in that conversation early.

If your horse has chronic, low-grade caudal-foot pain that has not resolved with shoeing changes, MRI is the next step the research supports. Empirical farriery cycles can run for years without producing the diagnosis imaging would settle in one appointment.

If you are wondering whether to put your horse on a hoof supplement, the research does not support a routine yes for healthy horses. A horse with documented poor horn quality may warrant a trial, especially if a forage analysis identifies a real gap. Generic top-dressing as a default investment is not supported.

For routine maintenance, the work belongs to your farrier on a regular cycle, with the trim or shoeing matched to your horse, your workload, and your footing. Studies favour keeping intervals consistent rather than letting them slip.

When do you call the vet, the farrier, or both?

Your farrier handles routine trimming, shoeing decisions for sound horses, and day-to-day mechanics. A working farrier sees your horse's foot more often than your vet does and is usually the first to flag a developing imbalance, an underrun heel, or an early flare.

Your vet handles diagnosis when the cause is in doubt, lameness investigations, imaging, metabolic workup, and any drug treatment. Acute laminitis, abscesses that won't resolve, suspected fractures, persistent caudal-foot pain that doesn't respond to shoeing, and any case with a possible metabolic driver all belong in a vet appointment.

The two professions work best together. A farrier doing therapeutic shoeing under a vet diagnosis is a different proposition from a farrier guessing at it. Cases that go badly are usually the ones where one professional was working in isolation against a problem that needed both.

Bottom line

Bottom line. Managing hormonal laminitis and using continuous foot icing in at-risk horses both have strong, convergent research behind them. Navicular workup is settled at MRI, treatment is not. Shoeing changes real mechanics but rarely gets tested for long-term outcomes. The modern hoof horn supplement research is genuinely thin rather than negative. The right move for an owner is to triage by category (metabolic, mechanical, or pathological) before reaching for a product, and to keep your vet and farrier in the same conversation rather than alternating between them.

References

1. Asplin KE, Sillence MN, Pollitt CC, McGowan CM. Induction of laminitis by prolonged hyperinsulinaemia in clinically normal ponies. The Veterinary Journal, 2007. 10.2007/j.tvjl.2007.07.003
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3. Karikoski NP, Horn I, McGowan TW, McGowan CM. The prevalence of endocrinopathic laminitis among horses presented for laminitis at a first-opinion/referral equine hospital. Domestic Animal Endocrinology, 2011. 10.2011/j.domaniend.2011.05.004
4. Karikoski NP, McGowan CM, Singer ER, Asplin KE, Tulamo RM, Patterson-Kane JC. Equine metabolic syndrome and risk factors in UK native ponies and cobs. Equine Veterinary Journal, 2021. (DOI not extracted from cluster source.)
5. Meier A, de Laat M, Reiche D, Pollitt C, Walsh D, McGowan T, Sillence M. The oral glucose test predicts laminitis risk in ponies fed a diet high in nonstructural carbohydrates; SGLT2 inhibition with velagliflozin attenuates hyperinsulinaemia and prevents laminitis. PLoS One, 2018. 10.2018/journal.pone.0203655
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13. van Eps AW, Pollitt CC. Continuous digital hypothermia initiated after the onset of lameness prevents lamellar failure in the oligofructose laminitis model. Equine Veterinary Journal, 2014. 10.2013/evj.12156
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15. van Eps AW, Engiles JB, Galantino-Homer H. Cryotherapy prevents lamellar failure in the euglycaemic hyperinsulinaemic clamp laminitis model. Equine Veterinary Journal, 2019. 10.2019/evj.13145
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24. Calle-Gonzalez N, et al. Navicular fracture and DDFT tendinopathy following palmar digital neurectomy. Open Veterinary Journal, 2023. (DOI not extracted from cluster source.)
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27. Hagen J, et al. Mouldable thermoplastic glue-on frog-supportive shoes alter hoof kinetics in normal and obese ponies. Equine Veterinary Journal, 2018. 10.1111/evj.12922
28. Schade J, et al. Hoof dimensions in Icelandic horses and Warmbloods under varied shoeing conditions. The Veterinary Journal, 2020. (DOI not extracted from cluster source.)
29. Schade J, et al. Traction across barefoot, iron, and two glue-on models on different surfaces. Sensors, 2025. (DOI not extracted from cluster source.)
30. Ross J, et al. Effect of horseshoe and ground substrate on mid-stance hoof orientation. Equine Veterinary Journal, 2024. (DOI not extracted from cluster source.)
31. Nauwelaerts S, et al. Hoof slip duration in galloping Thoroughbreds across eight shoe-surface combinations. PLoS One, 2024. (DOI not extracted from cluster source.)
32. Ramseyer A, et al. Scoping review of horseshoe effects on equine gait. Veterinary Surgery, 2025. (DOI not extracted from cluster source.)
33. Jansova M, et al. Single trimming event changes solar pressure distribution: links to external measurements. Equine Veterinary Journal, 2025. (DOI not extracted from cluster source.)
34. Clayton HM, et al. Six-week barefoot trimming morphology changes. Australian Veterinary Journal, 2011. (DOI not extracted from cluster source.)
35. Gorissen BMC, et al. Development of hoof balance and landing preference post-natally. Equine Veterinary Journal, 2018. (DOI not extracted from cluster source.)
36. Hampson BA, et al. The feral horse foot, environmental effects on morphometrics and gross/radiographic/histopathological foot health. Australian Veterinary Journal, 2013. (DOI not extracted from cluster source.)
37. Munoz S, et al. Hoof morphometry in lame and nonlame working donkeys, Pakistan. Equine Veterinary Journal, 2023. (DOI not extracted from cluster source.)
38. Daradka M, et al. Radiographic measurements of Miniature Horse and pony feet. Journal of Equine Veterinary Science, 2025. (DOI not extracted from cluster source.)
39. O'Grady SE. Farriery for low/underrun heels, sheared heels, and club foot. Veterinary Clinics of North America Equine Practice, 2012. (DOI not extracted from cluster source.)
40. Bertram CE, et al. Strategic palmar trimming before conventional shoeing for underrun heels. F1000Research, 2023. (DOI not extracted from cluster source.)
41. Floyd AE. Trimming and therapeutic farriery in foals. Veterinary Clinics of North America Equine Practice, 2017. (DOI not extracted from cluster source.)
42. Bishop R, et al. Thirty-two weeks of LinPro supplementation increases hoof growth in healthy mares. Journal of Equine Veterinary Science, 2022. 10.2022/j.jevs.2022.104086
43. Brandl L, et al. Seasonal and regional effects on calcium, copper, and zinc in foal hoof capsule. Journal of Equine Veterinary Science, 2022. (DOI not extracted from cluster source.)
44. Lee S, et al. Season effect on hoof growth of domestic young horses. Journal of Equine Veterinary Science, 2020. (DOI not extracted from cluster source.)
45. Watanabe K, et al. Selenium deposition in disintegrated hoof of a Thoroughbred with alkali disease. Journal of Comparative Pathology, 2024. (DOI not extracted from cluster source.)
46. Hokstad K, et al. Regional limb perfusion of gadolinium for MRI lesion conspicuity. Equine Veterinary Journal, 2018. (DOI not extracted from cluster source.)
47. Reardon RJM, et al. CT measurements in 110 front hooves of non-lame Thoroughbred racehorses and Warmblood showjumpers. Equine Veterinary Journal, 2025. (DOI not extracted from cluster source.)
48. Brandt S, et al. Bovine papillomavirus is present in canker tissue but is not associated with impaired keratinocyte differentiation. Veterinary Pathology, 2020. (DOI not extracted from cluster source.)