The old adage “no hoof, no horse” is so true. We often take for granted the health of our horses’ feet until something happens. We’ve learned never to ignore when we suspect our horse is just a little bit “off,” as it’s often an indicator of something worse than she is immediately presenting.

One day in August as we were riding up the trail to the pasture and riding ring, I noticed Morgan’s walk was somewhat rough. She seemed to almost stumble. I immediately jumped off and checked to see if she had a stone or other object wedged in her foot; she did not, but was a bit fussy standing on her left front foot to let me examine her right foot. This enabled me to identify which foot was bothering her. I led her back to the barn.

It had been a disappointing summer and autumn, as she had come up with an abscess more than once, which meant no riding for a few weeks each time until she healed. Although I couldn’t see any cause for her soreness in that front foot, I knew from experience that she could have an abscess coming. I gave her five pellets of hepar sulph (hepar sulphuris cacareum), a homeopathic remedy we’ve found to be effective, as it promotes the opening of the abscess to drain and therefore alleviate the painful swelling, in addition to soaking the foot in a bucket of warm water and Epsom salts.

By the next day, I noticed she was pointing her foot from time to time to relieve the stress of her weight. I detected a bit of heat on her left side up by her withers and shoulder, and her muscles seemed tight on that side, probably from attempting to compensate for the pain in her hoof. In addition to the hepar sulph three times a day, I gave her an anti-inflammatory product that seems to help with the pain. In a few days the abscess came out and her pain was relieved.

Morgan is an “easy keeper” and a bit overweight. In trying to determine a cause for the abscess, I realized it may have been the result of grazing our lawn for about 20 minutes the day or so before. The lawn is much greener than her sparse pasture, but I didn’t think that 20 minutes of good grass would cause her any distress. After this episode, though, I kept her off pasture for a few weeks and rested her.

By the end of the month it appeared as though the bars of one front foot had grown abnormally. When our trimmer Emily came, she explained that it must have been an old abscess that had come out through the bar of her foot. Morgan was still off pasture, eating free-choice hay and a half-cup of Teff and timothy grass pellets twice a day in order to monitor her food and prevent other abscesses from occurring. But in October her hind foot was sore – she had another abscess.

I requested our veterinarian, Dr. Nebzydoski, to take samples of Morgan’s blood to determine why she was getting so many abscesses. Our trimmer, doing some research, suggested that the problem could be equine metabolic syndrome (EMS) or Cushing’s disease (equine pituitary pars intermedia dysfunction, or PPID). EMS develops first in young and middle-aged horses, while Cushing’s affects mainly older horses. Both present similar symptoms – mainly laminitis.

EMS is a condition where the fat tissue is active and produces its own hormones, reducing a horse’s response to insulin. The horse is insulin resistant (IR) and has a high concentration of insulin and glucose in the bloodstream, similar to “horse diabetes.” It also increases the level of cortisol, similar to Cushing’s. Most horses with EMS are “easy keepers” or obese.

Horse Tales: Could it be Cushing’s – or EMS?

Morgan was diagnosed with EMS and treatment involves careful monitoring of the food she’s getting to cut out sugars and starches and feeding hay from a bag rather than free choice. We switched to a smaller mesh after her diagnosis. Photo by Judy Van Put

The most important aspect of EMS is laminitis, which is difficult to manage. Horses with IR are predisposed to laminitis as the condition alters blood flow and reduces the delivery of nutrients to the hoof tissues (lamellae), causing inflammation and damage to hooves. Grazing on lush or rich grasses, or grazing after a frost or period of cold nights and warm days that increases the level of sugars in grass, are triggers for laminitis. To diagnose EMS, blood tests are taken to measure insulin and glucose levels.

Cushing’s is a dysfunction in an area of the horse’s brain that disrupts the normal balance of hormones. The stress hormones of cortisol and ACTH are mainly affected, and a blood test to measure those levels determines if the horse has significantly higher levels of ACTH.

Although Morgan is overweight and has a cresty neck, as is typical of a horse with Cushing’s disease, her coat is shiny and smooth. She doesn’t exhibit the classic long, shaggy coat that doesn’t shed out. Other symptoms are lethargy and fat deposits in the shoulders and around the base of the tail. Most important is laminitis, an inflammation and breakdown of the inner layer of the hoof wall that supports the pedal bone in the hoof capsule.

Cushing’s causes a disruption and breakdown in proteins and reduces blood flow in the lamellae, which also makes the horse prone to laminitis. It can begin early in the progression of the disease, which often leads to the diagnosis of Cushing’s. Treatment for Cushing’s includes management of foods, regular dental care, deworming and regular farrier care. For a shaggy coat that does not shed, you can clip or trim the coat in warm weather. There are also lifelong medications for Cushing’s, which needs to be closely monitored.

The results of Morgan’s blood tests showed that her glucose, ACTH and cortisol levels were normal – she did not have Cushing’s disease. However, her insulin level was high – 60.69, compared to a normal reading of 10 – 40. Our vet suspects that she has EMS.

He suggested I use a hay bag for all of Morgan’s hay. I had been giving some free-choice hay as well as using a bag, but immediately switched to using only bags to slow down her feeding, and I cut out all the treats I would give her. She had already been restricted on her turnout to the paddock rather than her 15-acre pasture, and I began hand-walking her until her sore feet healed, as daily exercise can decrease insulin resistance.

Treatment of EMS involves weight loss, regular exercise and management for laminitis. Other suggestions include soaking the hay, removing sugar, starches and fat from the horse’s diet and not allowing grazing on new, lush, frozen or rich grasses. Your vet may recommend medications to help hasten improvement if laminitis recurs.

In a relatively short period of rest, restricted hay and diet, I am happy to relate that Morgan has shown improvement – so much that we recently had a short but enjoyable trail ride, with no sign of her stumbling or walking with any discomfort. She has adjusted well to the smaller mesh hay bags and seems to be content. We hope that her EMS will be controlled; we’ll stay in touch with our vet and trimmer and monitor her closely.

by Judy Van Put