16/11/2025
Wow. If you own a horse. You MUST read this. Awesome research Lindsay Setchell.
Join HM's free rehab group The Phoenix Way: Path 2 Hoof Health and save your horse.
The BHM Team ❤️
What We Left Behind: How Laminitis Research Forgot the Hoof
“The hoof tells the truth. We just stopped listening.”
Laminitis has become a poster child for metabolic disease - something horses get when their insulin is too high, or their diet too sugary. It’s a tidy story. Convenient, measurable - and definitely marketable.
You can test for it, feed for it, even sell supplements for it. And you can make people very scared of it... because it can 'hit' at any time - and it is everywhere.
The problem is, that story is not true.
What you are about to read lies the real story of why laminitis is still ruining lives, both equine and human, despite all the “science” and drugs thrown at it.
What got left behind - almost entirely - was the hoof. The structure that is distorted in every laminitic horse. The capsule that separates and diverges, the bone that ‘rotates’ but never independently - and then the laminae that tears apart.
But the metabolism was never the villain in this story.
Something far more sinister, and far more difficult to stop... was taking our horses from us. In eye-watering numbers.
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The Hoof Was the Starting Point
Back in 2000, Chris Pollitt - now an emeritus Professor, who built the Queensland University Laminitis Research Unit, and now regarded as the ‘godfather’ of laminitis research - published detailed anatomical studies showing that the lamellae could be compromised by mechanical tension.
He described how changes in the dorsal hoof wall, what he believed was excessive toe length and unnatural breakover points, together with incorrect trimming techniques, could place strain on the suspensory apparatus of the distal phalanx (SADP).
We have since proved (easily), through real life rehabs, that the SADP theory is untrue… but those early papers still exist where Pollitt stated that capsule distortion itself could cause the laminae to tear.
He was telling the world that the foot could be manipulated into failure.
He saw it in histology. He saw it in radiographs. He saw it in practice.
And then, rather mysteriously, just four years later, he stopped looking. He completely turned away from the hoof.
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The Pivot That Changed Everything
By 2004, Pollitt had introduced the carbohydrate overload model of laminitis, using oligofructose to induce the condition in otherwise 'healthy' horses.
This aligned perfectly with the direction both veterinary and human medicine were heading into at the time. There was a huge 'gold rush' and explosion of interest around diabetes, insulin resistance, and inflammatory disease.
At the same time, pharma was investing heavily in diabetes drugs. Veterinary researchers were pivoting toward endocrine issues. And insulin became framed as the villain. Sugar, the trigger. And laminitis - the result.
The world was told, that horses were being crippled by their own metabolism.
And right there and then, the hoof capsule fell off the radar completely.
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Pollitt’s Pivot and the Metabolic Narrative
Pollitt’s early work in the 1990s hinted that mechanical strain could affect lamellae. By 1999, he introduced the theory that matrix metalloproteinases (MMPs) - enzymes triggered by metabolic cascades - were the key to laminitis - tearing the laminae apart.
It aligned neatly with the rising pharmaceutical agenda. This opened the door for researchers to test for insulin, trial drugs like metformin and later, ertugliflozin - and the era of metabolism driven peer-reviewed studies began in earnest - and this meant highly profitable and sellable endpoints.
It didn't seem to matter that no-one was 'fixing' the problem. And horses were dying in their hundreds and thousands - still.
But then, just like that, as early as 2004, Pollitt quietly started to roll back from the MMP theory. The enzymes he once believed were the culprits of tearing - he now believed were in fact a downstream event. A result of trauma first.
Pollitt changed his mind.
It wasn’t the first time he changed his mind either. Even though he knew that the hoof capsule itself clearly played a part in lamellae destruction - he decided to stop looking. That hard to measure, hard to quantify, hard to control pesky hoof capsule, just fell off his radar. And everyone else followed his lead.
The industry, and Pollitt, pivoted. The hoof was gone from the frame. Completely.
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What They Stopped Measuring
Those changes had consequences. In the studies that followed over the next 20 years, researchers rarely documented the shape or balance of the hooves before inducing laminitis.
They didn’t record trimming history, sole depth, heel height, or toe length. The hind feet, which show a completely different pattern of involvement in laminitis, were simply ignored.
The assumption started to take root that the systemic insult is what matters, the hoof was just the victim.
But that assumption back then and now, never held up in the field. Not once.
If laminitis were purely metabolic, then the disease should affect all four feet equally. The horse is a quadruped after all - and blood flows freely throughout the entire body. Yet this disease of laminitis didn't seem to affect all four feet the same.
The front feet - which are incorrectly trimmed more often, reshaped more dramatically, and pushed further for aesthetics and breakover - were nearly always worse.
The hinds, often left alone from serious manipulation in the majority of ‘laminitis’ cases, showed minimal damage or none at all.
Not because the hinds bear less weight, and certainly not because their blood is different, but because they haven’t been as aggressively manipulated.
Yet this basic observation was, and still is, left completely out of research methodologies. Had they looked, had they studied the hind limbs properly, they would have found that lamellar separation simply wasn’t happening to the same degree.
And at that point then, the metabolic model, based on a systemic disease that should affect all laminae, would have crumbled.
But by ignoring the hind feet in laminitis research… the metabolic model didn’t crumble. It got reinforced. Some would say conveniently so.
Research that focused on one front leg of a four-legged animal was always going to produce skewed data - and it did.
It wasn't just the data, nor the hooves that were being manipulated... a whole nation of horse owners, vets and HCPs too - all of them were conditioned to go along with the story.
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Why We Left the Hoof Behind
There are reasons this shift happened. Hoof capsule distortion can’t be quantified in blood panels. You can’t bottle trimming technique. You can’t drug your way out of a chopped off toe, distorting growth rates, or an unnaturally raised heel, ‘protecting the DDFT’… you can’t make a drug to stop people chasing pathology or aesthetics.
You can't stop people - simply put - making it up.
If laminitis was mechanical - if it started with the foot, not the blood - then the biggest and most scariest horror of all would be unveiled… that laminitis starts with us. With the trimmers. With the farriers. With the humans shaping the hoof.
The trouble is, that makes laminitis political. It makes it personal. Very personal.
And it makes it harder to turn into a research grant or a pharmaceutical product.
So instead of developing deeper understanding of the hoof capsule - the one thing Pollitt had noted very early on - that hoof capsule distortion caused laminae strain - instead of digging deeper into that hornet’s nest… he left it behind and he became laser-focused on the metabolism.
And so did the rest of the world.
Protocols and treatment plans were built around quantifiable and measurable numbers. They obsessed over tissues through the lens of a microscope. But in all of that hyper-focused observation, in all of that 'skewed' data, they lost contact with the structure that actually distorts and causes the tearing. The hoof.
Digital diagnostics took over. Radiographs became digital, blood panels became baseline, and metabolic markers became the story. Everything moved toward easy to measure data.
And the hoof - this adaptable, responsive structure at the heart of the suffering - was just left out of the equation.
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The Great Clinical Contradiction
And yet, in the real world, in rehab focused on internal anatomy and not the blood - horses recover. Successfully so.
What we are seeing now is a completely different story to the 25 long, painful years of huge losses and failures, where drugs, confinement, and remedial interventions took over.
Horses’ hooves recover not from new drugs. Not from low-NSC hay. Not from better supplements. They recover when their hooves are allowed to rebalance. When mechanical strain is reduced. When tension is relieved.
But people like to argue. And people don't like to be told they are wrong. We weren't facing a disease of metabolic induced epidemic proportions... we were facing a world of human beings ignoring the natural biology of the hoof.
We were in the era of personal preference trimming - PPT.
Yet we see recovery every day in rehab: when you stop having opinions, and you start following Mother Nature's true constants - you rebalance - then divergence stops. P3 settles back to a stable natural position. Lamellae grow in well connected again. Horses walk again - not because the feed changed, but because the foot changed.
Which, at this point, brings us back to what caused it in the first place… the blood or the foot? True natural rehab tells us, over and over, it never was the blood. Or standing for long periods on one foot. Or toxic shock. Pure and simply - 'it' - laminitis - was a symptom of a distorted hoof.
In all the years we have been successfully rehabbing horses, we have never, ever found a 'rotated' P3 in a completely balanced hoof capsule - ever. And that is not anecdotal, that is just what laminitis research left out.
We see P3s ‘rotate’ only when the hoof capsule is imbalanced, even when their bloods are perfect. We see hind feet spared over and over again. We see horses recover fully with no metabolic intervention, just better hoof care.
And even with all the open evidence we are showing to the world - fully documented, measured, and x-rayed - true sequential histories - far more than from those who would like you to think we are 'dangerous'... we still get told, again and again, that we’re not following the peer-reviewed science.
But the real irony is: if they actually read those peer-reviewed papers - all of them, not just the ones that reinforce their model - they would see how incomplete the picture really was.
Because the 'science' was skewed. It was flawed. The methods were not robust. They missed important variables... they steered the world where they wanted you to go.
The hoof capsule distortion, and lack of sequential hoof histories, were all left out of study after study. The hind feet missing completely from analysis.
If they looked, they would see how the very thing that fails in laminitis - the lamellae - wasn’t being measured for mechanical load or stress or manipulation history - not at all.
So in 25 years of intense investigation into the metabolism, going nowhere fast, the literature doesn’t say what the world thinks it is saying. The studies were incomplete.
Laminitis is not a catastrophe of the metabolism, it is a catastrophe of the hoof.
Real-world rehab has something to teach science - the science that never looked at the living rehabs or the hoof.
Something it’s been too busy, too biased, or too blinkered to see.
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What We Must Do Now
We have to put the hoof back to front and centre of laminitis research. That means more than just imaging. It means proper tracking of trimming practices, hoof balance, dorsal wall distortion, growth rates, caudal heel heights and feedback mechanisms.
It means studying the hind feet, seriously. It means confronting the fact that many horses with metabolic profiles have no laminitis - and many laminitic horses have no metabolic issues.
Pollitt stopped looking at the hoof when he should have dug deeper. And once the field followed him into metabolism, they stopped looking at the hoof too.
Dysfunctional metabolism doesn’t change the hoof shape. It doesn’t initiate the failure.
That comes from the outside in.
From us.
From the hoof.
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The Last Word
If you want to solve laminitis, you have to start with the foot first. All four feet in fact.
You have to balance them - properly. Then you will stop the strain. Stop the tearing. Stop putting P3 on the rack. Stop the confusion.
Read the literature - all of it. Read why they pivoted and when. And when they left the hoof capsule behind.
Then go outside. Look at your horses’ hooves. Look at the fronts. Then look at the hinds. Because when you do, you will realise the answer isn’t in the blood. It’s in the capsule.
And it’s been there all along. Staring you in the face.
Laminitis - didn’t start in the bloodstream.
It started under the rasp.
And this is going to hurt. Really hurt. Because the world didn’t see it coming - because we were told not to look.
Well, rather unapologetically, for the sake of the horse, we are now looking. And we are looking hard.
You might not like it. But we will never be hood-winked into not looking at the hoof again. The era of obsessing over the blood is over. Now we obsess over the history of the hoof. The sequential data.
And we will lead a revolution of horse owners who will never be told to starve their horse again.
These owners will learn, they are learning, and they are doing something on a grand scale the likes the equine world has never seen before: saving their own horses from the hands of ignorance - and misdirection.
Now we don't just look... we SEE. Truly this time, for the sake of the horse - we won't be silenced.
Lindsay Setchell
HM.
Join our free rehab group The Phoenix Way: Path 2 Hoof Health - and find out how you can fix your horse's hooves - right - now.
