How to Use Cold Therapy to Help Prevent Laminitis in Horses

By Dr Duncan Houston

Laminitis is one of the horse conditions where speed matters.

By the time a horse is standing rocked back, shifting weight, reluctant to move, or walking like the ground has personally offended them, damage may already be happening inside the hoof. That is why cold therapy matters most before obvious foot pain develops, especially in horses at high risk after colitis, retained placenta, grain overload, severe systemic illness, or another inflammatory trigger.

Cold therapy, also called cryotherapy or digital hypothermia, is not glamorous. It is wet, cold, labour-intensive, and usually involves a lot of ice. But when used properly, it can be one of the most useful emergency prevention tools we have for certain types of laminitis.

The important part is knowing when it helps, when it is not enough, and how to do it properly.

Quick Answer

Cold therapy can help reduce the risk and severity of laminitis in horses when started early during a high-risk period, especially before clinical signs develop in horses with systemic inflammatory disease, colitis, retained placenta, grain overload, or severe illness. The aim is continuous cooling of the hoof and lower limb, usually with ice-water slurry, to keep the hoof wall cold enough for long enough. If your horse is already lame, has strong digital pulses, heat in the feet, a sawhorse stance, or is reluctant to move, treat laminitis as a veterinary emergency and call your vet immediately. AAEP advises seeking veterinary help immediately if laminitis is suspected.

What Is Laminitis?

Laminitis is damage and inflammation of the laminae, the interlocking tissues that attach the hoof wall to the coffin bone inside the foot.

When those attachments weaken, the coffin bone can rotate or sink within the hoof capsule. That is where laminitis becomes catastrophic. The problem is not just pain today. It is the risk of permanent structural damage, chronic lameness, recurrent flare-ups, and, in severe cases, euthanasia.

Merck Veterinary Manual describes laminitis as inflammation and separation of the hoof laminae, with causes including carbohydrate overload, excessive weight bearing, and endotoxaemia. Severe cases can involve coffin bone rotation or sinking and carry a guarded to poor prognosis. (Merck Veterinary Manual)

Laminitis can be triggered by several different pathways, including:

The key clinical point is this: laminitis occurs in the feet, but the cause is often somewhere else in the horse’s body.

Why Cold Therapy Helps

Cold therapy works by cooling the tissues of the foot and lower limb.

The goal is to reduce the destructive processes that can damage the laminae during the developmental phase of laminitis. Cooling can reduce tissue metabolism, reduce blood flow, and reduce the movement and activity of inflammatory mediators in the foot. A University of Saskatchewan review explains that continuous digital hypothermia helps reduce tissue damage, inflammation, pain, blood flow, and metabolic activity in the affected region. (wcvm-today)

In practice, cold therapy is most valuable when the risk is known before the feet become painful.

That means starting early in cases such as:

• Colitis

• Severe diarrhoea

• Retained placenta

• Metritis

• Grain overload

• Severe systemic inflammation

• Severe infection

• Toxicity or endotoxaemia risk

• Major illness requiring intensive care

• A serious limb injury creating supporting-limb laminitis risk

This is where owners need to understand the timing. Cold therapy is much more useful as a prevention tool than as a last-minute rescue attempt after the horse is already severely lame.

When Does Cold Therapy Help Most?

Cold therapy has the strongest clinical logic when used before laminitis signs appear in a horse at high risk.

A key internist review states that in horses with intestinal disease and high risk for laminitis, cryotherapy is the only proven treatment for reducing laminitis risk, although treating the primary disease early is also critical. The same review notes that early treatment of the underlying disease, systemic inflammation control, and foot cryotherapy are initial prevention steps in horses with systemic inflammatory disease. (ScienceDirect)

There is also field evidence in horses with colitis. A study of horses diagnosed with colitis found that horses receiving prophylactic digital cryotherapy had much lower odds of developing laminitis than horses that did not receive ice. (beva.onlinelibrary.wiley.com)

That does not mean cold therapy prevents every case of laminitis.

It means that when a horse is in a recognised high-risk window, cooling the feet early is one of the few interventions with meaningful evidence behind it.

Cold Therapy Is Not the Whole Laminitis Plan

This is the correction I would make very strongly.

Cold therapy is important, but it is not a complete laminitis prevention strategy.

For endocrine laminitis, the long-term prevention plan is usually about controlling insulin dysregulation, body condition, diet, exercise, pasture access, and PPID where present. UC Davis explains that EMS, PPID, and laminitis are connected through endocrine disruption, and that treatment involves diet and exercise management, with PPID requiring lifelong treatment when diagnosed. (cehhorsereport.vetmed.ucdavis.edu)

For sepsis-related laminitis, the priority is treating the primary disease, controlling inflammation, supporting circulation, managing pain, and protecting the feet.

For supporting-limb laminitis, the priority is reducing overload on the opposite limb, managing the original injury, and providing mechanical support.

Cold therapy can be part of the plan, but it is not the plan.

In practice, the horse does not need “ice only.” The horse needs a vet-led laminitis prevention or treatment strategy.

How Cold Does the Foot Need to Be?

The target is not simply “make the leg feel cold.”

For laminitis prevention, the hoof needs to be cooled deeply and continuously enough to affect the tissues inside the foot. University of Saskatchewan notes that veterinarians using continuous digital hypothermia often aim to cool horses’ hooves below 10°C for approximately 18 to 72 hours, with treatment sometimes continuing 24 to 48 hours after signs of inflammation recede. (wcvm-today)

That is why a quick hose-down, a few frozen gel packs, or 20 minutes of cold therapy is not the same as laminitis cryotherapy.

For high-risk laminitis prevention, think:

• Cold enough

• Deep enough

• Continuous enough

• Long enough

The practical barn version is usually an ice-water slurry that stays near freezing and surrounds the hoof and lower limb.

What Methods Work Best?

Not every cold therapy method cools the hoof adequately.

The strongest practical options usually involve wet ice therapy, especially ice-water slurry. Studies comparing methods have found that ice bags or wader-style boots filled with ice slurry can cool the digit effectively, while gel pack boots may not produce substantial cooling. (ResearchGate)

Common methods include:

The key is that the hoof and lower limb need sustained cold contact. Dry cooling methods may be convenient, but convenience does not help if the laminae are not actually getting cold enough.

How To Set Up Ice Slurry Cold Therapy

A basic ice slurry setup can be simple, but it must be managed carefully.

You will need:

• Crushed ice or small ice pieces

• Cold water

• Tall waterproof boot, wader boot, strong bag, or suitable ice boot

• Duct tape or straps if needed

• Thermometer if available

• Clean towels

• Safe stall setup

• Deep bedding or supportive footing

• Frequent monitoring

A practical setup:

1. Place the hoof into a strong waterproof boot, bag, or wader-style container.

2. Add crushed ice and water to create a slurry.

3. Fill high enough to cover the hoof, coronary band, pastern, and ideally more of the distal limb depending on the system.

4. Keep the ice slurry topped up continuously.

5. Replace melted ice frequently.

6. Check the horse, skin, stance, appetite, manure, and comfort regularly.

7. Continue under veterinary guidance for the recommended period.

This is not a “set and forget” job. It is active nursing care.

The horse must be supervised. Boots can slip. Bags can leak. Horses can step out. Skin can become irritated. The horse can become more painful, colicky, systemically unwell, or unsafe.

How Long Should Cold Therapy Continue?

There is no single perfect duration for every horse.

In high-risk systemic inflammatory cases, continuous cooling is often discussed in the 48 to 72 hour range, or longer if the laminitis risk persists. Veterinary literature notes that distal limb cryotherapy applied continuously from hoof to carpus for 72 hours is the validated prevention method for laminitis in horses with systemic inflammation. (ScienceDirect)

University of Saskatchewan’s review describes cooling below 10°C for approximately 18 to 72 hours, with some recommendation to continue 24 to 48 hours after signs of inflammation recede. (wcvm-today)

In practice, the duration depends on:

• The underlying disease

• Whether the horse is still febrile or systemically inflamed

• Whether diarrhoea, endotoxaemia, or infection is ongoing

• Whether laminitis signs have appeared

• Whether the horse can tolerate the setup safely

• Availability of ice, staff, and monitoring

• Vet assessment of the risk window

If the trigger is still active, stopping too early may leave the horse unprotected during the danger period.

Can Cold Therapy Help After Laminitis Has Started?

Possibly, but this is where the evidence is more cautious.

A Veterinary Evidence review found weak evidence that distal limb cryotherapy may be an effective treatment option when applied after clinical signs of acute laminitis have already started. It reported reduced histological changes and lamellar injury in randomised controlled trials, but concluded that more research is needed before definitive clinical conclusions can be made.

That does not mean “do not use it.”

It means the strongest case for cold therapy is early prevention or very early intervention. Once a horse is already lame, cold therapy may still be useful, but it should be part of a broader emergency plan involving your vet, pain relief, hoof support, diagnostics, and treatment of the underlying cause.

The mistake is waiting until the horse is badly lame and then expecting ice to undo the damage.

Ice is useful. It is not time travel.

Which Horses Should Be Considered for Early Cold Therapy?

Cold therapy should be discussed urgently with your vet if your horse has:

• Colitis

• Severe diarrhoea

• Grain overload

• Retained placenta

• Metritis

• Severe infection

• Pleuropneumonia

• Severe colic or intestinal disease

• Endotoxaemia risk

• Severe systemic inflammatory disease

• Toxic exposure linked to laminitis risk

• Supporting-limb laminitis risk due to serious injury

• Early signs of acute laminitis

For endocrine-prone horses, such as obese ponies, horses with EMS, insulin dysregulation, or PPID, cold therapy may be considered if acute laminitis is suspected. But long-term prevention depends on metabolic control, not repeatedly icing feet after the diet has gone sideways.

Signs Your Horse May Already Have Laminitis

Call your vet urgently if you notice:

• Reluctance to walk

• Short, pottery steps

• Worse lameness when turning

• Shifting weight from foot to foot

• Heat in the feet

• Strong or bounding digital pulses

• Rocked-back stance

• Front feet stretched forward

• Hind feet camped under the body

• Refusing to pick up a foot

• Lying down more than normal

• Sudden reluctance to move on hard ground

• Increased pain after grain overload or illness

AAEP lists acute laminitis signs including lameness, shifting lameness, heat in the feet, increased digital pulse, toe pain with hoof testers, hesitant gait, and the classic sawhorse stance. AAEP also advises treating suspected laminitis as a medical emergency and notifying a veterinarian immediately.

Risk Framework: How Worried Should You Be?

Low Risk

Low risk means your horse is bright, sound, eating normally, has no laminitis history, no recent illness, no grain overload, no retained placenta, no colitis, no supporting-limb injury, and no known insulin or PPID issue.

Action: Cold therapy is not usually needed. Focus on normal prevention: diet, weight control, pasture management, hoof care, exercise, and endocrine monitoring where relevant.

Moderate Risk

Moderate risk includes horses with EMS, PPID, obesity, cresty neck, previous mild laminitis, sudden pasture access, or a diet mistake, but no current lameness or systemic illness.

Action: Call your vet for advice, restrict high-sugar feed, monitor digital pulses, check soundness, and review metabolic management. Cold therapy may be considered if signs are starting or risk is escalating.

High Risk

High risk includes colitis, severe diarrhoea, retained placenta, metritis, grain overload, severe systemic infection, severe colic, toxic exposure, or a serious limb injury that overloads the opposite foot.

Action: Contact your vet urgently. Cold therapy should be started early if your vet recommends it and it can be done safely. Do not wait for foot pain to appear.

Critical Risk

Critical risk includes obvious laminitis signs, severe pain, refusal to move, bounding digital pulses, sawhorse stance, severe systemic illness, dehydration, shock, collapse, severe diarrhoea, or a horse that is down and struggling to rise.

Action: Treat this as an emergency. Call your vet immediately. Cold therapy may be started while waiting for the vet if safe, but it does not replace emergency veterinary treatment.

What Else Could Look Like Laminitis?

Not every sore horse has laminitis, but laminitis must be taken seriously until ruled out.

Important differentials include:

• Hoof abscess

• Sole bruise

• Foot puncture

• Fracture

• Tendon or ligament injury

• Severe arthritis

• Navicular-related pain

• White line disease

• Seedy toe

• Trauma

• Tying up

• Neurological disease

• Severe cellulitis

• Supporting-limb overload

• Bilateral foot pain from trimming or shoeing issues

The pattern matters.

Laminitis often affects both front feet, although any foot can be involved. A hoof abscess is often one foot and can be dramatically painful. Supporting-limb laminitis may affect the limb that has been overloaded because the opposite limb is injured.

In practice, I do not want owners guessing. If there is sudden lameness, strong digital pulses, heat in the feet, or reluctance to move, get a vet involved.

When Is This an Emergency?

Laminitis should be treated as an emergency if it is suspected.

Call a vet immediately if your horse has:

• Sudden reluctance to walk

• Rocked-back stance

• Strong digital pulses

• Heat in the feet

• Severe lameness

• Pain when turning

• Refusal to pick up a foot

• Lying down more than normal

• Grain overload

• Severe diarrhoea or colitis

• Retained placenta

• Fever with systemic illness

• Serious opposite-limb injury

• Known EMS or PPID with new foot soreness

• Rapid worsening over a few hours

Merck describes laminitis as one of the most important and catastrophic diseases in horses, with outcomes ranging from temporary loss of use to career-ending or life-threatening consequences. (Merck Veterinary Manual)

Do not wait to see if it is better tomorrow. With laminitis, time is hoof.

What Should You Do Right Now?

If your horse is high risk but not lame yet

Call your vet and discuss immediate cryotherapy.

While waiting for advice:

• Remove grain or high-sugar feed access.

• Keep the horse calm and confined safely.

• Start monitoring temperature, heart rate, appetite, manure, and comfort.

• Check digital pulses if you know how.

• Prepare ice, boots, bags, and a safe stall.

• Do not force exercise.

• Do not give medication unless your vet advises it.

If the risk is severe, such as retained placenta, colitis, or grain overload, cold therapy may need to start before foot pain appears.

If your horse is already sore or lame

Call your vet immediately.

While waiting:

• Keep the horse on deep bedding or soft footing.

• Do not walk the horse around to “see how bad it is.”

• Remove access to grain and lush pasture.

• Apply cold therapy if safe and practical.

• Do not trim, shoe, or medicate without veterinary direction.

• Prepare a clear timeline of recent illness, feed changes, pasture access, drugs, farrier work, and lameness onset.

If your vet recommends cold therapy

Ask specifically:

• Which feet should be cooled?

• How high should the ice slurry go?

• How cold should the system be kept?

• How often should ice be replaced?

• How long should therapy continue?

• What signs mean stop or reassess?

• What skin changes should be monitored?

• What pain relief or hoof support is needed?

• When should radiographs be taken?

Safety Concerns With Cold Therapy

Cold therapy is generally well tolerated when done properly, but it still needs monitoring.

Watch for:

• Skin rubbing

• Pastern irritation

• Coronary band irritation

• Swelling

• Redness

• Cracked skin

• Pressure sores from boots

• Slipping or unstable footing

• Anxiety or distress

• Exhaustion from prolonged standing

• Worsening pain

• Leaking bags or unsafe stall conditions

Reports of distal limb skin complications during prolonged sleeve-style cryotherapy have included dermatitis, cellulitis, alopecia, coronitis, tissue necrosis, and distal limb oedema, so horses undergoing prolonged direct ice-contact systems should be monitored closely. (ScienceDirect)

Practical barn translation: do not wrap a horse in ice for days and disappear. Check the horse. Check the skin. Check the setup. Check the pain level. Then check again.

Common Mistakes Owners Make

Waiting for obvious lameness

Cold therapy works best when started during the risk window before the feet become painful. Waiting for a sawhorse stance is too late.

Using gel packs and assuming the hoof is cold enough

Gel packs can feel cold to your hand without cooling the laminae adequately. Ice-water slurry is usually more reliable.

Cooling for 20 minutes and calling it done

Laminitis prevention cryotherapy is usually continuous, not a quick post-exercise ice session.

Focusing only on the feet

Laminitis often starts with a problem elsewhere: gut disease, retained placenta, grain overload, sepsis, insulin dysregulation, PPID, or supporting-limb overload.

Forgetting hoof support

A horse with suspected laminitis needs a full plan. Cold therapy does not replace deep bedding, mechanical support, analgesia, radiographs, farriery, and treatment of the underlying cause.

Stopping too early

If the systemic risk is still present, stopping cold therapy too soon may leave the horse vulnerable.

Treating endocrine laminitis as an ice problem only

For EMS and PPID horses, cold therapy may help in an acute episode, but prevention depends on insulin control, diet, weight, exercise, and medical management.

Long-Term Laminitis Prevention Beyond Ice

Cold therapy is mainly an acute risk-management tool. Long-term prevention depends on controlling the reason the horse is at risk.

A good prevention plan may include:

• Testing for insulin dysregulation in at-risk horses

• PPID testing in older horses or horses with suggestive signs

• Low non-structural carbohydrate diet where indicated

• Restricted pasture access for easy keepers

• Weight management

• Controlled exercise when sound

• Regular farrier care

• Avoiding sudden grain or pasture changes

• Safe feed storage to prevent grain binges

• Prompt treatment of colitis, retained placenta, severe infection, and systemic illness

• Monitoring digital pulses in laminitis-prone horses

• Radiographs when laminitis is suspected or recurrent

• Coordinated vet and farrier planning

Merck notes that endocrine dysfunction is probably the most common underlying cause of laminitis in horses today, with hyperinsulinaemia considered a key predisposing condition. (Merck Veterinary Manual)

So the long-term prevention question is not just “Should I ice the feet?”

It is “Why is this horse at risk, and how do we stop the trigger?”

FAQs

Does cold therapy prevent laminitis in every horse?

No. Cold therapy is best supported for horses in a known high-risk period, especially systemic inflammatory or sepsis-associated laminitis risk. It is not a substitute for managing EMS, PPID, diet, pasture, weight, hoof care, or supporting-limb overload.

Should I ice my horse’s feet if I suspect laminitis?

Call your vet immediately. If it is safe and your horse will tolerate it, cold therapy can be started while waiting for veterinary advice, especially in early or high-risk cases. Do not delay veterinary care to set up ice boots.

Are gel ice boots enough for laminitis prevention?

Often, no. Some gel pack systems do not cool the hoof deeply enough for laminitis prevention. Ice-water slurry systems around the hoof and pastern are usually more effective. (ResearchGate)

How long does a horse need cold therapy for laminitis risk?

It depends on the cause and severity. High-risk cases often require continuous cooling for many hours to several days, commonly in the 48 to 72 hour range, or longer if the risk persists. Your vet should guide the exact duration. (wcvm-today)

Can cold therapy treat laminitis after lameness starts?

It may help, especially early, but evidence for treatment after clinical signs begin is weaker than for prevention during the high-risk phase. A horse with laminitis signs needs urgent veterinary care, pain relief, hoof support, diagnostics, and treatment of the underlying cause.

Final Thoughts

Cold therapy is one of the most useful tools we have for preventing laminitis in horses during certain high-risk situations, but it only works if it is started early, applied properly, and maintained long enough.

The real power of cryotherapy is timing.

A horse with colitis, retained placenta, grain overload, severe systemic illness, or supporting-limb risk should not wait until the feet are screaming before anyone thinks about ice. By then, the disease may already be moving.

At the same time, cold therapy is not magic. It does not replace veterinary care, pain relief, hoof support, radiographs, farriery, metabolic testing, or treating the disease that triggered the laminitis risk in the first place.

The best laminitis care is fast, calm, and coordinated: recognise the risk, call your vet, cool early when appropriate, support the feet, and manage the underlying cause.

If you are unsure whether your horse is at risk of laminitis, whether cold therapy is appropriate, or whether new foot pain should be treated as urgent, ASK A VET™ can help you decide what can be monitored, what needs immediate veterinary advice, and what should be treated as an emergency.