Equine laminitis has been with us for a long, long time. Fortunately, in the last 10 to 20 years there have been great strides in understanding the causes of this terrible condition. Laminitis is now regarded as a syndrome that occurs secondary to something else, rather than a discreet disease all in itself. This has allowed much more focused research and effort in treating the cause rather than treating just the symptoms that occur in the hoof. It doesn’t matter how great the trim is, or what shoes are used, or how deep the bedding. If initiating causes such as EMS (Equine Metabolic Syndrome – see Equine Metabolic Syndrome & Equine Cushing’s Disease, Early Summer 2018 issue of Canadian Horse Journal) or PPID (Cushing’s disorder) are not addressed, the laminitis and the pain will continue.