Hoof Care for horses with PPID/Equine Cushings, EMS or Insulin Dysregulation

Endocrinopathic (hormonal) dysregulation can result in development of the following diseases or conditions:


· Insulin Resistance or IR (more accurately termed Insulin Dysregulation)

· PPID (Pituitary Pars Intermedia Dysfunction), otherwise often called Equine Cushings Disease

· Metabolic Syndrome (where horses display symptoms or conditions associated with the above but may not necessarily fit any one diagnosis upon diagnostic testing.


IR and Metabolic Syndrome are considered Metabolic types and are treated primarily through appropriate management (diet, exercise and hoof care) whereas PPID is a progressive disease and should be treated through medication primarily as well as management to reduce risk factors and limit the occurrence or duration of associated diseases or conditions such as laminitis or infections.


It is important to know that horses with these conditions have reduced resilience and it directly impacts their soundness and hoof health and potentially also their hoof score.


You can learn more about caring for a metabolically challenged horse in our blog post here.


Meet Nelly - a sound 21 year old Connemara Pony with metabolic disorders - AND nice hooves!



Nelly has one eye and lots of spirit! He has several challenges (aside from his sight which doesn't seem to bother him), namely PPID/Cushings, Insulin Dysregulation, off set capsule, (probably) knee arthritis, and has had bouts of laminitis in the past. He is managed on a wood chip dry lot and minimum grass ATM. He is 100% sound on all terrain and at times, walks in hand around the rugged tracks around the farm and forestry land where he lives (at our HQ at Holistic Reflections CIC).

Last spring his Equibiome test showed high levels of pro inflammatory microbes in his gut profile and we set about changing his microbiome. Nelly was diagnosed with PPID and ID in October and after 6 months on 0.5mg pergolide/prascend, his levels are down from 167 to 27 and both Liphook and our vets are astonished... he is down to 0.5mg pergolide 2 out of 3 days and we will test him in August to see if we need to continue on this dosage or raise it to support him during naturally occurring seasonal rises in ACTH levels - when he is naturally most at risk of endocrinopathic laminitis and infections.

To support his health and resilience, and to minimise the need for prescription drugs, we use phytochemicals (herbs) including APF (adaptogenic herbs) and digestive cleanse Remount, EquiNectar digestive enzymes, proferm pro and prebiotics and mineral balance to our hay which is around 6% combined ESC & Starch. His feed and hay are sprayed with a 10% solution of activated Actiferm effective microbes too.

Nelly is a super example that an integrative and holistic approach to whole horse hoof care can provide incredible results, and in a timely fashion!


Nelly is on track to develop healthy ideals (posture and hoof proportions) after years in shoes and then BF; but managed in a way which didn't fully support a return to healthy ideals, until now! His hoof score is around 3.5/6 and in a trim or two will be 4/6. This means he could in theory perform at low level exercise potentially under saddle or in harness for instance. I have assessed him based on whether he displays healthy ideals and you can learn more about this here.

To put this into perspective, Nelly has higher scoring hooves than most apparently healthy horses and ponies we meet and this is due to the integrative hoof care provided!
The prevalence of low scoring domesticated horses (typically 3/6 or less) in the UK is a real concern for us - we believe many are being asked to perform at a level beyond their current physical, emotional and mental capability and this places them at greater risk of injury, trauma, infection and disease - including metabolic diseases!

These is just one of Nellys front hooves today....


The yellow sloping line from fetlock to the ground is straight and depicts the hoof pastern axis or HPA - which in this case is ideal. The vertical yellow line is a line bisecting the HPA and the approximation of the centre of rotation (or COR) of the foot. The green line is perpendicular to the COR line and illustrates the approximate heel:toe ratio around the COR and should be close to 50:50 (or 40:60 in the healthy barefoot horse where there is a straight HPA and appropriate palmar P3 angle).


His heels are growing in at a healthier angle every month and he is due a trim in a couple of weeks. I took this photo to illustrate sole and bar exfoliation for a client. He doesn't have ideal heel:toe ratio around the centre of rotation yet but I can see he will achieve this soon if his metabolic health stays good. He does have adequate height to the capsule and a straight HPA and his posture tells me he is probably comfortable, is moving and resting efficiently and is well supported.


If you have a horse with less than ideal healthy ideals, is diagnosed with a metabolic disorder, laminitis or is simply not quite sound, please consider an equine podiatry consult. We love to work in collaboration with you and your horses team members.

How might you define 'healthy' and have you considered what your horses hoof score might be? How might you assess your horses health? Does your farrier, EP or trimmer document your horses hooves and provide a hoof score? Are they healthy, up to the job being asked, or if pasture soundness is you goal, is this truly being achieved? If they are NOT healthy, is there a plan to achieve healthy ideals and maintain them? Can you use HOOF SCORING as a tool in helping support your horses health and hoof proportions?

We provide educational events for professionals and conscientious horse owners looking to better support horses whole health, from the hoof, up! Browse our events here and if there isn't one near you, contact us to host an event or mentorship opportunity near you!


Beccy Smith BSc ADAEP EBW

Diploma in Advanced Applied Equine Podiatry and Independent Equine Podiatrist, Consultant and Therapist

CEO and Founder of 100% Non-Profit Community Interest Company Holistic Reflections CIC


If, like our clients, you want to learn a PRO-Active approach to hoof care and wish to prevent lameness in your horse, consider booking us for an Integrative Podiatry Consult, Educational Event, Mentorship, On-line Course or join our new VIP membership where you can learn top tips straight from an expert!

We take an integrative and holistic approach to whole horse hoof and body health. We appreciate the relationship between body, limb and hoof and seek to address imbalances while positively influencing appropriate static and dynamic hoof balance and biomechanics.


Beccy Smith BSc DAEP EBW – Independent Equine Podiatrist and CEO of Holistic Reflections CIC

Holistic Reflections CIC – a 100% non-profit organisation promoting wellbeing and resilience in people, horses and the environment - for the benefit of all.

www.holisticequine.co.uk | www.holisticreflections.co.uk