Cryotherapy of the distal limbs: an effective treatment for equine laminitis following onset of lameness?



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PICO question

In horses with acute laminitis, does cryotherapy of the distal limbs applied after onset of clinical signs lead to improved clinical outcomes compared to horses treated without cryotherapy?


Clinical bottom line

Category of research question


The number and type of study designs reviewed

Four papers were critically appraised; there were three randomised, controlled trials, and one retrospective cohort study.

Strength of evidence


Outcomes reported

There were reduced histological changes and lamellar injury in limbs treated with cryotherapy in the randomised controlled trials and reduced clinical severity of laminitis in horses treated with cryotherapy in the retrospective cohort study.


In horses with acute laminitis there is weak evidence to suggest that cryotherapy of the distal limbs is an effective treatment option when applied following onset of clinical signs. Further randomised, controlled trials should be performed to assess clinical outcomes of cryotherapy in order to draw definitive conclusions.


How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.


Open Access Peer Reviewed


Belknap, J. (2015). Laminitis In Horses. [online] MSD Veterinary Manual. Available at: [Accessed 27 October 2020].

Cockcroft, P. (2019). Grading the evidence and writing the clinical bottom line. Veterinary Evidence. 4(4). DOI:

D'arpe, L. (2010). The ice shoe to prevent and treat equine laminitis. European Society of Veterinary Orthopaedics and Traumatology, 19, 196–199.

Dern, K., Watts, M., Werle, B., van Eps, A., Pollitt, C. & Belknap, J. (2017). Effect of Delayed Digital Hypothermia on Lamellar Inflammatory Signaling in the Oligofructose Laminitis Model. Journal of Veterinary Internal Medicine. 31(2), 575–581. DOI:

Dern, K., van Eps, A., Wittum, T., Watts, M., Pollitt, C. & Belknap, J. (2018). Effect of Continuous Digital Hypothermia on Lamellar Inflammatory Signaling When Applied at a Clinically-relevant Timepoint in the Oligofructose Laminitis Model. Journal of Veterinary Internal Medicine. 32(1), 450–458. DOI:

Faber, J. & Fonseca, L.M. (2014). How sample size influences research outcomes. Dental Press Journal of Orthodontics. 19(4), 27–29. DOI:

Godman, J., Burns, T., Kelly, C., Watts, M., Leise, B., Schroeder, E., van Eps, A. & Belknap, J. (2016). The effect of hypothermia on influx of leukocytes in the digital lamellae of horses with oligofructose-induced laminitis. Veterinary Immunology and Immunopathology. 178, 22–28. DOI:

Guyatt, G.H., Oxman, A.D., Kunz, R., Vist, G.E., Falck-Ytter, Y. & Schünemann, H.J. (2008). What is “quality of evidence” and why is it important to clinicians? BMJ. 336(7651), 995–998. DOI:

Kullmann, A., Holcombe, S.J., Hurcombe, S.D., Roessner, H.A., Hauptman, J.G., Geor, R.J. & Belknap, J. (2013). Prophylactic digital cryotherapy is associated with decreased incidence of laminitis in horses diagnosed with colitis. Equine Veterinary Journal. 46(5), 554–559. DOI:

Leise, B.S., Faleiros, R.R., Watts, M., Johnson, P.J., Black, S.J. & Belknap, J.K. (2011). Laminar inflammatory gene expression in the carbohydrate overload model of equine laminitis. Equine Veterinary Journal. 43(1), 54–61. DOI:

Sauerland, S., Lefering, R. & Neugebauer, E.A.M. (2002). Retrospective clinical studies in surgery: potentials and pitfalls. Journal of Hand Surgery. 27(2), 117–121. DOI:

Van Eps, A.W. & Pollitt, C.C. (2010). Equine laminitis induced with oligofructose. Equine Veterinary Journal. 38(3), 203–208. DOI:

Van Eps, A.W., Pollitt, C.C., Underwood, C., Medina-Torres, C.E., Goodwin, W.A. & Belknap, J.K. (2014). Continuous digital hypothermia initiated after the onset of lameness prevents lamellar failure in the oligofructose laminitis model. Equine Veterinary Journal. 46(5), 625–630. DOI:





Vol. 6 No. 4 (2021): The fourth issue of 2021

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  /  Exotics  /