Little is known about the pathogenesis of laminitis and its association with EMS (112). Damage to the lamellar (dermo-epidermal) interface in the horse’s hoof can result in structural changes, such as distal phalanx disorientation and lameness, both of which are defining features of laminitis (113, 114). However, the role of inflammation,as well as the mechanism leading to hypoperfusion and damage to the endothelium of vessels of lamellar tissue in hyperinsulinemic laminitis, has not been adequately defined. The basic principles of endothelial damage may be partly identical to humans. However, the consequence of this endothelial damage in the vessels of the hoof seems to be liable to other mechanisms, because it does not result in the same structural changes observed in arteriosclerosis