Laminitis is a costly and frustrating disease for the horse owner and veterinarian alike. It is difficult to treat successfully and retain the horse's previous level of performance and soundness. Regardless of the cause of laminitis, the pathophysiology is still unclear. Early recognition, identification, and prompt aggressive treatment of horses that may suffer from laminitis as a secondary effect of a systemic disease, however, is the key to successful recovery. This article will review the definition, suspected pathophysiology, clinical signs, and diagnosis of laminitis, as well as current medical recommendations and hoof care considerations in the laminitic horse.