Andrew van Eps, Simon N. Collins, Christopher C. Pollitt Veterinary Clinics of North America Equine Practice August 2010 26 2 287-302 Supporting limb laminitis poses a threat to all horses suffering from severe unilateral lameness. Despite its devastating effects, relatively little is known about the precise pathologic processes that lead to its development. This article reviews the potential mechanisms of supporting limb laminitis, and the authors present some preliminary data based on advanced imaging and computer-based modeling techniques aimed at further elucidating the etiology of this unique form of laminitis. Gaining a better understanding of the pathologic processes that lead to supporting limb laminitis is essential to enable the development of appropriate countermeasures to safeguard horses at risk of the disease.