Club Foot 2-28-05 Pete Ramey with 2018 edits
Copyright 2006
A “club-footed”
horse is defined by most people as a horse with one hoof that
grows more upright (particularly at the heel angle) than its
mate on the other side. Normally we’re talking about the front
pair of hooves. Many folks have treated it as a hoof problem and
worked to make the pair of hooves match each other, but it is my
opinion that this is a backwards way of looking at the problem.
When a problem above
the hoof limits the range of motion or practical length of a foreleg
(any injury or pathology, differences in length of pairs of
bones, even back, hip or dental problems), the hoof usually responds by becoming more upright. This is the horse’s attempt
to find some measure of balance in an unbalanced situation. This
does not take all of the responsibility from the farrier. If
left unchecked, this pattern will become more severe over time.
Each hoof needs to be treated as an individual and trimmed for
adequate and uniform sole thickness, for longer stride, for
heel-first impact and to grow out any wall flaring. Meanwhile,
we should try to identify and heal the true problem while
understanding that the deformation of the hoof is only a symptom
of that true problem.
I’ll
lay out some of the problems that can lead a horse’s hoof to
become pathologically upright, and some treatment options.
Added in 2018 – Left or Right-Handedness
Like you and I,
horses are born with tendencies to favor one side over another
in almost everything they do. A majority of horses are
right-handed, meaning that the right side of the front end is
stronger. The left side is more flexible. This makes these
horses favor turning left, they favor a left lead cantor, they
graze with the left foot forward most of the time, the flex
easier to the left, bend easier to the left, and may be mentally
more reasonable to work with from the left. As foals they will
try very hard to develop a club foot on the right front foot, or
low left/high right heel syndrome.
Personally, I would
have called these horses left-handed, instead. But I will stick
with the description by the late Kerry Ridgway, DVM (one of the
best equine locomotion analysts that ever graced this Earth) who
explained to me that these horses are considered right-handed,
because they are always trying to brace or support the majority
of the load on the right front (and left hind) limbs, and that
this is why the other limbs are free to reach out and flex
more.
Nomenclature aside,
a hoof trim or a shoe package is not going to fix this alone,
right?
Instead, start
trimming the foals as early as possible. Don’t force the feet to
match each other – instead, focus simply on not allowing
distortion. Optimize the breakover on the high and low feet,
shortening the trim cycle if you see ANY wall flaring (see
http://www.hoofrehab.com/Breakover.html for details). Keep the
heels trimmed to the callused sole plane, respecting each foot
as an individual (see
http://www.hoofrehab.com/HeelHeight.html for details). Try to leave the frog alone – it is a very
good thing if the frog protrudes longer than the heels, provided
the foal lands heel-first at the trot and is comfortable in the
turnout environment (seehttp://www.hoofrehab.com/FrogTrim.html
for details). Place a 3/8”-tall rocker on the high
foot (from the bar/wall junction, back) to keep the foot out of
the way of a longer stride at all times. Manage foal bars and
quarter walls slightly longer than the callused sole and roll
the walls. Leave the sole alone to callus.
In any age horse,
the owner should do daily forward stretches of the front limbs.
The high foot’s limb will generally be stiffer, resisting
straightening the carpus (knee) when the foot is brought forward as if
onto a hoof stand. Stretch both limbs, striving to balance their
flexion over time. As often as you can afford, have professional
stretching and massage done to the whole body – this condition
is affecting everything– the professionals are best at sorting
through the whole problem, and hopefully teaching interested
horse owners daily treatment options for their individual
situation.
Smart training
work – in hand, under saddle, at liberty or in a round pen that
is designed to balance flexion to both sides and to balance lead
preference helps more than anything else you can do. As the
movement, flexion and lead preference becomes more balanced, the
hooves will follow. With foals, this can be done on the lead or
lunge line – be careful and wise.
Every left
and every right in this previous section flips to the
opposite when we find a left-handed horse. Everything is working
exactly the same way, except it all switches sides. I used
right-handed horses as the discussion example, simply because
they are far more common.
From my observations
in the field, this is one of the most common. Square up the
horse while someone holds the mane out of the way so that the
withers and the shoulders can be viewed from behind. You may
have to stand on a bucket or something to get this view. If the
shoulder on the side of the club foot falls away from the
withers more steeply or is smaller, nerve damage may be your
culprit.
There are two
muscles that run along the outside of the scapula (supraspinatus
and infraspinatus). Their primary job is actually that of a
ligament – to hold the scapula against the body. The reason they
are muscle, rather than ligament is for increased flexibility.
These muscles are innervated by a motor nerve (suprascapular).
If this nerve is damaged the muscles cannot contract as well.
The nerve is usually
damaged during a one-time event. The foreleg is extended and
under power, and suddenly loses traction and slips backward.
When this happens, the lack of nerve stimuli allows the muscle
to contract and become a more tendinous type of material.
Fortunately, the shrinkage of the muscles and their replacement
by connective tissue forms functional ligaments (James R.
Rooney, DVM) which continue to do the job of holding the scapula
in place, but with a limited range of motion.
In severe cases,
this is commonly called "sweeny,” but I see it very commonly to
very slight degrees. The hoof adapts to the reduced extension of
the foreleg by becoming more upright.
Most people only
notice the horse’s resistance to turn in that direction, pick up
that lead or perhaps that their saddle is always shifting to
that side.
From a medical standpoint, the nerve damage is irreversible, but I have seen massage therapy and daily stretching significantly help the situation. Anything that increases mobility of the limb (massage, stretching, and exercise) will in turn “normalize” the hoof. I have heard one veterinarian and one massage therapist who use electric therapy to stimulate muscles claim they can cause nerves to “jump” into the muscles, reversing the problem. I have yet to see it with my own eyes, though, so if anyone out there has documentation of this, I would love to see it.
Tendon contracture
is a misnomer. Tendons do not contract beyond their rest length.
The muscles that work the flexor tendons can and do contract for
many reasons. An overfed foal can “outgrow” the muscles and
tendons. A stall bound horse can have simple muscle contraction
(read stiffness)
due to a lack of movement. Any injury that causes reduced use or
movement of a limb can result in muscle contraction. The list
goes on. Either way, if this is suspected, a competent vet and
farrier need to have their heads together and be on the job.
Again, exercise, routine stretching and massage therapy may be
the best cure and routine hoof care throughout the horse’s life
and plenty of exercise are the best preventatives.
Very often,
pathologically upright hooves are caused by a horse moving to
avoid pain. The result of this will often be increased
musculature on the “club” side. Any of the problems in the back
of the foot discussed in my Navicular
article (www.hoofrehab.com
) or many other injuries,
advanced thrush or improper trimming can cause a horse to
continually land toe-first on one or more hooves. The heels
react by “reaching” for the ground and becoming more upright.
Again, identify the real problem and work to correct it while
simply trusting the callused sole plane and prioritizing heel-first
impact on each individual hoof while trimming. The heels will
almost lower themselves as you fix the real problem (Read
Heel Height – the Deciding Factor
for details).
Involuntary Pain Contracture
Recently, I
worked a chronic case with severe flexor contracture. The horse
constantly stood on its tiptoes and sometimes knuckled over
onto the front of its pasterns to rest. I trimmed, padded
and applied hoof casts to the horse about eight times at three
week intervals (sadly we then decided to put her down). The
attending veterinarian was performing a palmar digital nerve
block for each trim/shoeing, and as soon as the block would take
effect, the horse would settle down onto her heels. This proved
(to me) that foot pain alone can cause reflexive flexor
contracture.
Added 2018: Years later, Dr. Debra Taylor and I were called to several horses with extraordinarily tight flexor muscles with the heels jacked off the ground in tension. Same thing – PDN blocks immediately relaxed the flexor muscles for the duration of the block. We started using the term Wind-Up to describe the condition – an involuntary “cramp” of the flexor muscles caused by nerves firing out of control during extreme foot pain. This is a true emergency, as it is literally ripping the horse apart. While I am not generally a fan of PDN neurotomy, if pain management of the foot doesn't stop the involuntary contracture within a few days, it would be something worthy of discussion with the attending vet.
Another thing to
check for is pastern joint and coffin joint mobility. If a joint is over flexed
(a horse stepping in a hole, etc.) the articular cartilages that
surround the bones can be damaged. As the body attempts to
repair this damage, new bone can form and the result over time
is a seized or partially seized joint. Again, this limited range
of motion can cause the hoof to adapt to a steeper form that
supports the horse as well as possible. Hacking down the heels
in this case can only add pain and more damage.
This one is probably
the worst news on the list. Consult a vet to see if anything can
be done for the horse. More than likely, the horse’s working
days are over, although pasture soundness and light work may
still be an option for the horse.
Some horses are just
born with upright conformation. The best thing to do is not to
breed them and create more. A horse with an upright conformation
on one or more hooves can live over 40 years without having a
lame day, but this is unlikely. A pathologically upright limb is
more susceptible to almost every locomotion problem you have
ever heard of. None of the shock absorbing features of the horse
work as well, and none of the mechanics of the hoof itself are
set up correctly. Is a horse going to die from an upright
conformation? No – but arthritis, founder, navicular, problems,
the list goes on, will always be more likely to occur down the
road.
I should point out,
though, that genetically upright horses are not as common as
most people think. The tradition of thinking it is okay to
neglect foal hooves is very often the true culprit. The foal can
quickly develop high heels, particularly if it lives in soft
terrain, and if left unchecked, the joints, ligaments and
tendons will form this way permanently. Hooves should be
routinely maintained by a competent professional from the very
beginning. It will pay big dividends down the road.
The same goes for
the development of club feet in foals often blamed on grazing
stance. A foal will often get in the habit of grazing with a
particular limb forward, while the other one is held back. This
causes the hoof that is most commonly in the "back" position to
become more upright, while the hoof that is usually in the
forward position tries to "run away" and flare forward at a
lower angle. Again, just because a horse tries to develop this
hoof pattern does not mean we have to allow it to permanently
effect the hooves and limbs.
Routine, balanced
trimming will keep the hooves and the whole horse in balance.
Many riders tend
to load one stirrup more than the other. Or hole placement in
the stirrup leather may be 1/2" out of balance on each side.
Either can cause
imbalanced movement in the horse, which can cause one foot to
grow steeper than the other. If a horse is turned out 24/7 and
gets ridden a few hours a month, this will have little or no
effect on the feet. If, however, most of the horse's exercise
happens under saddle, the effects on the feet can be very
dramatic. Since most people are right handed, this type of
problem is most common on the front right foot, with secondary
problems on the left hind diagonal.
To fix this one,
you simply need to train yourself. You should immediately
suspect this if you have more than one horse with the same
problem.
Remember the scapula
must travel back underneath the saddle for the horse to extend
the leg forward. Something as simple as a loose nail in a saddle
or a saddle that is so tight it restricts this movement can
cause these problems.
Tack up your horse
and slide your hand between the shoulder and the saddle pad.
Have someone lead your horse forward as you walk along beside
it. If the shoulder blade causes pain or hard pressure to your
hand, you can bet it bothers your horse as well. Imagine a full
day of that pressure. As this causes soreness, the
horse will start to move with a shorter (farther back) stride so
that the scapula doesn't have to slide behind the saddle when
the limb is extended forward. Over time, this compensative
movement forges an upright foot.
Sometimes, for various reasons, people just think it’s okay to raise the heels on a horse. Don't second guess the callused sole plane (read http://www.hoofrehab.com/HorsesSole.html for important details). It is a window to the inner structures and will generally show you the heel height the individual horse needs at a given time. If someone has been simply leaving the heels too high, the sole will show you exactly what the horse needs. In most club feet, I simply exfoliate (with my hoof pick, only) any dead sole in the back half of the foot and then lower the heels until they are 1/16 inch longer than the callused sole plane. If the sole is thin at the toe, this heel work appears to be a rocker, as I am trimming parallel with the collateral grooves, and thus the internal structures (please read Heel Height – the Deciding Factor at www.hoofrehab.com for important details and exceptions). If this still yields an exceptionally high heel, I also add a 1/4"-1/2"- tall (depending on limb flexion) rocker behind the bar wall junction to (get the heel "out of the way" of a longer stride and to promote heel-first impact).
Read http://www.hoofrehab.com/Balance.html
We all have
differences in our trimming from one side to the other. We use
the same hand to trim, all the way around the horse. These
differences can cause changes in the movement, thus the growth
patterns of the hoof. A trimmer that habitually leaves the front
left heels 1/16 inch longer than the front right, or is a little
better at addressing flare on one side, or always starts with
the same foot and is tired by the time they get to the last
foot, can create major differences between the feet over time.
Pay close attention to patterns that show up on several horses
in your care.
Over-trimming the sole causes high heels as well. If a farrier or trimmer has been lowering the heels so far that they thin the sole to ½”-thick or less, the body will respond by quickly growing the proper sole thickness back (and then some) to compensate for the wound the body perceives. The thinning of the sole also causes the lateral cartilages and thus the sole's corium to move downward as well, effectively raising the heels from the inside. The "flip-side" of this is that if the live sole is left alone to callous, it will push the structures beneath upward, lowering the heel to the height that is right for the individual hoof and also concaving the sole and thus straightening the bars (Read Reversing Distal Descent).
It is also
important to be aware that many heels appear to be high (based
on hairline height off the ground), but are actually not high at
all. Instead, the coronet has migrated up the limb (or if you
prefer, the horse has sunk down through the hoof
capsule). Evaluate heel height from radiographs and with
the collateral groove depths, rather than with the location of
the highly mobile coronet. The dissections at
http://www.hoofrehab.com/Coronet.html illuminate this
concept.
Many farriers
exacerbate the problem by (intentionally or subconsciously) trying to match the feet by allowing
the club foot to flare. Most of the imbalances we have discussed
will usually only cause a two or three degree difference between
the pair of hooves. People tend to allow or even encourage the
club foot to flare so that the overall hoof angle matches the
"good side." It looks better that way to most farriers and
owners.
When you bring
breakover forward (relative to P3) it generally shortens stride.
A shorter stride causes a hoof to grow more upright. The farrier
then lets the hoof flare even more... The vicious cycle
continues and escalates. Eventually, P3 and the upper band of
new hoof growth are almost vertical, when all the horse wanted
was a few degrees difference between the feet.
Now I've seen
otherwise very competent trimmers who are horrified to try to
grow out flare on a foot this steep. "The new hoof would be
vertical!" The truth is, as you start to grow out the toe flare,
breakover is moved back, lengthening stride. The hoof responds
by becoming less upright. By the time you get the flare grown
out, often the feet look almost perfectly matched. I have dozens
of clients who think I fixed their club foot, when all I did was
allow the feet to have the two degree difference the horse
wanted to begin with.
Studying her upper growth angle at the setup trim, you might
think that if you grew out the flare, the new hoof would be
almost vertical. Five months later, as the flare was grown out,
the upper growth angles have "normalized" as stride is
lengthened and more natural movement is working on our side. As
breakover comes back (relative to P3) stride lengthens. As
stride lengthens, more natural angles emerge – a better type of
"snowball effect."
Meanwhile, massage and stretching of the limb was being performed by a professional sports massage therapist. The result was two or three degrees of remaining difference between the hooves and a very sound balanced ride. She now willingly picks up either lead and turns to the left with fluidity and ease. The reddened, rippled walls and divergent (fan-shaped) growth rings have almost grown out, replaced by smooth hoof horn growing at the same rate at heels and toe.
It is doubtful she will ever have "normal" hooves or body, but is happily working with what she's got.
In the case below, at the setup trim I found lameness on the
left side and comfort in the right club foot. The left heels
were being allowed to grow unchecked and wedged. The sole at the
toe was severely thinned in an attempt to make the angles match.
Most of the front left pain was caused by the crushing of the
long under-run heels. The rest of the pain was from the
excessively thinned soles.
The second set of photos was taken one year later. The horse is
very sound on both feet. Did I fix anything? Not really – I just
accepted the angle differences this horse needs and didn't go to
war them.
Although the veterinarian and a skilled massage therapist have
been unable to pinpoint the source of the imbalance, we know
it's there, somewhere. Fortunately if we just listen to the
adaptive capabilities of the hooves, the horse can form exactly
what it needs to compensate.
Trust that sole and don't allow the walls to flare! The result
again, was another barefoot horse outperforming its former shod
self.
Any club foot
that has been around a while will have a sensitive, unused,
underdeveloped frog/digital cushion. You can fix everything else
and still have the back of the foot too sensitive for the horse
to land on, which will cause the shortened stride and resulting
club foot on its own – another vicious cycle. Using foam hoof
boot inserts and deep pea gravel beds in loafing pens to develop
the digital cushion and callus the frog will break this cycle
like nothing else.
The bottom line to
all of this is that you can’t force a hoof to make a horse
sound. Almost always, I am called to club foot cases when the
horse goes lame on the normal side. This is usually
caused by people trying to force the hooves to match each other.
This thinking often leads a farrier to cut the sole out from
under P3 at the toe and allow the heels to grow unchecked on the
normal foot. Two wrongs don’t make a right. Treat the hooves as
individuals, figure out the true cause of the club foot and see
if you can help the true problem. As you fix or partially
relieve the problem, the sole at the back of the upright hoof
will turn into chalky material, indicating that the body is
ready for you to lower the heels. Meanwhile, the horse will be
more comfortable and move in the most balanced way possible to
support daily life and healing.
Most importantly,
have foals professionally trimmed on a 4-week trim cycle,
beginning as early in life as possible. So many permanent
problems in adult horses – including almost every clubby or
high/low horse – could have been prevented if the bones, joints,
ligaments, tendons and muscles had not been allowed to form on
neglected feet.