Secondary musculo-skeletal issues from hoof deformation due to shoes or

The Idiots Guide to Hoof Problems (no disrespect meant)!

 By Chrisann Ware

Equine Myofunctional Therapist, UHHGM & Co-ordinator of Equethy Barefoot Education (Aust.)

 

As an Equine Myofunctional Therapist I dealt daily with equine musculo-skeletal problems.  Then  through Equethy workshops and my combined work with Andrew Bowe "The Barefoot Blacksmith" (who have now delivered hundreds of workshops all over Australia in the past seven years), I have had the pleasure to meet many horse owners who turned to barefoot rehabilitation as a last ditch effort to have a sound horse. 

The comment I hear all the time after they see the dramatic changes that occur both in hooves and bodies is “I wish I had known how to spot hoof problems earlier.... I could have helped my horse years ago instead of wasting all that time while he was getting steadily worse......I feel like such an idiot!"

 

I tell them "don't" because you are not alone.  I was just the same at one time until I learned a little hoof anatomy and some brilliant hoof specialists who were prepared to totally leave their comfort zone to find permanent healing for horses.

Many horse owners/trainers know instinctively that their horses are “not quite right. They ask their farrier who says “well he doesn’t have great feet, its a breed thing, just keep him shod and he will be OK.” 

Trust me...doesn't ..........and he won't!

So naturally the owner dismisses the hoof as a source of body problems and moves on in their search.... and on.... and on.....and the horse is seen by a passing parade of "experts" and aura polishers!  All the time getting slowly worse.  

Now there is more knowledge of barefoot often the owner has a friend who has already rehabbed their horse this way so they see the dramatic changes that are possible but if they don't then sadly, many horses never receive the help they need and are left with career ending lameness problems, sometimes life ending problems. 

I have put this article together to try to offer some insights for horse owners/trainers who are scratching their heads about where to look next. 

Firstly if you have the obvious a hoof with cracks, splits, bulges, flares then you have advanced hoof deformation and a litany of full blown body issues to boot. But these are easy to see even for the non hoofy.  But sometimes hoof problems are not so obvious and when you don't know about what a physiologicially correct hoof should look like, because we live and ride in a world of deformed shod feet we often accept a lot of horses with very poor hoof form as just normal for the breed! 

I have endeavoured to explain a few of the vast number of secondary musculo-skeletal issues that arise from long term hoof pain. These postural adjustments are as obvious as the nose on your face once they are pointed out to you.

These are not the rantings of the barefoot obsessed (well only slightly), but there has recently been a huge amount of research into the hoof by leading veterinary researchers and there is now the science to  support what barefoot trimmers have been finding at the "coal face" of hoof care for many years now. 

Firstly let me say one thing;  Horse shoes slowly deform horses’ hooves. They alter the very integrity of the structures inside the hoof that were engineered by nature to withstand the huge weight of this animal in motion. They weaken them and this weakness causes the deformation of the hoof capsule and a squashing effect on its inner soft tissues structures. 

Don’t think it’s possible? Just look at our own history and the pictures below from the practice of foot binding during the Tsang Dynasty. “Well, horses are different” I hear you say. Actually the way living tissue and bone reacts to years of unnatural stresses is not as different as you may think. (refer Wolfes Law of Orthopaedics).

 

Steel horse shoes that support the horse by hanging the entire horse's weight from the hoof walls, deform, weaken and change the tissues within the hoof. Professor Robert Bowker in his research into the hoof at cellular level found no indication that the laminar tissues that bond the capsule wall to the pedal bone ever evolved to support the horse's weight!  He says it is a miracle that we can shoe them at all and a testament to the amazing ability of the hoof to adapt .... but it does have a consequence which is eventually the entire hoof mechanism becomes dysfunctional.

The very structures that were meant to dissipate concussion at ground level and protect the horse are severly compromised and begin to atrophy.  With this deformation of the hoof capsule comes inflammation of the tissues in the caudal heel area (back of the hoof). This inflammation goes unnoticed as it requires an MRI scan to see these changes and most vets do not have access to this type of expensive equipment.  The area of the sole and frog are rich in nerves and so quickly react with a pain response from the constant compression of these tissues. The horse then adjusts his gaits and posture to avoid totally loading his sore heels.

Why pain in the caudal (back) hoof area? Because this is where all the soft tissue structures lay inside the hoof capsule. They fill the back half of the hoof and sit behind the pedal bone because the horse, like most mammals was meant to do a heel first stride landing.  

So...depending on the breed, the age of first shoeing (the equine skeleton including hoof bones does not mature till the horse is 5 to 6 yrs...yes thats correct, no horse, no matter what breed is ever mature till they are at over five) and the abilities of those trimming the foot for the application of shoes, the deformation can happen very quickly, or slowly over many years, but it will happen. 

The young race horse below already has his fate sealed by advanced hoof deformation. He will never reach his potential!

Hoof pain in the heel area is often the first symptom.  It is clearly demonstrated above in the photo by this young horse's attempt to do toe first stride landings!

Often not obvious with hoof testers because it is in both front feet and the nerves there now are becoming dysfunctional due to constant firing. This doesn't mean that the horse can't feel his feet it just means that it is a different kind of pain being felt, similar that that experienced with frost bite.  

Once the process of hoof deformation has started the only way to correct it is to allow these tissues to regenerate naturally.  Corrective shoeing is only more of the same thing that created the problem!  The horse may appear to be more comfortable but it is temporary and merely paliative care.  For performance horses corrective shoeing usually preceeds the end of their careers whereas those who undergo barefoot rehabilitation and stay barefoot, usually return to competition. 

Recognising Deformation:

The hoof will deform into two classic shapes ....... by either running forward and becoming splayed and flat, often with long toes and under heels (as happens in the thoroughbred breed and to horses with wider hooves which contain wider P3 shapes), or for Arabs and pony breeds it will usually start to contract at the heels and become more upright and boxy as they have slightly different shaped pedal bones (P3) and it is the shape of the bone that dictates the shape of the hoof capsule.  Front feet are usually the first to deform because of the role they play in the equine biomechanics.

Below are extreme examples of both types of hoof deformation.

Many horses thought to have navicular syndrome actually have acquired caudal hoof pain stemming from their deformed hooves. It presents just the same way that navicular pain does. Every single case of navicular syndrome displays some degree of hoof deformation! I repeat ........every single one! It is never seen in physiologically correct hooves.

 

 

Postural changes - a clear warning sign:

 

If you don’t know a thing about good hoof form and your horse isn’t limping lame how can you know if the horse is sore? 

Easy... just look at the way they choose to stand.

If you have a sore foot yourself and walk and stand avoiding the sore area, after a time you will find you have secondary body problems such as a sore back or hip. 

Continue to adjust your posture and live with pain and eventually this will lead to a litany of secondary musculo-skeletal issues......even leading to changes in your neck and amazingly, even your eyesight too can be affected because you will carry your head tilted to offset the tilted hip. A checkerboard of problems will arise throughout your body. The same thing happens to horses.

To identify horses with hoof pain it is first necessary to identify the stance of a comfortable horse.   We live in a world of sore horses and alarmingly most of us have come to accept their various abnormal postures of our horses as normal. We need to look again armed with some knowledge of why they are choosing to stand as they do.

Sadly over the years many of the early warning signs of hoof pain have been mistaken for conformational problems and even written about as such in well known veterinary and farriery texts as being from conformation faults.  Some are but the majority are not. 

Horses are said to be “over at the knees” when in fact they have no knee problems at all and their strange stance with bucked knees stems from caudal hoof pain. Others have been said to have overly sloping pasterns when they are merely “forced” to have these due to abnormal P3 articulations due to abnormal angles of P3 in the hoof capsule.  This forces abnormal angles on the pasterns as the horse's body compensates.  

No amount of corrective shoeing, remedial body work or chiropractic work will relieve upper body problems caused by constant postural adjustments due to hoof pain.  It is the single greatest cause of musculo-skeletal issues in the domestic horse.

Normal Posture: Whether a young foal or an old horse they should be able to utilize fully their “stay apparatus” muscles of the forehand and partial stay apparatus of the hindquarters. To do so they must be able to keep their front legs vertical as illustrated below. 

 A comfortable stance is shown on both these horses fully engaging their front leg stay apparatus with forelegs locked vertically.

Notice the good definition of the musculature in the older horses neck & shoulders; the deep indent in front of the scapular (shoulder blade) in front of the withers. These forehand muscles are as they should be. Soft and flexible and normal size.

How to identify hoof pain:   Simple! Sore horses lean forwards to unweight their sore heels.  Its clearly visible.

 

The chest is clearly be seen to be held forward ahead of the legs to take the weight off the caudal hoof.  

Most of us are familiar with identifying limping lameness but what is so insidious about hoof deformation from shoeing is that the horses don’t technically limp. They just start to move like stick insects!  So these horses can’t limp in the clinical sense but are indeed very lame.

Even if you don’t know a single thing about the hoof except where it fits on the end leg you can clearly see horses who adopt this forward posture. It’s a huge warning light. If you see it in your shod horses they are already very sore. 

At first these postures are subtle, but as the hoof deformation and associated pain progresses so does the advanced forward leaning stances and gait adaptations. 

Riders may notice they are less forward going, less keen to stretch out. Sour. They seem to fear walking down slopes and tippy toe down.  They become clumsy and begin to trip and seem un-co-ordinated.  Dressage riders find their horses begin to loose impulsion and they have to resort to more severe training to gain that ilusion of lightness for those few moments of competition.  Show jumpers find they will start to run out on jumps or buck on landing, trail riders and endurance riders find their horses are foot sore after an outing. 

Beware – the toe first landing - they signal impending tendon problems.

These sore horses will try to do toe first landings with every stride instead of the correct heel first landings nature intended. Of course at speed horses are unable to control their landings as there are no muscles below the lower leg and the centrifugal forces on the hoof will over ride any corrections the horse tries to make with its upper musculature.  But our horses don't gallop very often so its the cumulative nature of constant toe first landings all the rest of the time that are a concern.

How can you tell without a slow mo camera? If you look closely at a horse with hoof deformation land a stride at the walk you will see a little spray of dirt shoot out ahead of the toe as the horse lands toe first. If your horse trips a lot it is because his toe first landing often causes the hoof to dig in and butt against something solid in the ground surface. These horses may also buckle and go right down onto their knees due to overly contracted and weakened foreleg musculature. 

 

Many racing thoroughbreds like the fellows at right, suffer early onset hoof deformation due to the practice of very early shoeing so common in that industry. Thoroughbreds are often shod when their hooves are barely past foal development. The bones of a horse do not mature till the horse is at least five years of age, this includes the bones of the hoof, some bones in the spine even later. So shoeing horses as yearlings puts them straight on a fast track for hoof problems. This early shoeing in the race industry has implications for both horse and rider as tripping and falling are not something that you would like to have happen to valuable horses who work at speed and carry a human life atop them. Another sinister consequence of toe first landings is the snapping effect that it causes to the tendons.  This “whip lash” effect occurs as the horse drops its weight onto the hoof after a toe first landing. This tends to be a quick, uncontrolled and badly co-ordinated drop after a toe first landing without the dampening of concussion and controlled release that should normally happen.  This "drop" causes continual micro-traumas to the tendon. The cumulative damage often leads to serious career ending tendon tears and suspensory damage.

Note the very evident toe first landings (front and rear) on these three year olds!         These young horses carry a multitude of secondary musculo-skeletal problems.   This fellow is already flexing his knees to avoid heel pain.

Great heel first landings!

The picture (left) of Carol Layton’s booted endurance horse clearly shows great heel first landings. He is working in harmony with his biomechanics.  Most of the concussive shock is being absorbed in the caudal hoof and dissipated at ground level which will lead to less injuries during his performance career.  Amazingly long distance riders often notice that they also suffer less knee pain when they ride barefoot horses! At left is Louise McCormack and Duo Park Ume.  Louise turned to barefoot trimming to rehabilitate  Ume who had been suffering lameness problems when competing shod.  It was discovered by vets that Ume had bone spurs on both her forefoot pedal bones and a 90 percent tendon tear and they suggested that she be retired as she would never be competition sound again.  Not everything is as it seems!   At left, after barefoot rehab.  Louise and Ume successfuly completing the 400 Klm Quilty Endurance ride.  Louise used no boots throughout the ride and went on to successfully complete many other 80 klm rides with Ume.

 Sore hooves lead to sore bodies:

Adopting a continual brace in the horse's forehand has horrendous consequences for the musculo-skeletal system. Firstly it creates dysfunctions in the “stay apparatus” muscles of the forehand. Later their entire locomotory musculature of the horse becomes involved from one end to the other due to secondary compensations.

The “stay apparatus” in the forehand works to lock the leg straight, from shoulder to pedal bone by exerting equal and opposite forces from shoulder to hoof, down through a system of muscles and tendons.  This "lock" allows the horse to sleep and rest in a standing position. Not just something nice for horses to do, but an evolutionary necessity to avoid fatigue for an animal that lives most of the time on its feet. 

When the horse has physiologically correct hoof form they hold the leg effortlessly in this lock, with practically no muscular effort; but the foreleg MUST be vertical for this system to work efficiently. Horses who adopt a forward leaning posture cannot align their forelegs in this vertical position.

 

Horses who cannot “lock” their foreleg stay apparatus
to rest must use other muscle groups in the forehand to assist in keeping the forelegs straight

 

These  muscles normally would be involved
in locomotion and taking on a continual support role causes them to over-develop, become fibrotic,
contracted and fatigued. 

 

Many horses are undergoing continual body therapies and chiropractic manipulations for problems that will only return again and again as the source of theses problems remains undiscovered and unchanged.... the deformed painful hooves. 

Notice the over development of muscle groups in the  shoulder and neck of this horse at above. He has no indentation in front of his scapular due to muscular over development and now has a thick and blocky neck. 

Many equine body therapists do no training in their courses that deals with hoof issues.  They know very little even about correct shoeing so unless they have developed an interest in barefoot rehab. after their training , to them, if the hooves look tidy and well shod and the horse is not limping lame they won’t suspect hoof pain. 

I cannot stress how important learning about natural hoof care can be for any equine therapist. If you are working on horses and don’t have this knowledge you have become part of the problem instead of part of the solution.

Long term effects from hoof deformation:

As the years pass and the hooves deform further, the pain increases and the horse begins to suffer on and off lameness. In some the muscles of the shoulders and upper legs become so fatigued and stressed from trying to maintain this lean that some horses actually adopt a slightly bent knee stance to gain some relief.

By now it’s obvious to their owners that they have a serious problem and veterinary attention is sought. Usually the hoof deformation is not considered as the source because as yet many vets, even those in top equine hospitals, have not been exposed to barefoot rehab. and will recommend traditional methods of surgery and corrective shoeing.

The old solution for these really severe problems was and still is, expensive and invasive salvage surgeries to cut ligaments, tendons, or destroy nerves. After these surgeries the horse lives with a regime of corrective shoeing and pain medication for life.  I believe this is merely palliative care. More of the very thing that caused the problems while the hoof deformation continues unchecked causing bone loss and bone deformities within the hoof capsule.  

By now these bony changes are clearly obvious on x-rays and so are thought to be the cause of the lameness when they are actually secondary changes for years of living with advanced hoof deformation.

If this course of action has been suggested to you by your vet you might like to contact a veterinarian who deals in natural hoof care rehabilitation and seek a second opinion.  (Australian vets who actively promote barefoot rehabilitation and can help you are listed on the website www.easycaredownunder.com.au/ under Hoof Care Providers).

 

 Secondary hind quarter muscle problems from hoof pain –

“Reversed Angles”  and their associated body issues. 

As time goes on and the horse develops a checkerboard pattern of compensation throughout his body. Next hind quarter problems arise and lumbo-sacral pain and hamstring stiffness appear. This is due to the horse bracing their forehand which causes them to shift greater amounts of weight onto their hindquarters.  

With this constant transference of weight off the forehand and onto the hind quarter the hind hooves become involved in the deformation process too.  They begin to deform, and develop abnormal hoof angles and low heels as the heels collapse and fold down toward the ground. Often the angles on hind and forefeet become “reversed”.  

 

 Professional Barefoot Trimmers know this “all hoof involvement” as Reversed angles or may call it the “Box Stance” so called because the posture appears as if the horse is standing on a small box like a circus elephant. Often the gluteals located in the rump become so stressed and tight that they appear like little pillows bulging up on both sides of the rump, even on thin horses.

How does this “box stance” happen to shod horses? It is easy to understand if you think about it. If the farrier is shoeing to match the increasing hoof deformity, and many do. Then as the heels crush and become lower the steel shoe prevents any wear or natural correction from happening. Shod like this the horse is forced to bring his hind hooves further and further underneath him just to stand and so places more and more weight on his hind heels.

The pedal bone (P3) of the forefeet, and hind feet have evolved to be slightly different in their shapes and the angle on their anterior surface is also slightly different. This is because the hind and fore hooves play different roles in the equine biomechanics and need to be slightly different in their shape and angle. The forefeet are basically used for braking and impulsion in an upward direction whilst the hind hooves are more trowel shaped to dig in and push, so providing the huge powerful thrusts necessary for speed.  

For the horse to function effectively and in harmony with his bio-mechanics and avoid musculo-skeletal issues it has been my observation that they must have hind hooves at least four degrees steeper than the forefeet. Naturally steeper ....... not created by wedges or corrective shoes. These only lift the back of the hoof they don't address the internal articulation of the pedal bone nor the angle of the hoof wall to the front of P3.  Once the hoof angles diverge from normal these horses are fighting their own biomechanics for every step.

Reversed angles cannot be artificially addressed with wedges or pads either as it is the actual alignment of the pedal bone inside the hoof capsule that dictates the hoof shape and this affects the articlulation of the short & long pastern joints. Chocking heels up with wedges so that they look better is merely cosmetic, it actually crushes the heels further and tilts the pedal bone abnormally.

Horses with “reversed angles” need to GROW more heel height in the correct alignment. To do this the hoof must be encouraged back into a physiologically correct form. They must have their “fulcrum point ” in the hoof capsule returned to the correct position so that their weight pivots at the anatomically correct point in the centre of the bony column of the leg.. 

This can only be done by addressing the hoof deformity and encouraging the growing of a correct hoof form again. It usually takes about six months and they MUST be regularly trimmed every four weeks, but the rewards are great. As well as sound movement often the entire topline of the horse will change and redevelop. Many owners say that their horses look and move better after barefoot rehab. than they have since they were young horses.

Secondary Hock & Stifle problems:

Horses with reversed hoof angles often suffer patellar problems and hock and stifle issues. Often this is mistaken for locking patellar by owners and veterinarians who are unfamiliar with physiologically correct hoof form. 

The hock and stifle joints work with reciprocal action – flex one and the other flexes equally but opposite. What is not commonly known is that there is also a role played in patellar action by the tensor fascia latae muscle and the lumbo-sacral joint. All of these are affected by abnormal reversed angles as they are unable to work in concert as they should. 

One the hoof angles verge away from normal they are in fact forced to work in opposition to each other. Working in opposition creates tight hamstrings and lumbo-sacral pain. This hock and stifle pain is often mistaken for arthritis in older horses. 

 Rehabilitation Therapies:

Barefoot rehabilitation is firstly aimed at halting and reversing the hoof deformation. You will be astounded at how powerful a tool this can be even for horses with serious hoof problems.  Its best done with the guidance of a Professional Trimmer but if you don’t have access to a professional there are many great books and dvds available now that will help you and your current farrier make a start in the right direction.  Doing something is better than doing nothing.  If you don't have access to a professional trimmer then march up to your farrier and hand him a copy of Pete Ramey's books or the Barefoot Blacksmith dvd's!  Its high time he learned about natural hoof care.  He is a link to health and soundness for every horse he works on and he MUST know how to perform a correct barefoot trim.  Not some half hearted impression of one!

You will need to be strong and insist that your farrier take of leap of faith and follow proper barefoot methods its not something he will have been taught in his farrier training so he is obliged like any professional to be aware of current developments in his industry.

It’s your horse and you have a right to have him trimmed as you choose, stay committed. There is no such thing as a “sort of” barefoot trim. It will only leave your horse sore and stall your rehab. as you will be removing important architecture from the hoof that it needs to redevelop properly and may not be removing the leverage forces that are the actual cause of the hoof deformation.

A professional trimmer will explain in detail what problems they see in the hoof and assess what forces are causing the hooves to morph into an unhealthy form. They will then do a set up trim which is stage one of your rehabilitation. Followed up by regular trims aimed at encouraging the hoof to grow in the correct form.  If you can also find an equine massage therapist to work in conjunction with the trimmer they can begin to release tight contracted muscles right from the initial trim. This will speed up the resolution of body problems.
 
Over the next few months and via a series of regular trims, the hooves are slowly encouraged back into the correct form. It’s important that they are regular trims, no longer than four weeks apart or you will be right back where you started every time the trimmer comes. Regular trimming re-establishes the correct break-over point, hoof balance and will return a normal range of motion to the joints. As this happens the musculature also responds positively.

 Right from Day One deal with those toe first landings: I cannot stress how important this is!   You must provide boots and pads as part of the rehab process.

Horses that have had to deal with years of hoof pain will habitually do toe first landings. Their brain has become hard wired to move this way. When you remove their shoes they will hunch their shoulders when ridden trying to protect their sore feet. This “hunching” adds to their upper body problems and slows down their recovery. It is important that they “relearn” how to use there bodies correctly and to do so they have to feel one hundred percent confident about doing heel first stride landings.

Easycare Hoof boots with therapeutic pads are the very best thing to give confidence to these horses. They don’t need them in the pasture because when at liberty they can take their time to move about and pick their footing, and exposure to varying surfaces is part of the rehab. process, but they do need them for any work or lunging you do. See www.easycaredownunder.com.au for the latest boot information.  Most professional trimmers in Australia can also supply and fit the Easycare range of boots for you.

Why us boots and pads? Dr. Robert Bowker’s recent research using Ultrasound has shown that the greater the peripheral loading of the hoof (as with shoes) the worse the blood flow throughout. With less peripheral loading, the greater the perfusion of blood flow through the hoof. Better blood flow equals healthier hooves and faster rehab time.    Horses that have been shod long term had their hoof constantly loaded only on the peripheral wall, suffering altered blood flow and all the damage that follows. So this has to be reversed. The digital cushion must be regenerated and as the hoof capsule regains structural integrity the heels will decontract somewhat too relieving the pressure in the caudal hoof area.

Solar loading by putting pads in boots promotes blood flow through the hoof. This constant all over contact mimics the stimulation that the hoof would receive naturally.  Bowker’s studies show that blood perfusion through the foot is highest when a hoof is on pea gravel and on foam pads, both rating at 90 on his index.

The very best and quickest way to regain physiologically correct hoof form and thus a sound horse without any musculo-skeletal problems, is to have regular trims and to give the horse gentle exercise in boots with pads. The horse’s own weight in motion will strengthen the internal tissues of the hoof, and break up adhesions. For horses with shrivelled, non functional frogs there are even special therapeutic pads for extra stimulation.  

It is pointless trying to rehab. serious hoof problems without providing hoof comfort as well, as you will be undoing your good work every time the horse is ridden.  Unless they can comfortably land heel first again they will never rebuild the tissues of the digital cushion and caudal heel area.

Once the horse is comfortable its time to think about some "core strength exercises" to rebuild their musculo-skeletal strength and create self carriage again.  I don't mean exercises that require collection,  I mean exercises that will create suppleness and length in the areas of overdevelopment.  Talk to your therapist about an exercise plan.

Barefoot is not about being “bare”.  It’s about a better quality of life....... for the horse’s entire life. Good luck with your rehab. You will be greatly rewarded for your efforts.

Chrisann Ware

Equethy Barefoot Educational Workshops (Australia)  www.equethy.com/