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Proceedings of the 16th

Carrara, Italy
January 29-31, 2010

Next SIVE Meeting:

Feb. 4-6, 2011 – Montesilvano, Pescara, Italy

Reprinted in the IVIS website with the permission of the

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Shoeing strategies for palmar foot pain

Tracy Turner
DVM, MS, Dipl. ACVS
Anoka Equine Veterinary Services - Elk River, Minnesota

The importance of a balanced foot in the treat- tracted heels was defined as frog width less
ment of equine lameness is well document- than 67% of the frog length. Sheared heels
ed.1-4 However, the assessment and choice of was defined as a disparity between the medial
options for correction of an imbalanced foot and lateral heel lengths of 0.5 cm or more.
can be quite subjective.1-3,5,6 Balance is de- Small feet (small feet to body size) was de-
fined as the harmonious adjustment of parts. fined as a weight to hoof area ratio of greater
For the hoof, balance has been defined as the than 78 pounds per square inch. The purpose
equal distribution of weight over the foot.2,5,6 of this paper is to show how measurements of
This must be more precisely defined as equal the feet and radiographs can be used to graph-
medial to lateral distribution of weight since ically document the presence of hoof abnor-
more weight is normally placed on the caudal malities.
half of the foot.5 Caudal to cranial imbalance Eleven measurements are made of each foot.
has been defined as deviation in the hoof The horse’s weight is determined with a weight
alignment or as problems with heel support. tape or scale. Seven measurements are made
Effective communication between the veteri- of the hoof length with a tape measure: me-
narian and farrier is imperative for proper dial and lateral heel lengths, medial and lat-
treatment of most lamenesses in the horse. eral quarter lengths, dorsomedial and dorso-
Unfortunately, it is often difficult for both to lateral toe lengths, and sagittal toe length.
attend the horse at the same time. There can These measurements are recorded on a graph
also be a difference in semantics between the to illustrate the general shape of the foot. In
professions which can lead to misinterpreta- addition, the frog’s length and width are meas-
tion of clinical findings and recommended ured at their longest and widest points. The
corrections which can in turn lead to resent- hoof circumference immediately below the coro-
ment. It is important therefore, to develop ac- nary band, and the hoof angle (using a hoof
ceptable definitions of problems and methods gauge) are also measured. From these measure-
of communicating precisely. ments, two additional measurements can be cal-
Six hoof balance abnormalities have been de- culated: the frog ratio (frog width divided by
scribed7: broken hoof axis, underrun heels, con- length) and the body size to hoof area [horse’s
tracted heels, shear heels, mismatched hoof weight (pounds) X 12.56 / square of the hoof
angles, and small feet. Some authors have at- wall circumference(C) (inches)].
tempted to define these hoof abnormalities ob- A dorsopalmar(plantar) and a lateral radi-
jectively.2,3,7 A broken hoof axis exists when ograph of the hoof can also be used to deter-
the slopes of the pastern and hoof are not the mine valuable information about hoof bal-
same. This condition is further defined as bro- ance. The horse must be standing with the
ken-back, when the hoof angle is lower than the metacarpus (tarsus) perpendicular to the
pastern angle, and as broken-forward when the ground which can most easily be determined
hoof angle is steeper than the pastern angle. by either the use of a level placed against the
Underrun heels have been defined as angle of cannon bone or the use of a weighted string to
the heels of 5o less than the toe angle. Con- align the leg. The radiographic beam should
153
Proceedings of the Annual Meeting of the Italian Association of Equine Veterinarians, Carrara, Italy 2010
Published in IVIS with the permission of SIVE Close window to return to IVIS

be horizontal and centered on the hoof. Rest- er leg joints (fetlock, pastern, and coffin) will
ing the horse’s foot on a block to raise the be affected. The hoof wall length can be meas-
hoof off the ground facilitates these exposures ured directly from the film. The symmetry of
(the opposite limb should be similarly elevat- weight bearing can be predicted in a similar
ed). For easy identification of landmarks, ra- manner.
diopaque markers can be attached to the hoof. Numerous factors contribute to the balance of
A wire placed sagittally (midline) along the an equine hoof.1-7 Toe length is important be-
toe from the coronary band to the ground, a cause it determines the length of the lever arm
thumb tack in the apex of the frog and thumb over which the limb rotates and the timing of
tacks in the most caudal point of the ground hoof lift.4 Hence, a long toe, that would delay
contact of each heel emphasize these areas on breakover, could be expected to increase the
the radiographs, making their identification pressure of the deep flexor tendon over the
much easier. navicular bone, increase the tension on the
After plotting the hoof wall lengths, one should proximal suspensory ligament of the navicu-
have a curve that reflects the shape of the hoof. lar bone, and increase the dorsal rim pressure
For a hoof of average hoof angle (48o-55o), flat- on the joints of the leg.4,8 The optimal toe
tening of the plotted curve indicates that the length has not been determined. Toe length to
heels are underrun. A flat curve would also be a certain extent will be dictated by the horse’s
expected for very upright hooves (> 60o). Gen- use as well as the horse’s height and weight.
erally speaking, the 3 measurements at the toe Guidelines have been described that relate toe
should be equal. The measurements at the quar- length to body weight: 3 inches (7.6 cm) for
ter are usually 1-2 cm shorter than the toe (for 800 to 900 pound horses, 3.25 inches (8.25
the average hoof). The heel length should gen- cm) for 950 to 1,050 pound horses, and 3.5
erally be about one-third of the toe length. The inches (8.9 cm) for horses weighing 1,150 to
remaining measurements are used in the previ- 1,250 pounds.4 A graph of hoof measure-
ously described formulas to determine weight to ments will document disparities in hoof wall
body size and frog ratios for determination of a length between feet. Lengthening one hoof
contracted foot. over its opposite has been suggested as a
Examination of the lateral and dorsopalmar treatment for limb length disparity in the
(plantar) (DP) radiographs provides excellent horse.9 However, this condition has not been
pictorial evidence of imbalance. The lateral scientifically documented in the horse. It has
radiograph should be evaluated for P2 and P3 been the author’s experience that apparent
alignment which gives insight into the pres- limb length disparities are more commonly
ence of a broken-hoof axis. In addition, the due to mild flexural deformities (contracted
alignment between P3 and the hoof wall tendon) rather than actual differences in limb
should be assessed. If the hoof wall and dorsal length and that this condition is most com-
surface of P3 are not parallel the functional monly manifested as mismatched hoof an-
hoof angle can be determined by measuring gles. One study indicated that 28% of normal
the angle of the dorsal surface of P3 with the performance horses may be affected in this
ground. Usually the slope of the heels can be manner.3 This can most easily be documented
seen on the radiograph and can also be used to utilizing the lateral radiographs.
determine whether the heels are underrun. The hoof angle should be the same as the hoof
The DP radiographic projection should be as- axis.2-7,10,11 Utilizing the lateral radiographic
sessed for joint alignment, medial and lateral projection, the ideal hoof angulation to prop-
hoof wall lengths, and foot symmetry. Joint erly align the second and third phalanges can
alignment is determined by examining the be measured accurately. The appropriate cor-
symmetry of the joint space. Malalignment is rection can be determined by measuring the
present if one side of the joint is more narrow. degree of malalignment (flexion or extension)
This phenomenon can also be caused by poor present in the coffin joint and raising or low-
positioning in which case all three of the low- ering the hoof angle that amount.11 For in-
154
Proceedings of the Annual Meeting of the Italian Association of Equine Veterinarians, Carrara, Italy 2010
Published in IVIS with the permission of SIVE Close window to return to IVIS

stance, if the lateral radiographic projection a narrow frog should alert the clinician that
showed 4o flexion of the coffin joint, then the steps need to be taken to promote hoof expan-
hoof angle should be lowered 4o. In most cas- sion.2,3,7 These may vary from simply ensuring
es, the aligned hoof axis is 52o+2o for the front proper heel support to encouraging hoof ex-
feet and 55o+2o for the back feet.2,4,5,7,8 Inten- pansion through the use of slipper heels.
tional lowering of the hoof angle has been Medial/lateral imbalance or shear heels has
used to increase stride length in racehorses but been shown to cause, or predispose to, a num-
studies have shown that this is not true8; there- ber of hoof related lamenesses.2-4,6,7,15 Medi-
fore, there is no reason not to shoe for a cor- al/lateral balance can be assessed by both the
rect hoof axis and a broken hoof axis can pre- hoof measurements and the radiographic ex-
dispose to lameness problems2,4,5,7 and it has amination. The graph of hoof wall measure-
been associated with a greater risk of break- ments will clearly show if one side of the hoof
down in racehorses.12 is longer than the other. The obvious correc-
In addition to hoof axis deviations, the lateral tion is to make the walls equal, although it is
radiographic projection can be used to docu- not always that simple.2-4,6,7,15 The dorso-pal-
ment problems of heel support, i.e. underrun mar radiograph will also clearly demonstrate
heels. In horses with hoof angles between 50 any imbalance. Since this projection will also
and 55 degrees, the hoof length graph also doc- show the effect the imbalance has on the cof-
uments underrun heels if toe length to heel fin joint, this radiograph can be used to em-
length ratio is less than 3:1. The proper position phasize the need for correction. The magnifi-
of the heels can be determined by either draw- cation in most radiographs makes even subtle
ing a bisecting line through the metacarpus to disparities more obvious. It is accepted that
the ground.4,5 or measuring the appropriate po- conformation can alter this balance.4-6,15 The
sition on the radiograph.7 Where these lines radiograph will help determine if the imbal-
contact the ground is the point where the heels ance is hoof related or conformational. Hoof
should be. From a practical point, the heel- related imbalances will show medial/lateral
ground contact should be even with the base of hoof length disparities, and the first and sec-
the frog.2 Underrun heels are the most com- ond phalanges can be bisected equally. If the
monly encountered hoof abnormality. In one medial/lateral disparity is conformationally
study of foot related lameness it was found in related the first and second phalanges will ap-
77% of the horses2 and in another study of nor- pear oblique on the DP radiograph.
mal performance horses this condition was The final assessment of balance is the weight
found in 52% of the horses.3 The necessity of of the horse in proportion to its feet. Small
correcting underrun heels has been well docu- feet have been a commonly described prob-
mented.1-7 If left uncorrected underrun can lem, particularly in Quarter Horses, that pre-
cause alterations in hoof wall growth that can dispose the horse to lameness.2,3,7,16 One study
be very difficult to correct and it can predispose identified small feet as an indicator of poor
to lameness problems that range from bruised prognosis in the treatment of navicular syn-
heels to navicular syndrome.1,2,7 drome.2 Most descriptions of what actually
One of the most difficult parameters to assess is constitutes a small foot are quite subjective.
the hoof’s ability to expand.13,14 Applied clinical However, studies have been performed utiliz-
studies have shown that the frog length to width ing simplistic formulas to make this assess-
ratio is useful for this purpose; when the frog’s ment objective.2,3,7 These studies measured the
width is at least two-thirds its length, the hoof circumference of the hoof immediately below
has normal expansive abilities.2,3,7 When the the coronary band. This was done to get a
frog is narrow, hoof expansion is thought to be rough idea of the hoof cross sectional area.
reduced. Whether this is a function of frog This was then compared to the horse’s weight
pressure is not known, although both reduced and statistical analysis was performed. Seven-
and excessive frog pressure have been shown ty-eight pounds per square inch was deter-
to cause hoof contracture.13,14 Identification of mined to be the maximum weight to hoof area
155
Proceedings of the Annual Meeting of the Italian Association of Equine Veterinarians, Carrara, Italy 2010
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ratio for a normal performance horse. The 3. Turner TA, Stork C. Hoof abnormalities and their
steps to determine this number have been sim- relation to lameness, in Proceedings. 34th Annu
Conv Am Assoc Equine Practnr 1988; 293-297.
plified to the following formula:12.56 X 4. Balch O, White KK, Butler D. Factors involved in
wt(lbs)/C2(in2). Once identified, a high weight the balancing of equine hooves. J Am Vet Med As-
to hoof area ratio can be used to show a client soc 1991; 198:1980-1989.
that their horse should lose weight. In addi- 5. Butler KD. The prevention of lameness by physi-
tion, it can be used to show the necessity of ologically-sound horseshoeing, in Proceedings.
31st Annu Conv Am Assoc Equine Practnr 1985;
fitting a shoe as fully as practical in order to 465-475.
produce the largest surface area as possible for 6. Moyer W. Therapeutic principles of diseases of the
that particular horse’s hoof. foot, in Proceedings. 27th Annu Conv Am Assoc
Assessment of a horse’s hoof balance utilizing Equine Practnr 1981; 453-466.
hoof measurements is a method that can be 7. Turner TA. Shoeing principle for the management
of navicular disease. J Am Vet Med Assoc 1986;
easily incorporated into the routine examina- 189: 298-301.
tion of the hoof. It actually takes very little 8. Clayton H. Comparison of the stride of trotting hors-
time (about 2 minutes) to make the necessary es trimmed with a normal and a broken-back hoof
measurements. Radiographic examination of axis, in Proceedings. 32nd Annu Conv Am Assoc
the feet is a routine diagnostic assessment al- Equine Practnr; 1986; 289-298.
9. Gonzales T. Proper balance movement: a diary of
ready performed. By assuring proper position- lameness. Manassas: REF publishing, 1986; 9-25.
ing and alignment of the hoof during radi- 10. Schryver HF, Bartel DL, Langrana N, et al. Loco-
ographic examination, additional information motion in the horse: kinematics and external and in-
that can be invaluable in the case assessment ternal forces in the normal equine digit in the walk
can be attained. The information will help and trot. Am J Vet Res 1978; 39:1728-1733.
11. Bushe T, Turner TA, Poulos P, et al. The effect of
show problems of imbalance, can be used to hoof angle on coffin, pastern, and fetlock joint an-
graphically illustrate the problem to an owner gles, in Proceedings. 33rd Annu Conv Am Assoc
or trainer, and can be used to clearly show the Equine Practnr; 1987; 729-737.
shoeing needs of the horse, thus improving 12. Kobluk CN, Robinson RA, Clanton CJ, et al. Com-
overall communications between veterinarian, parison of the exercise level and problem rate of 95
Thoroughbred horses: a cohort study, in Proceedings
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471-476.
13. Colles CM. The relationship of frog pressure to
REFERENCES heel expansion. Eq Vet J 1989; 21:13-16.
14. Colles CM. A technique for assessing hoof function
1. Moyer W, Anderson JP. Lameness caused by improp- in the horse. Eq Vet J 1989; 21:17-22.
er shoeing. J Am Vet Med Assoc 1975; 166:47-52. 15. Moyer W, Anderson JP. Sheared heels: diagnosis
2. Turner TA. Navicular disease management: shoeing and treatment. J Am Vet Med Assoc 1975; 166:53-55.
principles, in Proceedings. 32nd Annu Conv Am 16. Stashak T. Adam’s Lameness in Horses. Philadel-
Assoc Equine Practnr 1986; 625-633. phia: Lea & Febiger, 1987; 499.

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Proceedings of the Annual Meeting of the Italian Association of Equine Veterinarians, Carrara, Italy 2010