Hoof Balance and Alignment

By Dr. Caili Fulgoni D.V.M.

So many horses are being injected repeatedly and/or going around in some form of discomfort that could be resolved or at least substantially reduced by looking more closely at their hoof balance, alignment and shoeing. Coffin joint pain along with navicular pain and pastern pain are the most common issues we treat in the front feet. Traditional injections using corticosteroid and hyaluronic acid, biologicals such as IRAP and modalities such as shockwave and acupuncture can be very effective and are even necessary at times, but you should consider why it is your horse is having an issue with pain and inflammation in that particular joint, tendon, ligament or bursa in the first place. There are cases in which a horse may already have arthritis and injections may be required at intervals to help manage the joint, but often horses are being treated every 6-12 months or more frequently before the formation of visible arthritis for joint inflammation or pain. Being diligent about the alignment of your horse's foot you may be able to avoid any joint injections, nsaids or shockwave or at least reduce the frequency at which its required.

Hoof Pastern Alignment:
The majority of front foot lameness issues have to do with alignment irregularities. Sometimes these irregularities can be very subtle radiographically and are not evident by simply looking at the foot. In other cases, horses may have a very visible conformational alignment issue but the key to dealing with it may be a lot different than you thought which is why radiographs and proper interpretation are essential. Broken back hoof pastern axis with long toe and low heel is the most common alignment issue we see in the front foot and leads to joint inflammation, navicular issues and soft tissue injuries, all of which result in lameness. The issue is regularly overlooked, especially in cases that are not obvious without radiographs. Unfortunately, when managing these cases people often let the horses grow more heel to compensate but that generally just causes the heels to become underrun leading to even more issues. Another common issue is the club footed conformation. It is a type of angular limb deformity that begins when the horse is a foal and is caused by having contracted deep digital flexor tendons. These horses tend to be broken forward and grow a steep hoof with a lot of heel. The natural response for most people is to take as much heel off as they can to try and get the foot to appear more normal, improve weight distribution and improve the broken forward nature of the foot. However, I have seen too many occasions when the heels were trimmed aggressively to achieve alignment and though it did improve the alignment of the foot it also led to injury of the deep digital flexor tendon due to the tension created by the angle change. In some cases the increased tension/stretching on the DDFT causes it to contract further and pull on the coffin bone causing it to rotate creating laminitis. In these cases it is important to keep the horses on a short trimming/shoeing cycle no longer than 6 weeks. Small and continuous change is the only way to get the tendon to gradually give and adjust to the angle changes and over time. If the horse is on a long cycle and a great deal of hoof needs to be trimmed away then a wedge should be placed to help ease the tension on the tendon and frequent gradual changes should be made moving forward with gradual reduction of the wedge.
Horses feet can be quite deceiving by external appearance compared to their radiographic appearance. For example, it is assumed by most horse owners that a horse with very steep pasterns that grow quite a bit of heel ( club foot appearance) would never need heel elevation, but looks can be very deceiving. In fact, there are a great deal of these club footed looking horses that are actually broken back at the coffin joint and who suffer from a great deal of pressure/impingement of the dorsal aspect of the coffin joint. These horses respond very well to a good balanced trim to remove all excess hoof and some form of a heel wedge.


Medial to Lateral Imbalance:
Medial to lateral balance or imbalance refers to the symmetry of the hoof comparing the inside (medial) half to the outside (lateral) half. Radiographs allow you to compare hoof length from side to side with differences in joints space form the medial to lateral aspects of the coffin and pastern joints. Radiographs also give you the ability to assess the symmetry of each pastern bone and how it relates to the length of the hoof from side to side so you can have the farrier make adjustments if needed. Any imbalance can lead to joint inflammation/arthritis and serious soft tissue injuries as well. You can look at the hoof in person and find that one side of the hoof is longer than the other and have your farrier trim the horse so that its even, and you may be right...however that might be the way the horse needs to grow in order to compensate for some bone asymmetry in the pastern and maintain proper joint space balance. The bottom line again is that radiographs are necessary to know what's really going on inside the foot and if any changes in the trim need to be made.

Here is what you need to do:
Maintaining proper foot balance and alignment is crucial to the soundness of your horse over time. Though it has the potential to save you a great deal of money and time by helping to  prevent the need for medical treatment, it does require commitment. Every horse should have a hoof balance and alignment consultation, not only to help those who have had soundness issues but also preventatively in sound horses.

1. Make an appointment with Dr. Fulgoni. The first visit would entail a baseline movement exam and two radiographs of each foot. This should be done within 1-2 weeks before your next farrier visit or same day. If the farrier is present then the corrections can be made Findings will be reviewed at the time and a report will be written for the owner and farrier. If no changes need to be made then a second appointment to meet with the farrier is not necessary.
2. If the farrier is not present on the initial visit then schedule a second appointment with Dr. Fulgoni to come at the same time as the farrier. It is best to have her there during the trim to work with the farrier and potentially take more radiographs once alterations have been made to ensure the issues have been corrected and make any alterations to the trim if needed.
3. Balance radiographs should be taken every 3-6 months depending on the horse to ensure proper balance is being maintained and so that corrections can be made if needed.

Please call text or email with any questions and look for Dr. Fulgoni’s next post that talks about shoes and how she can help you figure out what shoe type might be right for your horse.

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