Understanding club foot

Abnormally upright conformation of a single foot is rarely just a “hoof problem.” The imbalance can affect a horse’s whole body. But most cases can be treated or managed readily.
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Abnormally upright conformation of a single foot is rarely just a “hoof problem.” The imbalance can affect a horse’s whole body. But most cases can be treated or managed readily.

You are always up for new challenges, so when your friends decide to take dressage lessons, you sign up, too. But after watching you ride, the instructor pulls you aside and says, “Just so you know, you’re only going to be able to go so far with this horse in dressage. He has a club foot, and his strides will never be even.”

club foot

You stare at your horse’s front feet, but the differences are tough to spot. Sure, one hoof is slightly narrower and steeper than the other, but no horses’ hooves are ever perfectly symmetrical. And your horse has never taken a lame step in his life. Is this really a problem?

Probably not. At least not for your horse, your farrier assures you later.

Attentive trimming is keeping him sound, his gaits are comfortable to ride, he carries you happily over the trails, and he has always been able to do whatever you have asked of him. In fact, he may even be able to do more. Horses with mildly clubbed feet have competed and won at the highest levels of many athletic endeavors, from endurance and jumping to barrel racing and cutting. Assault, the “Club-Footed Comet,” won 18 races including the 1946 Triple Crown despite having a club foot on the right fore.

Still it’s a good idea to keep tabs on the condition of the upright foot as well as how your horse moves overall to catch any developing problems early. Here’s what you need to know.

A matter of degree

In a club foot, the angle of the hoof and pastern in relation to the ground is abnormally steep.

In the past, the condition was defined as any hoof angle that exceeded 60 degrees, but the reality is not quite that exact. A “normal” angle for a horse’s hooves varies by the individual. On sound horses, hooves tend to average from 53 to 58 degrees, but some with more extreme angles may still be just fine.

The ideal hoof angle for any horse depends on many factors in his overall conformation, but especially the angles of the pastern bones and coffin bone. A horse with an upright alignment of the pastern bones will also have upright hooves---a situation that is sometimes mistaken for club foot.

A true club foot is significantly more upright than the other hooves, or the angles of both hoof walls are steeper than the angles of the pasterns. The severity of the problem is commonly graded on a four-point scale:

Grade 1, the mildest form of club foot, might be so subtle it’s hard to spot. “A grade 1 might have a three- to five-degree difference between the two feet, with a taller heel on the one foot compared with the opposite foot,” says Paul Goodness, CJF, senior member of Forging Ahead, a farriery group practice in Round Hill, Virginia. “You also start to see some changes in the coronary band with a little flattening in the front and some puffiness between the bulbs of the heels.”

Grade 2 is a club foot with about five to eight degrees difference between the two feet. “Grade 2 is more noticeable,” says Goodness. “The pastern angle may be broken forward, instead of being in a straight line. You start to see divergent growth rings, where the heel is growing faster than the toe. The growth rings are uneven---thinner at the toe and wider at the heel. The wall at the toe is actually being compressed as it grows out.”

Grade 3 is a hoof wall that shows a noticeable “dish” in the profile of the toe, and the coronary band may bulge forward. “The growth rings are twice as wide at the heel as they are at the toe,” says Goodness. “Sometimes after the farrier trims the foot, the heels may not touch the ground as the horse walks---maybe not at every step, but they tend to stay up in the air.”

Grade 4 is a hoof “in serious trouble,” says Goodness. “The dorsal [front] wall of the hoof is about 80 to 90 degrees [perpendicular to the ground], and the coronary band is almost parallel to the ground. The hoof is almost as tall at the heels as it is at the toe. The foot may buckle forward. When the heels are trimmed, they do not touch the ground. The tendon is very tight and has a tremendous amount of stress on it.” Some foals with severe contractures of the deep digital tendon may be even worse. “The dorsal wall may be beyond 90 degrees,” says Goodness. “The feet may knuckle over, and the foal is walking on the front of the hoof wall. Not all of these foals can be corrected.”

Causes of club foot

Most cases of club foot develop in foals. Although the specific causes are not fully understood, several factors, alone or in combination, may be involved. Club foot often accompanies congenital limb deformities, which develop within the mare’s uterus and are present at a foal’s birth. Acquired limb deformities develop later, if a foal’s bones and tendons grow at different rates. “Often there is a nutritional component,” says Travis Burns, CJF, lecturer and chief of farrier services at the Virginia–Maryland College of Veterinary Medicine. “Foals need a well-rounded, balanced diet that does not go beyond the nutritional requirements.”

A diet overly rich in calories and nutrients puts young horses at risk for developmental orthopedic disorders (DOD), a collection of bone and joint abnormalities including osteochondritis dessicans (OCD), subchondral bone cysts, physitis and other serious problems.

The pain from any of these conditions can cause a young horse to load the feet in an abnormal way that enables a club foot to develop. “Often the club foot or feet are secondary to OCD lesions in the shoulder, for instance,” says Burns. If it’s painful for the horse to put weight on that limb, the flexor muscles eventually contract and pull the heel up, and the horse puts more load on the toe. With less wear on the heels, they grow longer and create the upright foot.

Genetics, too, may play a role---club foot seems to develop more often in certain families of horses. “There probably is a genetic component but I also wonder if it’s partly management,” says Mike Pownall, DVM, a veterinarian/farrier with McKee-Pownall Equine Services in Campbellville, Ontario. “If the mares are all foaling at the same farm and getting the same feed, there may be some environmental causes such as nutrition.”

In fact, all of these factors may work together: A horse genetically programmed for fast growth, who also gets excess nutrients, may experience developmental problems that lead to discomfort or pain, all of which creates a club foot.

“Some years back I had the opportunity to work on a number of horses that were sired by a very popular local Thoroughbred stallion during the 1980s and early ’90s,” says Tia Nelson, DVM, a veterinarian/farrier from Valley Veterinary Hospital in Helena, Montana. “About 75 percent of his offspring ended up with a club foot on the right front. These were colts and fillies that I’d seen from the time they were born. With all of them, the club foot appeared quickly, between one trimming and the next, when they were about a year and a half of age. I know there was a genetic component because that particular stallion produced a lot of foals that ended up this way.”

Nevertheless, Nelson adds that multiple factors may have been involved in these horses’ problems: “I think it was a pain response. I think what happened is that they had OCD in their elbow or shoulder, and because of the pain from those bony lesions they avoided putting full weight on that limb.”

Club foot can develop in mature horses, too, for similar reasons---any injury or chronic pain that causes a horse to consistently favor one foot can lead to contracting and shortening of the muscles and tendons (specifically the deep digital flexor tendon and muscle apparatus) in that leg, eventually pulling the foot into a more upright position.

“I watched one young Paint horse become club-footed through the course of a summer,” says Nelson. “He also started bucking. I finally looked at his saddle and saw that it was very badly twisted. When this horse was ridden with a different saddle, he didn’t resist and he didn’t buck. When his owner got rid of the saddle with the twist, this horse went back to normal in his attitude, and his normal hoof growth resumed.”

Infrequent or improper trimming may also lead to, or worsen, a club foot in horses of any age. Trims that leave a horse’s feet mismatched or unbalanced may leave him with an uneven stride and/or a rough gait that causes him to consistently lift his heels and place weight on his toes in a way that, over time, forces the hoof horn to grow faster at the heel than at the toe.

Treatment and management

The best course of action for a horse with one or more club feet depends on his age, the cause of the condition and the severity of the case. “The goals are generally the same in managing these feet, at any stage of development, and any stage of severity,” says Goodness. “The main goal is to try to achieve alignment of the phalanges [pastern bones and coffin bone] as close to normal as possible in the respective joints [pastern joint, coffin joint] without causing any further hoof capsule distortion.”

Veterinarians and farriers may take a number of aggressive actions with foals and young horses who are still growing (see “Club Foot in Foals,” page 76). With a mature horse, the first step is to consider whether intervention is even needed. Trimming to lower the heel might seem like an obvious solution. However, if a mild club foot has been there throughout a horse’s adult life, and he is sound, comfortable and able to perform the work asked of him, then it might be better to not try to change it. “We need to get away from the idea that the feet should match perfectly---or trying to force them to match or have the ideal angle,” says Burns. “You can’t simply remove the heel to make it look normal or you may make the horse lame or crippled.”

Nelson agrees: “Trying to lower the heels and put an extended toe on the foot will cause more problems. It causes the coffin bone to start rotating within the hoof capsule, because you are fighting the pull of the deep digital flexor tendon, and it is stronger than the laminar bond between the coffin bone and the hoof capsule. You cannot correct it mechanically by trimming the foot; it simply makes it worse.”

But that doesn’t mean the horse’s feet do not require attentive care. He may need to be trimmed more frequently than normal to keep his feet balanced. “If the hoof is growing a lot more heel than toe, there’s a problem,” Burns says. “The opposite foot will tend to grow a lot more toe than heel, and that in itself is a problem, so frequent trimming can keep them from becoming too mismatched with an uneven stride. It is important to keep the hoof capsule as healthy as possible.”

Also, says Burns, “Having the upright heel predisposes the hoof to more risk for shoe loss so we need to pay careful attention to where breakover is and where the shoe is placed on the upright foot. The shoe should not be pushed out beyond the perimeter of the upright hoof, even though that’s still a very common practice. Glue-on shoes can be a good alternative for upright feet; this eliminates some of the shoe loss.”

If, however, a club foot is a recent development in a mature horse, especially if he is also unsound or exhibiting changes in behavior, then have him examined by a veterinarian to look for signs of pain or stiffness throughout his body. Injuries, muscle soreness, arthritis and other problems in the neck, shoulders, back and other parts of the body can alter a horse’s way of going enough to affect his feet, and no intervention with the hoof will help if the underlying cause is not addressed.

Attempting to reduce the height of a clubbed foot---to help a horse who is unsound or has an uncomfortable, uneven gait---must be done carefully Your farrier will need to develop a strategy targeted toward your horse’s specific needs.

“You have to address each one case by case,” says Pownall. “If you have a broad rule or method that you apply to all horses, it may work on some but it won’t work on others. You need to be open to many methods, and creative, and try to understand what caused this club foot. Having x-rays can be helpful, to determine sole thickness and the shape of the coffin bone and whether there is any rotation. Sometimes you have to treat it like you would a foundered hoof. It’s important to find ways to make that horse more comfortable so he can move more freely.”

Your farrier will most likely recommend some sort of pads, wedges, pour-in packing or other methods to support the sole and coffin bone while slowly and carefully lowering the heels. He may suggest supporting the opposite foot as well. “It makes sense to protect the sole with a pad of some kind. You are pushing the hoof capsule around [changing the stresses on it], so you have to be careful as you do it,” says Goodness.

“Generally, we accomplish our goal by lowering the heels a bit but simultaneously easing tension on the deep flexor tendon by adjusting the point of breakover,” he adds. “We can do that by trimming and rolling the toe or with a shoe, using a rocker toe or rolled toe shoe---grinding the toe of the shoe away. There are several ways to adjust breakover. With those two strategies a person can often get the foot to the point where it functions better. It may not look exactly like the other hoof, but mechanically it can function more normally, and the horse will travel with a more even stride. Many horses improve and can go on to be successful in their careers.”

A club foot is a little more serious than just a conformation blemish, but doesn’t necessarily mean that a horse can’t participate in most equestrian activities. “There have been some tremendous athletes, with a good long career, managing very well with some degree of club footedness,” says Goodness. “When properly dealt with by the farrier, with continual management, these horses can continue on with the best of them.”

This article first appeared in EQUUS issue October 2014, #445.