When is a foot problem not a foot problem?

This is something that has been circling around my mind for a  long while.  Having spent the past few years studying hooves and hoof trimming, the biggest revelation has been in just how often hoof problems aren't actually hoof problems.

Most of us horse people, including vets, tend to see the hoof as being almost separate from the rest of the horse.  Even if we know better intellectually, the practice of relying on a farrier to do hoof care perpetuates the perception that the hoof is separate.  The notion is further reinforced by our veterinarians.  Vets don't trim feet and will refer you to a farrier when the foot is involved.  Even when Ramsey had surgery on his foot at Cornell, there was a very distinct difference between the farrier work done on his foot and the medical work.  They were even billed separately.  The advice I was given about his hoof care contradicted the medical instruction.  I've encountered the same conflict with every vet and every farrier I've ever worked with.  

The vets seldom look below the coronet band and the farriers don't see above it.  However, the hoof is a reflection of the overall health of the horse.  If the eye is the window to the soul, the hoof is a window to the body.  Everything that affects the body, eventually shows up in the feet and vice-verse. Every one of the animals whose feet I have worked on in the past few years has really pounded this lesson home for me.

Lakota was a prime example.  While my posts about him focused primarily on his feet (I'm as guilty of separating horse from hoof as anyone else), the longer I worked on him, the stronger my conviction became that his hoof problems were a symptom, not his primary problem.  We did know this and made many changes to his diet and environment.  Trying to find professional help in sorting out his issues was an insurmountable hurdle.

Anyone who followed his progress will have seen the triumphs, setbacks and ultimate failure.  What I may not have made clear enough though was the correlation between improvements in his hooves with improvements in diet and management along with the correlation between his setbacks and the times when he broke out of his strict management protocol.  We were also never able to fully diagnose his exact medical problems.  We know he had severe metabolic issues, but he also showed signs of long term renal problems that his vets were never able to pinpoint.  We won't ever know what the exact problem was, but we know there was a problem.  His feet were a byproduct of his medical issues - a symptom that was his ultimate downfall.  Unfortunately, his feet were only the problems that we could actually see.

I struggled for a long time to figure out how to manage Ramsey’s foot.  It wasn't until I abandoned all of his foot care protocols, stopped focusing on just the foot and looked instead at the entire limb that I finally found some direction and balance.  Both of his front feet turn out, but the deformity on the right is worse than the left.  It may be genetic.  It may be from abnormal hoof growth following his surgery coinciding with rapid bone growth.  It is probably a bit of both.  It doesn't matter now, he is what he is and there is no changing it.  The point is, that the hoof he has and the hoof that works for him is a reflection, a byproduct, of his conformation, body condition and bio-mechanics.  If I don’t take into account his unique limb deviation and way of going, his hoof falls apart.  As long as I trim according to what his body tells me, he stays sound.  If I look only at the hoof, everything falls apart.

I looked at a four year old filly last week who had conformation problems in her hind end that gave her a very long back with a terribly upright stifle that also turned outwards.  The stifle issue had been compounded by an injury to her left hind pastern that occurred when she was a yearling.  She got caught in some wire and damaged her pastern, bowing the tendon in that leg at the same time.

Now, at four years old, she appears to be almost completely sound with only a very, very faint gait abnormality visible when she moves up and down hill and a sort of tiny wobble in that foot just before it lands.  Oddly enough, the first thing you might notice as seeming to be not-quite-right is that her left shoulder seems noticeably larger than her right.  If you look at her hooves, the fronts look good, but the left is worn shorter than the right.  The right hind hoof is short with a marked medial-lateral imbalance.  The left foot is long and hardly worn at all because she unloads that foot every chance she gets.  When she is moving around, it takes a really sharp eye to notice that she is not-quite-right.  She may stay sound enough for a life-long riding career.  Then again....only time will tell.

It was that shoulder that really made me sit up and take notice though because it's part of a puzzle I've been struggling with for several years now.  Hawkeye's left shoulder is markedly larger than his right while his hind hoof shows slight signs of the same sort of distortion the four year old filly shows.

Those of you who have been following this blog for a while will remember that Tessa was kicked in her right stifle as a three year old.  Her right shoulder is somewhat larger than her left while her hind foot shows slight medial-lateral distortion.  I first noticed that shoulder unevenness about 18 months ago.  I had a veterinary sports-medicine specialist look at her and he was as puzzled by the shoulder as I was.  He was equally puzzled by Hawkeye, as have been all of the vets, farriers and chiropractors who have seen both horses.

I am NOT criticizing or finding fault with any of these people.  My point is that the relationship between hoof shape and wear, compensatory muscle changes and lameness/conformation faults is not well understood and generally seems to go unrecognized even by experienced professionals.  It wasn't until I saw this rather exaggerated case (after spending two years thinking about it) that the puzzle pieces finally came together for me. The pattern is exactly the same in each case: the enlarged shoulder and hoof distortion are compensating for a nearly invisible stifle problem.  The wear patterns in the feet tell the same story in each horse.  The only differences are in the severity of the changes, from minute in Tessa to fairly clear in the filly.

I could give other examples of hoof changes that occur in conjunction with knee problems.  If I had enough horses with joint problems to study, I truly believe that a specific pattern of hoof wear would show up for every distinct joint problem.

If any of you are still with me through this rather long, rambling post, the main point I am trying to make is this:  If you are struggling with a hoof problem that won't go away, it may not be a hoof problem.  It is certainly true that hoof issues can and will cause joint/muscle problems, but the opposite is true as well.

Long term problems become a sort of chicken-and-egg question...was it the foot problem that caused the joint problem or the other way around?  For horses like Lakota, the answer to that is pretty clear.  For Hawkeye, who is showing age related lameness, not so much.  At some point, when the problems become irreversible, it no longer matters.  For a horse like Tessa, who is sound at the moment, but may have problems later, it could matter, but only if I manage to recognize the subtlest of signs when they first appear and only then if there is something that I can do about them.

The bottom line is, if you are riding a horse and are struggling to identify some subtle not-quite-right lameness, take a step back and look to the feet to see what they are telling you.  Look at the muscles in shoulders, hips, back, neck, everywhere.  If they aren't the same, is it because one is atrophied or is it that one is working harder than the other? Don't assume that an enlarged shoulder means a problem in the front end or a smaller hip means a hock issue.  Look at the whole horse, especially the feet.  The feet never lie.  Interpreting what they have to say may be a challenge, but they don't lie.

If you are struggling with a horse who has constant, unending hoof problems - look at the rest of the horse.  First, get the diet right with high forage, low sugar and well balanced minerals.  If you still have trouble, look for metabolic issues.  If that doesn't work, look for other diseases, tumors, etc.  A healthy horse will grow healthy feet.  An unhealthy horse can't grow healthy feet.  Either way, the feet never lie.

Kris Maxwell