Club Foot Concerns

Club feet might be one of the most common growth problems in young horses. Affecting youngsters primarily between birth and 6 months of age, the club foot actually is a flexural deformity of the distal interphalangeal joint (coffin joint) caused by a shortening of the musculotendinous unit of the deep digital flexor tendon. As a result, the hoof capsule becomes distorted, the hoof angle approaches 60° or greater, and the horse begins walking on its toe. It is most commonly presented in the front legs, usually affecting one limb but occasionally occurring in both. It usually is an acquired condition, but can be congenital (present at birth).

In congenital forms of club feet, the newborn is unable to extend the joint of the distal limb, is unable to place its heel on the ground, and thus walks on its toe. Usually both forelimbs are affected. Stephen O'Grady, DVM, MRCVS, of Northern Virginia Equine, says, "This could be due to uterine malpositioning of the fetus, nutritional management of the mare during gestation, exposure to influenza virus, or possibly a genetic link."

With acquired forms, O'Grady says, initial clinical signs might be subtle -- abnormal hoof wear at the toe, a normal or slightly increased hoof angle, and possibly a prominent coronary band. Heels might not contact the ground after trimming.

"As the condition progresses, severe changes will occur," reports O'Grady. "You get a prominent bulge around the coronary band, a higher heel, a broken-forward pastern angle, and a boxy, tubular-shaped foot that's dished out along the dorsal surface of the hoof wall."

Acquired forms usually involve one leg, and are considered to be from developmental orthopedic disease. Tracy Turner, DVM, MS, Dipl. ACVS, Professor of Large Animal Surgery at the University of Minnesota, explains, "This disease is associated with the growing horse. As the young horse's bones are lengthening out from the growth plates, anything that causes the animal pain can cause the problem. Epiphysitis (inflammation of the growth plates) is a primary cause. If that occurs, the pain causes the animal to have a withdrawal reflex, such as if you would put your hand on a hot stove, then immediately pull your hand away. It's the same sort of reflex. It results in the horse trying to lift its heels up off the ground because the withdrawal reflex is carried in the flexor tendon."

Other factors associated with acquired club feet include:

  • Genetics -- "Often you find mares which had a club foot will produce offspring with a club foot in the same limb," O'Grady notes.
  • Rapid growth -- "This is more common in Quarter Horses and warmbloods, although we see it in Thoroughbreds, too," says Turner.
  • Overweight -- "Overfeeding of carbohydrates (grain) or mare's milk can make the baby too bulky," Turner says. "Warmblood mares, especially, can produce milk like a dairy cow, so the baby simply gets too much."
  • Nutrition -- "Nutrition has always been incriminated, especially calcium/phosphorus deficiencies and/or imbalances," states O'Grady. "Copper was recently thought to be a problem, but that's unproven."
  • Over-exercising -- "Sometimes young show horses are longed and conditioned, especially for halter shows," Turner notes. "This can cause trauma leading to leg problems."
  • Environment -- "Exercising on very, very hard ground, combined with excessive, improper, or insufficient trimming can contribute," says O'Grady.

Getting Grounded

Diagnosis is via clinical observation and radiography. O'Grady strongly recommends grading the severity of the disorder. "Grading the club foot is a good idea," he states. "This ensures that veterinarians and farriers are on the same wavelength." He uses a grading system developed by Ric Redden, DVM, as follows:

  • Grade I indicates a hoof angle three to five degrees greater than the opposing foot and fullness at the coronary band.
  • Grade II signifies a hoof angle five to eight degrees greater than the opposing foot, growth rings wider at the heel than at the toe, and a heel that doesn't touch the ground when trimmed to normal length.
  • Grade III denotes a dished anterior hoof wall and growth rings at the heel twice as wide as at the toe.
  • Grade IV has an anterior hoof wall heavily dished with an angle of 80° or more, a coronary band as high at the heel as at the toe, and a sole that is below the ground surface of the hoof wall.

Conservative Treatment

Treatment depends on severity. "In newborns, repeated intervals of brief exercise in a small paddock the first few days of life may be all that is necessary," says O'Grady.

Sometimes veterinarians will administer oxytetracycline, an antibiotic with muscle relaxant properties, to allow the affected musculotendinous unit to stretch out and the newborn to load the leg normally, Turner adds.

Other cases might require more intensive therapy. "Physical therapy in the early stages, which involves manually straightening the limb two or three times daily, may also be helpful," O'Grady says. "If the condition has not improved by the third day post-foaling, every-other-day administration of oxytetracycline under veterinary supervision is frequently beneficial along with the application of a toe extension. The toe extension is cut from a thin piece of aluminum upon which the foal's foot has been traced along with the amount of extension needed. The toe extension is then taped on the foot with Elastikon (an elastic bandage). In severe cases, splints can be combined with the toe extension."

In acquired cases affecting the older youngster, O'Grady says grade I or grade II deformities usually only need therapeutic shoeing, anti-inflammatory agents to relieve pain, oxytetracycline to cause muscle relaxation, and exercise restriction.

Turner prefers to relieve the tension on the tendon by raising the heel with either glue-on shoes or shoes and pads, which he says, "makes the condition look worse, but it gets the horse to bear weight very comfortably throughout its foot." Rest allows the muscle spasms from the reflex to relax. Once the tendon appears relaxed, usually after one to two weeks, then the foot is restored to its normal position, and exercise is gradually increased.

Another method involves the use of exercise restriction, anti-inflammatories, oxytetracycline, and lowering the heel. Says O'Grady, "The heels are lowered and Equilox (which can be used to form an artificial hoof wall) can be applied to the dorsal hoof wall to form a toe extension. The Equilox-impregnated fiberglass is continued over the solar surface to protect that area from further bruising. The toe extension will serve as a lever arm for the toe."

Often when the heels are rasped off excessively, the heels will not contact the ground. In that case, O'Grady cautions that a toe extension will create severe tension in the deep digital flexor tendon, which can damage the laminae of the immature foot and make the condition worse.

"Another approach is to take the heels down as much as possible, then put a wedge underneath these animals and raise them back up," O'Grady says. "This will make the animal load the heel area and not the toe of the foot. Over time, as we continue to trim these animals, we'll slowly let them back down where they should be. This procedure is not always effective in the cases I see."

With medical therapy and therapeutic shoeing, the horse with a grade I or grade II condition should improve within two weeks, says Turner. "Once they are normal looking, they can go back to work anytime. Introduce the work gradually." Prognosis for full recovery is good.

Surgical Correction

In more severe grade III and grade IV cases, surgery and therapeutic shoeing is necessary to achieve correction. The distal check ligament provides the upper attachment for the deep digital flexor tendon that attaches to the horse's foot. "We cut that ligament and that releases stress on the tendon, allowing us to go ahead and make hoof capsule corrections," Turner explains.

Immediately after surgery, a toe extension should be applied, suggests O'Grady. This increases the surface area of the foot, promotes weight-bearing on the heels, and protects the toe portion of the hoof. The heels are lowered in a tapered fashion from the point or apex of the frog to the end of the heel until the sole adjoining the hoof wall becomes soft. To create a toe extension, the dorsal hoof wall and ground surface of the foot in front of the frog is prepared for Equilox using a rasp or Dremel tool. Deep separations are exposed and filled with Keratex putty, if necessary. The foot is washed with solvent and dried with a heat gun. The composite is applied to the prepared surface and piece of one-eighth-inch aluminum is incorporated into the Equilox to provide strength and reinforcement to the toe extension.

"Foals undergoing this procedure are usually between two and five months of age. The size and weight of the foal makes reinforcing the toe extension necessary. This reinforcement allows the older foals to be walked daily without the toe extension breaking or wearing out," adds O'Grady.

Turner reports that there are no side effects. "Surgical correction is immediate, and the ligament will eventually heal back together. Full recovery takes about six to eight weeks.

Post-surgically, horses should receive two weeks of stall rest with two weeks of hand-walking, followed by turn-out, recommends Turner. "I try to keep the bandages on their legs for an extended period of time so the cosmetics of the surgery turn out better."

With regards to farrier care, O'Grady recommends trimming the heels at two- to four-week intervals, depending on the amount of hoof growth. "The object is to normalize the hoof capsule," he says. "The toe extension is maintained for two months following the surgery. The heels are lowered as necessary from the point of the frog back, and the toe is rasped back from the front of the hoof wall until the desired hoof conformation is attained. We remove no sole anterior to the frog. When the desired effect is reached, we trim the foot normally."

Once the problem is successfully resolved either surgically or therapeutically, horses should be able to continue in their careers. "We've found that these horses meet or better their expected potential," Turner states.

Reduce The Risk

While it might not be possible to prevent club feet in every affected horse, Turner states that risks can be minimized. "Watch the foals' nutrition, try to make sure they don't grow too rapidly, and try to keep their weight down," he says. "Don't overdo forced exercise."

Should signs of a club foot begin to appear, seek early treatment. Doing so can mean the difference between conservative treatment and surgery, and can help ensure a successful outcome.

Want To Know More?
For more information on club feet and flexure deformities, check out the website of Stephen O'Grady, DVM, MRCVS at (click on podiatry, then click on flexure deformities in foals).

About the Author

Marcia King

Marcia King is an award-winning freelance writer based in Ohio who specializes in equine, canine, and feline veterinary topics. She's schooled in hunt seat, dressage, and Western pleasure.

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