Club Foot Experience: Bluegrass Laminitis Symposium

The first presentation on the agenda of the 16th annual Bluegrass Laminitis Symposium, held January 16-18 in Louisville, Ky., was a discussion of the club foot--a problem seen in all places and breeds. While probably all of those present had seen and worked on affected horses before, they were all interested in improving their understanding and treatment success with this problem. Ric Redden, DVM, the symposium's host and founder of the International Equine Podiatry Center in Versailles, Ky., discussed the etiology of and his treatment experiences with club feet, beginning with an account of his club foot grading system. "It makes no sense whatsoever to talk to anyone about a club foot without a reference point," he stated. "You have to know what level of foot you're talking about. It's the same with laminitis or anything else."

The club foot is characterized by higher hoof angle than is normal for that horse due to an increased pull of the deep digital flexor tendon (DDFT) on the bottom of the coffin bone. The grading system that Redden uses appears at right.

"A lot of people say they don't see low-grade club feet--but that's because they don't have their trifocals on," said Redden. "You've got to look at these feet for the early changes. The foot might be three to five degrees steeper than it was, the frog might be atrophying just a bit, the pastern might be getting just a little bit out of alignment, and the shape of the bars might be changing a bit. When the point of the bars starts to hook in towards the center, watch out. That hook looks like a hawk's beak. Only club feet have that beak, and when it gets worse there's more of a curve--it can start looking like a parrot's beak rather than a hawk's." He also described another signal of a club foot as a reduction in the depth of the depression just above the bulbs of the heel.

"The sole begins to drop at the toe, with the apex of P3 getting pushed into the sole (from the tightened DDFT rotating the bone) and no sole growth beneath it," he added. "The increased pressure on the toe area begins breaking up the toes. Then gravel can occur because the white line gets stretched and dirt can get in there. I've never seen a unilateral (occurring in only one front or hind foot) white line disease case that didn't involve a club foot. White line disease is nothing more than a scar with opportunistic fungi invading it. You see it in high-stress areas--for example, on the medial side in a toed-out horse and on the lateral side in a toed-in horse."

Correction of the Club Foot

"The club-footed horse is bearing weight on tissues that aren't designed to be abused at the toe," Redden explained. "The heel is designed to be abused, but it isn't even used in the club foot."

Many people in the past have treated club feet by trimming them to match the other, normal foot (in a unilateral case, or one affecting only one front or hind foot) or a "normal" ideal. Often this involves trimming off the unusually high heel and rasping off any dish present in the toe of the hoof wall. Redden strongly recommends against that approach. "You can't change these things with a rasp," he said. "You think you've got problems now, wait until tomorrow."

He went on to describe how taking off the heel of a club-footed horse unloads that heel since the DDFT is too tight to allow the shortened heel to contact the ground. "Then you overload that small area of the foot (that's bearing the horse's weight)," he said. "You want to load the back of the heel and unload the apex (of P3). Think of going inside the foot and lifting the apex off the sole, not of making the foot look better. It's the same treatment as for laminitis, but for a different reason."

Redden described a rocker rail shoe that he's had success with, especially for grade 1-2 and low grade 3 cases. He also adds a hinge at the toe and an adjustable bar across the heels to help spread out very narrow-heeled club feet. A bolt attaches the bar to each heel, and it can be removed and replaced with a longer bar as the horse's heels spread apart. "You can really hurt them with this shoe, so you must be very careful," he cautioned. "If you take out the bolt and the heel contracts back in, it's not ready for a new one. If it stays in place, then you can put in a longer bar."

Shoeing Guidance

"You have to take an X ray of the club foot to see what makes that foot look like it does," Redden recommended. "Farriers and veterinarians not using X rays to find soft tissue parameters are missing out on a lot. You can't define these things without looking inside the hoof capsule."

Cutting the DDFT and/or its check ligament was also discussed for various situations. The biggest factor, Redden said, is shoeing treatment prior to surgery as well as subsequent resets. "You need shoeing mechanics to augment the tenotomy," he stated. "If you leave the mechanics the same, then the tendon or check ligament will grow back at its original length. Consequently, the foot doesn't change much either.

Surgery isn't always indicated, however. Redden said that one can do quite a bit for these horses with proper shoeing mechanics. "The force of the DDFT affects every pathological problem in the foot," he explained. "If you can learn to manipulate the forces of that tendon, you can create a better healing environment for most any pathological problem."

"We do not have a clue today as to what triggers this mechanical problem," he noted. "In humans, a club foot has been found to be a problem in the synapses (nerve-muscle cell units) that causes them to contract and stay contracted. I think that one day we'll find that that's exactly what's going on with these horses."

About the Author

Christy M. West

Christy West has a BS in Equine Science from the University of Kentucky, and an MS in Agricultural Journalism from the University of Wisconsin-Madison.

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