Readers Vote: Top Hoof Issues

A poll of readers showed laminitis, navicular disease, and barefoot vs. shod were their top issues involving horse feet.

When horse owners were asked in a poll on, “What do you think are the top problems relating to the health of a horse’s foot,” we received answers that might surprise you. 

Of nearly 1,500 respondents, more than half feel that laminitis is the No. 1 health problem for horse hooves. Considerable press has been devoted recently to this condition, partly due to its role in the loss of champion Thoroughbred Barbaro, but also because it has the potential to be a major obstacle for any horse.


Laminitis, simply put, describes inflammation of the laminae, the sensitive and highly blood-supplied tissues that “interlace” the hoof wall to the interior of the foot, thereby suspending and holding the coffin bone in position. A horse with laminitis is quite painful in his feet, tending to walk gingerly. When asked to turn, he will rock back on his haunches to relieve weight from his throbbing front feet. He might stand with both front feet stretched in front of him, or he might point one forward, or shift his weight from side to side, foot to foot. Some horses are so painful they are reluctant to pick up a foot to support weight on the opposite foot.

Treatment relies on anti-inflammatory medications, pain-relieving medications, and support for the frog and sole to minimize rotation of the coffin bone. The predominant anti-inflammatory medications that have been used to manage laminitis are phenylbutazone (Bute), flunixin meglumine (Banamine), and ketoprofen. The newest non-steroidal anti-inflammatory medication (NSAID) available is a COX-2 (cyclooxygenase-2, a hardmful enzyme) inhibitor called firocoxib (Equioxx).

According to Jim Belknap, DVM, MS, PhD, Dipl. ACVS, of The Ohio State University, “Although there is an increase in COX-2 concentration in the developmental stages of laminitis, COX-2 is also present in the laminar vascular wall in the normal horse, meaning that COX-2 is not only involved in pathologic mechanisms, but is also involved in normal homeostasis and protection of blood vessels.”

He explains, “Firocoxib should not be expected to be a better analgesic than the nonselective NSAIDs such as phenylbutazone or flunixin. The main reason for using it relates to fewer complications (especially gastrointestinal ulcers) when used long term than occur with the other NSAIDs. This drug should be a valuable addition to our choice of NSAIDs for the chronic lameness cases, including chronic laminitis cases, navicular syndrome, and cases of chronic degenerative joint disease.”

He emphasizes, “Research still needs to be performed to see if the drug is effective or possibly harmful in the acute case of laminitis, in which the laminar vasculature is inflamed. It may still be best to use a nonselective NSAID such as flunixin or phenylbutazone in the acute stage.”

Because pain has the tendency to promote constriction of blood vessels to the feet, another important laminitis managment strategy is to control pain and pain-related responses. Besides the COX-2-inhibiting NSAID, an analgesic that might be helpful in this role for severe pain is the fentanyl patch. Although a horse requires placement of more of these in larger sizes than used for small animals or people, this narcotic drug is absorbed through the skin, providing a convenient method of continuous, transdermal delivery.

Foot support is critical in preventing loss of structural integrity to the coffin bone and supporting laminae, and although many methods of foot protection and shoeing aren’t new, effective products have been developed to assist in this objective.

One such product is the equine digital support system (EDSS), which is a shoe that is offset to sit just behind the toe and is also beveled at the toe to ease breakover of the foot. The amount of wedging at the heels can be modified to relieve tension on the deep digital flexor tendon and minimize its pull on the coffin bone. This shoe is then applied in conjunction with cushion support material, another useful product developed to protect the sole and frog, with care taken to ensure that no pressure is placed on the sole. Another version of a shoe support system is achieved with the four-point aluminum rail shoe that raises the heel and rockers the toe to ease breakover.

Glue-on shoes are also advantageous in handling very sore-footed horses that cannot tolerate the concussion from hammering nails into the hoof. Appropriate nutrition and good farrier care play important roles in treatment and prevention of laminitis. New commercial feed products are available that are high in fiber and have minimal carbohydrates.

Navicular Disease

In poll, another major hoof health concern of horse owners is navicular disease. This term describes a degenerative syndrome with heel pain related to inflammation of structures in the back third of the hoof, namely the navicular bone, deep digital flexor tendon and its bursa (a saclike structure that protects the tendon from abrasion as it slides over the area), and supporting ligaments of the bone. In advanced cases the coffin joint also experiences inflammation and degenerative joint disease.

A horse with heel pain often has varying lameness in both feet, and common owner complaints are that the horse stumbles and/or has difficulty negotiating downhill inclines or hard footing, it backs off from normal performance, or it exhibits behavioral changes. Although fastidious trimming and shoeing techniques are critical to managing the footfall biomechanics of a heel-sore horse, there are additional therapies that might also facilitate a horse’s return to function.

Injection of the coffin joint or navicular bursa with anti-inflammatory medications are reliable techniques to manage many heel pain problems, but some horses might become refractory to this treatment—the horse no longer improves following intrasynovial injection.

Another joint therapy “product” that might be helpful in such cases is the use of IRAP (interleukin-1 receptor antagonist protein). Chris Kawcak, DVM, PhD, of the Orthopaedic Research Center at Colorado State University, explains, “IRAP contains a host of various enzyme antagonists and growth factors to inhibit interleukin activity, one of the primary mediators of joint inflammation.”

To obtain IRAP, blood is harvested from a horse needing treatment. The blood is collected in a special syringe with glass beads and incubated overnight, then centrifuged and filtered to collect the IRAP-rich serum. The harvested serum is injected into the desired joint using sterile techniques, and extra serum is frozen to be used for a series of three weekly treatments.

Researchers are looking at a relatively new drug called tiludronate (Tildren) to address cases where bone loss is part of the navicular disease process due to chronic inflammation. This medication has been used in people to counteract osteoporosis, but not with huge success. There have been favorable anecdotal reports for its use in navicular horses, but results have not been backed up with MRI. Currently tiludronate is only available in Europe and in selected U.S. veterinary trials in the United States.

Extracorporeal shock wave therapy (ESWT) is being used to manage horses with palmar heel pain. At the 2007 AAEP Focus meeting in Colorado, Wayne McIlwraith, BVSc, PhD, FRCVS, DSc, DrMedVet (hc), Dipl. ACVS, also of the Orthopaedic Research Center, and Kawcak explained that the use of shock wave is particularly of value for lesions that can be accessed from the skin surface and have nothing, such as hoof wall capsule, in the way.

David Frisbie, DVM, PhD, also of the Orthopaedic Research Center, stresses the importance using MRI, with its great value in facilitating the targeting of ESWT-treatable tissues.

Frisbie says he treats navicular-related pain by treating “the coffin joint and if no or short-lived improvement is seen, I treat the navicular bursa, and if still no or short-lived improvement, then MRI imaging better defines the diagnosis. This seems to be the most economical way of approaching horses with distal limb pain.”

Farrier Care and Shoes

The poll by also revealed a common thread from respondents—many owners claim the No. 1 hoof health issue is related to the use of shoes in general and/or poor farrier techniques.

In recent years there has been a lot of debate and discussion on whether barefoot or shod is better. Working with a capable farrier and veterinarian team is invaluable. For those deciding to forego shoes, many alternative products such as synthetic boots have been developed to protect the hooves. (Examples include Old Mac’s boots, EasyCare’s Easyboot Epic, Bare boots, or Boa boots, Marquis hoof boots, and HorseSneakers.) A boot isperfect for this situation, as it can be placed on the hoof when the horse is ridden, then removed until the next riding event.

Kawcak urges a comprehensive evaluation to shoeing, noting, “We need to take a more objective look at shoeing on individual horses and get away from generalities. With the advancement of MRI and the ability to identify disease in specific tissues, we can better target shoeing recommendations for specific problems.”

In all cases, barefoot or shod, the hoof must be trimmed to optimize performance, and to prevent or relieve concussion and stress on injured structures of the hoof.

About the Author

Nancy S. Loving, DVM

Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.

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