Healthy, well-maintained hooves can remain strong and functional for decades—supporting horses from their first wobbly steps to their final years.

Hellhole Mare was, actually, an angel of a horse. A cherished favorite among equine hoof scientists who study Brumbies—Australia’s free-roaming feral horses—the tough but gentle bay had given birth to at least 15 foals before becoming so thin and weak that researchers opted to humanely euthanize her.

When the scientists, with heavy hearts, examined this beloved matriarch, they discovered “skin and bones” and toothless jaws, says Chris Pollitt, BVSc, PhD, head of the Australian Equine Laminitis Research Unit at the University of Queensland.

One part of her body, however, showed no signs of age whatsoever—the very foundation she’d been standing on for nearly three decades. Her feet. “Nicely beveled along the edges, strong heels, no laminitis, perfect,” says Pollitt. “You’d think they’d been trimmed by a professional.”

For Pollitt and his colleagues Hellhole Mare epitomizes the equine hoof. “She was nearly 30 years old, but she had the feet of a 5-year-old,” he says, having lived in what Pollitt considers an ideal environment for natural hoof care in an unridden and freeroaming horse. “This tells us that if a horse’s foot is properly cared for, it will be perfect when the horse reaches the end of its life.”

Horse Hooves In Utero

Hooves form remarkably fast, becoming easily recognizable within 65 days of gestation, says Simon Curtis, PhD, FWCF, Hon-AssocRCVS, a farrier in Newmarket, U.K. That’s before limbs have bones, he says.

To prevent uterine damage from fetal kicks, an unborn foal develops a gelatinous horn covering. This protective layer, called the eponychium or deciduous hoof, is derived in part from the sole and white line.

The basic hoof structure fully forms before birth, Pollitt says. But because unborn foals’ hooves never bear weight, their suspensory apparatus—where the coffin bone hangs from the front hoof wall via lamellar structures—remains underdeveloped. The lamellae, which help distribute weight and support hoof function, also do not fully develop before birth. In fact, he explains that because of that lack of weight-bearing, the embryonic hoof’s first and second lamellae form a distinct crisscross pattern, positioned almost perpendicular to each other.

The First Five Months

Healthy foals usually make a wobbly stand on their hooves within the first hour of birth, and they shed their eponychium within a few hours. Pollitt says such weightbearing triggers immediate loading of the suspensory apparatus. Within a couple of days, lamellar structure angles already reflect their new loading—taking on the oblique form they maintain for the rest of the foal’s life.

Meanwhile, their tiny hooves start growing their first palmar processes—a sort of “hook at the back of the bone to which the cartilage is attached”—which are completely absent at birth, Pollitt says.

Despite these changes, though, foal hooves evolve in neither shape nor structure after birth. “The original foal hoof is a certain size—say, the size of a cup—and it can’t grow any bigger,” he explains.

Instead, new horn grows rapidly from the coronary band, at a rate of about 15 millimeters per month, to create a new, mature hoof that widens and flattens over approximately five months, says Curtis. In general, that leaves a clearly visible horizontal “birthmark” line on the descending horn.

This creates a sort of “inverse cone” by three or four months of age, with greater width at the coronary band than the bottom, he explains. That’s, in part, because the foal’s hoof wall thickens more than threefold as it grows from the top down.

Meanwhile, other structures inside the foot—bones and lamellar attachments, for example—must grow along with the horse, Pollitt adds. “Lots of things are happening inside the hoof capsule after birth,” he says. “And all of these changes have to occur in synchrony, in a coordinated fashion.”

In general, this runs remarkably smoothly, he says. “It’s marvelous to consider what—and how many—things could go wrong,” he explains. “It’s like a miracle.”

Still, things can go wrong, especially when conditions aren’t favorable to good hoof growth. Selective breeding for big bodies and small hooves, for example, can negatively impact hoof development. Rigid or oversoft terrains can as well, as the researchers have seen in feral horses.

The first few months also represent the sweet spot for club foot development. Typically, hoof horn at the heel grows faster than at the toe, which occurs especially when foals favor walking on their toes, Curtis adds. Club feet, characterized by an upright shape, long, contracted heels, and a pronounced or bulging coronary band, can sometimes go unnoticed for months or years. In his research, however, he has found they usually appear between 20 and 110 days.

In domestic settings these early months represent a critical time for skilled, frequent trimming to prevent club feet, angular deformities, and other distortions, Pollitt says.

The Rest of the First Year

As foals continue to grow, their hooves undergo significant changes as they gradually develop into the familiar adult form.

“Suddenly we see this hoof taking on the shape that we associate with hooves—which is now a truncated, oblique cone, that leans slightly backward,” Curtis explains.

The new, mature hoof structure usually lasts the rest of horses’ lives, Pollitt says.

Minor tweaks do continue. Horn growth, for example, gradually slows to around 9 millimeters per month by the horse’s first birthday, Curtis says.

Loading patterns—which start as weanlings but become more prominent as the horse’s weight increases—also come into further play, he says. Through pressure readings he found horses “don’t stand like table legs” but, rather, favor inner (toward their midline) versus outer hoof-wall loading.

Suspecting that loading was impacting natural hoof growth patterns, Curtis sought to “separate the changes horses are preprogrammed to experience versus those in response to uneven loading.” He realized the horn compresses under the horse’s weight. That means even if the hoof grows at the same rate across the coronary band, it ends up seeming shorter or longer in different parts of the hoof due to getting smashed.

As a result, the outer angles from the sole to the coronary band appear more oblique, or slanted, and give the impression that outer walls grow faster.

“Farriers recognize this, and they say it grows more hoof on the outside,” he says. “But it’s not because of the production of horn cells; it’s because of the compression.”

Dorsal (front wall) angles also change in the first year at a rate of about one degree per month until about 10 months of age, Curtis says. “So, there’s an extraordinary change in angle.”

Hooves During the Rest of Life

Once a hoof has become mature—at around 10 months of age—it changes very little in healthy horses, says Pollitt.

“My feeling is that horse’s hooves, once grown and once properly cared for and in the right environment, will virtually outlive the horse,” he says.

“A lot of people think that they age—and they’ll tell you that they do, and they’ll supply anecdotal evidence to support that,” he adds. “But my experience is that they’re a wonderful piece of evolution that serves the horse well throughout its life.”

Even so, minor natural changes occur, Curtis says. For example, hoof wall thickness increases to about 9.5 millimeters in an adult Thoroughbred, or around 11 millimeters in other breeds. And horn growth slows to about 6 millimeters per month for adults and even to 3 millimeters per month for seniors.

Researchers on an ongoing pilot study, meanwhile, seem to have confirmed what many farriers have long suspected—that with age, hoof angles continue to mildly flatten compared to the ground, Curtis says.

Still, it’s also possible older horses simply have changing hoof angles due to evolving trimming techniques, especially as owners change farriers, Pollitt says.

Despite these minor changes, though, our sources say owners often perceive age-related changes in their horses’ hooves. “It’s such a rarity that farriers find horses with symmetrical hooves,” Curtis says, and that might be in large part due to unnatural loading rather than age itself.

Age-Related Conditions

While hooves can remain strong over time, they are still vulnerable to age-related diseases and other conditions.

Many older horses suffer from low-grade laminitis, Curtis says. It is often due to excess nutrients, which weaken the laminae by altering the endocrine system, usually in combination with obesity. Besides contributing to rotation or sinking of the coffin bone within the hoof, that excess weight causes compression, especially along the sole.

Horses with age-related insulin resistance—especially related to pituitary pars intermedia dysfunction (PPID, equine Cushing’s disease) and/or obesity—can have chronic laminitic changes, Pollitt says.

That could mean they have a healthy back half of the foot but compression and changes in blood supply to the front half, Curtis says. These issues combined with a slight change in hoof angle could make the problem even more pronounced.

“As a horse ages, you might notice some changes in its hoof that are more related to age-related health conditions, such as Cushing’s (PPID), rather than changes in the hoof due to older age,” says Shannon Pratt-Phillips, PhD, a professor of equine nutrition in North Carolina State University’s Department of Animal Science, in Raleigh. “Good nutrition will still be important to support hoof health even with confounding factors such as Cushing’s or insulin dysregulation.”

Beyond endocrine disorders, geriatric horses simply have more years of impact on their feet—meaning greater chances of injury, such as to the coronary band, Curtis says. “Older horses definitely tend to have more problems, but I think it’s more a cumulative effect,” he explains. “There’s not a single problem that’s more a 20-year-old hoof compared to a 5-year-old hoof.”

Other issues might stem from a lifetime of environmental challenges—such as feral New Zealand horses navigating through rough terrain—rather than the aging itself, Pollitt says.

Likewise, aging, retired domestic horses could suffer from poor hoof health simply because they might receive less hoof care, he explains.

“A lot of people neglect their old horses,” he says. “Of course, if the environment is soft underfoot, they’ll develop long cracks, and they might be euthanized because of the condition of their feet. And (owners) say they’re an old horse with an old foot. But I don’t believe that, intrinsically, there’s aging about the hoof.”

Older horses might also experience nutritional and environmental deficits due to their decreasing social rank, says Pratt-Phillips.

“They end up standing in the mud all the time, or not getting their full ration, because the higher-ranking horses take their place,” she explains.

“Of course, the horse is old, and there will be the assumption that it’s getting old and, so, the hoof is falling away,” Pollitt says. “But in my experience many horses reach old age with hooves that are the same as when they were 3 years old.”

Take-Home Message

Hooves are phenomenal structures built to last a horse’s lifetime. Even so, they experience major changes in shape and structure through the first year out of the womb, while they adjust to bearing the weight of the foal. Once mature, healthy and properly maintained horse hooves can remain strong and functional throughout an animal’s life—provided equine veterinarians and horse owners manage all age-related diseases.

This article is from the Older Horse 2025 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

Q. How long does it take for pasture grass sugar levels to drop after the sun goes down?

—Debra, Texas

A. The level of sugar in pasture grass varies due to several factors, including the weather, how stressed the grass is, its maturity, the time of year, and the time of day. As sun shines on pasture grass, the plants photosynthesize. This creates sugar stores the plan uses overnight to keep growing. Therefore, grasses tend to have higher sugar contents later in the day compared to earlier in the day.

Time Pasture Access Carefully

Generally, veterinarians and nutritionists recommend horses sensitive to sugar in pasture grass (such as those with insulin resistance, equine metabolic syndrome, or a history of laminitis) graze very early in the morning. It takes several hours after the sun sets for sugar levels to drop, so ideally try to avoid grazing before 3 a.m. And, because sugar levels start to build up again with sun exposure, it’s best to remove sensitive horses from pasture by about 10 a.m. If there’s significant cloud cover, you might be able to leave horses out a little longer, because photosynthesis (which relies on the sun) will be slower and therefore the amount of sugar will be lower.

One exception would be if the temperature drops below about 40°F overnight. At this temperature and below, the plants’ growth rate slow, which means stored sugars aren’t used up. As such, they’ll still be high in the early morning. In this situation, potentially at-risk horses should not have pasture access.

And, you must consider that some very sensitive horses might never be able to graze safely, while others can with careful grazing and pasture management. It all depends on the individual horse. Grazing muzzles are a very useful tool to help limit grass intake but still allow pasture access. Studies have shown that some muzzles can limit intake by as much as 80%.

Proper Pasture Management

Another important consideration is that most of the sugar in grasses tends to be in the bottom 3 to 4 inches of the plants. While it might be tempting to think that a very short, overgrazed pasture is safe because there’s “nothing out there,” such pastures present several risks—grasses are very stressed and only the lower inches of the plant are available, meaning these pastures can be very high in sugar.

As such, proper pasture management is very important to keep grasses from becoming stressed. This means horse owners need to properly fertilize and irrigate (if necessary) pastures.

It’s better for the plant and safer for the horse to stop grazing when the pasture has only about 3 to 4 inches of height left. This not only reduces sugar intake by your horse but also leaves some leaf for the plant so that it can regrow without having to dip in to root stores too heavily.

Take-Home Message

With an understanding of pasture grass metabolism and careful pasture and grazing management, many horses should be able to safely graze for at least part of the day. But, always consult your veterinarian or equine nutritionist before turning out your potentially sugar-sensitive horses on pasture.

Giving horses sufficient time to recover from athletic events could help them avoid acute injury and long-term health problems.

Training and conditioning sport horses helps prepare them both physically and mentally for competition, but the process can take a toll on their bodies. Without adequate rest, a horse’s body cannot fully recover, leading to overexertion and potentially acute injury or longterm soundness problems, increased risk of injury, and the horse becoming mentally burnt out.

Recovery activities and the amount of time a horse needs to recuperate depend on the individual horse and his workload. For example, a horse jumping a 1.60-meter (5.25-foot) course in competition needs a different recovery plan than a racehorse in training or a dressage horse competing second level.

“The recovery time (needed) is dictated by the individual horse, the type of work performed, the general health of the body, age of the horse, and so on,” says Tim Worden, PhD, an equestrian sports performance consultant based in Ontario, Canada. “In general, younger and healthier horses will recover faster than older horses or those struggling with health issues.”

How The Horse’s Body Recovers

“Following exercise, the body works to restore normal function, repair damaged structures, remove any by-products of exercise, and replenish resources such as energy,” says Worden. “Additionally, exercise stimulates different signaling pathways, which lead to proteins being assembled in the body to improve exercise tolerance (e.g., structures in muscle that can improve oxidative capacity or increase force output) for the next time the horse needs to perform a strenuous activity.”

He adds that these processes take time, and a lack of proper rest can cause overexertion in the short-term or overtraining—an imbalance between workload and recovery—in the long-term. “While allowing the horse to recover from a workout on Monday, you can still perform work on Tuesday, assuming you accommodate the fatigue level from the preceding day and steer clear of exercises that place similar demands on the body (for example, avoid doing two high-intensity jumping workouts on back-to-back days),” he says.

What Can a Horse’s Recovery Time Look Like?

Recovery can be divided into two categories: passive and active. Passive recovery involves no added physical activity, which for horses usually means spending a day turned out with no ridden exercise or groundwork, says Worden. “Active recovery is the deliberate prescription of low-to-moderate-intensity exercise to aid in the restoration of the horse’s body,” he explains. This could be going for a trail ride or a light walk, trot, and canter on a track or in a field to let the horse stretch his body.

“Recovery will vary with the type of exertion and the horse’s level of fitness,”says Steve Adair, MS, DVM, Dipl. ACVS, ACVSMR, associate professor at the University of Tennessee’s College of Veterinary Medicine, in Knoxville. “Recovery time may be a few hours between events up to a few days. Recovery time can be anything from a complete layoff to non-sport-specific exercise such as trail riding.”

“If I am building a training program, I may have one passive recovery day per week (assuming the horse can have extended turnout), but most of the time I prefer to use active recovery means,” says Worden. “Active recovery is helpful for pumping nutrients to the musculoskeletal system while simultaneously removing molecules and chemicals that accumulated during the preceding intense exercise.”

Active recovery can also give riders a chance to identify any potential soundness issues during less-intense training and provide horses with a mental break from typical ridden ring work.

“In my opinion, the No. 1 recovery method will always be active recovery,” says Worden. “Getting horses out of their normal environment and doing something fun. Some horses enjoy going for hacks, others enjoy controlled gallops on a track, and some will enjoy going to the beach. Figure out what allows your horse to mentally recharge and build that into your program as often as possible.”

Adair says the type of recovery time horses need varies tremendously depending on the sport. “For instance, a halter horse is not going to need much recovery between shows, whereas a 100-mile endurance horse may require several days to a couple of weeks for recovery,” he explains.

The Trainer’s Role in Planning Recovery Time

When building a program, trainers should tailor a horse’s recovery time to match his workload. “As trainers, we are essentially stress managers,” says Worden, applying stress in the form of exercise to stimulate the signaling pathways mentioned earlier. This “will ultimately result in improved aerobic performance, technique, power generation, and so on.”

Trainers should also ensure the horse’s recovery time is efficient and maximizes the training benefits. “A horse can perform a lot of quality work in training, but if there are issues with the recovery means chosen, then any potential gains will be lost or, in worst-case scenarios, lead to injury,” Worden adds.

Always consider fitness when planning recovery time. “The less fit an individual, the longer the recovery period that is needed,” says Adair. “The tissues (muscles, tendons, ligaments, cardiovascular system, etc.) of an unfit individual have not been conditioned to withstand heavy stress, thus they are more susceptible to injury.”

Riders and trainers can work with exercise physiologists and their horses’ veterinarians to perform multiday fitness tests designed to determine horses’ readiness to perform following a variety of recovery times, says Worden. Fitness wearables, which can collect information on the movement and health data (i.e., heart and respiration rates), can also give trainers and veterinarians more information about horses’ optimal recovery times, especially if used in daily training.

Do Long Periods of Rest From Exercise Benefit Horses?

In some cases trainers might choose to give horses several weeks of rest, especially during the winter in colder climates.

However, long periods of complete rest are often not favorable to a horse’s health; keeping horses at a minimal level of fitness is often more beneficial, says Adair. “Exercise and movement are important to prevent nagging issues from becoming a problem,” he explains. “For example, older horses with arthritis tend to fall apart if they are laid off for several weeks. It is better that they have some type of exercise, even if it is just trail riding.”

Happy and sound mature horses in a well-constructed training program often do not need extended periods of rest, adds Worden. “I would prefer to give a week or 10 days of passive and active recovery a few times throughout the year versus one or two months off at one time,” he says. “The hardest thing to do in sports programming is to build an athlete back up (from significant time off or an injury) so, for that reason, I tend to stay a bit further away from extended time off.”

He adds that longer rest periods can help horses that have been overtrained, because giving the body time to fully recover is often the best way to counteract overtraining. “Once a horse has reached the overtraining stage, you cannot continue to train through it,” Worden says. “If you do, you are likely to have an injury arise at some point.”

Longer periods of rest might also benefit younger horses because it gives them a break from the training environment, which can be mentally draining for them. Having downtime turned out with other horses can help them remain happy and sound in their work in the future.

Care During Recovery

“Proper foot care is very important,” says Adair. Correctly shoeing and trimming the foot to match the conformation of the leg and offer maximum weight-bearing support under the limbs can help horses maintain long-term soundness and reduce their risk of injury.

“Chiropractic evaluation and massage therapy can also be of benefit,” he adds, noting that while there are many anecdotal claims about the benefits of complementary therapies for recovery, more research is needed to confirm their efficacy.

Having a skilled team available to regularly evaluate the horse will help maximize recovery time. “Someone who can ‘listen’ with their hands is vital for both guiding therapy and training decisions,” explains Adair. “To know exactly where the horse is muscle sore following a workout and how the body responds to different types of exercises can tell you a lot about strengths and weaknesses.”

Take-Home Message

Appropriate recovery time is crucial to a horse’s long-term health and happiness in his work. Following exercise, a horse’s body needs to restore normal function, repair, and replenish energy supplies. The amount of time a horse needs to recover can vary greatly depending on the individual and the work he performs. Riders and trainers can use both active and passive recovery in their training programs and should find active recovery methods horses enjoy to help them recover mentally from challenging work.

Know the horse. “Ultimately, the most important thing for owners, riders, trainers, grooms, etc., to do is observe the horse and listen to what it is telling you,” says Worden. “If you know a horse well, then you will be able to detect slight personality and movement characteristics that indicate it is not yet fully recovered and may need an extra day before the next workout. It is always better to give an athlete an extra day off than to push them too soon and (risk) an injury or impact their confidence.”

This article is from the Older Horse 2025 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

Age can complicate managing already tricky metabolic diseases in horses

Metabolic diseases, including both insulin dysregulation (ID) and pituitary pars intermedia dysfunction (PPID, previously known as equine Cushing’s disease) occur commonly in horses. Estimates indicate approximately 20% of horses 15 or older have PPID, while the prevalence of horses with ID or a combination of ID/PPID remains unknown.

The most important pathological—involving disease or damage—condition of both ID and PPID horses is laminitis, referred to in this setting as endocrinopathic laminitis or hyperinsulinemia-associated laminitis (HAL). As with other forms of laminitis, horses with HAL suffer extreme pain, lameness, and compromised quality of life.

Rather than delving into the clinical signs and diagnosis of ID and PPID, we’ll move beyond the basics in this article, focusing on best practices for managing aging horses with ID, PPID, or both. The key areas of management we’ll describe include diet and exercise tailored to aged horses, as well as medications. Special consideration also goes to managing older horses with osteoarthritis (OA) and understanding end-of-life care.   

Feeding Aging Metabolic Horses

Without a doubt, diet is the cornerstone of managing metabolic horses to decrease postprandial (after meals) hyperinsulinemia, even if the horse is not overweight.

“It is crucial to limit nonstructural carbohydrates, which are the sugar and starch components of the diet, in horses with ID to control postprandial hyperinsulinemia,” says Erica Macon, MS, PAS, PhD, of the Department of Animal Science at Texas A&M University’s College of Agriculture and Life Sciences, in College Station.

Scientists derived original recommendations of feeding commercialized concentrates and hay with less than 12% NSC from research in healthy horses, and they theorized this level would be safer for horses with metabolic disease. Since then, Macon and other nutritionists have recommended low-NSC hays, decreased pasture access, and ration balancers.

“However, it’s important to recognize that individual horses may have different insulin responses to the same diet,” says Tania Sundra, BSc (Hons), BVMS, MANZCVS (equine medicine), of Avon Ridge Equine Veterinary Services, in Brigadoon, WA, Australia. “Factors such as genetics and the gastrointestinal microbiome likely play a role in this interhorse variability, though this has not been fully elucidated. While some sources suggest a stricter threshold of 10% NSC, the 12% guideline is generally considered appropriate for most horses. Monitoring your horse’s insulin levels and adjusting the diet accordingly remains the best approach to managing horses with ID.”

Macon also points out that “nutritionists are trying to move away from percent-NSC basis. We now recommend that horses with hyperinsulinemia are limited to 0.1-0.15 grams NSC/kilogram body weight (BW) per meal.”

Forage should form the basis of the diet, and horses in good body condition should be offered 2% forage BW. However, if horses need to lose weight this might need to decrease to 1.75% BW or even 1.5% BW.

“But no lower than 1.5% BW, otherwise you jeopardize the integrity of the hindgut,” Macon says. The hindgut refers to the cecum and large colon (or large intestine).

Sundra adds, “Ideally the forage will be split into multiple small meals to mimic a more natural feeding pattern and help reduce the postprandial insulin response by preventing large spikes in insulin that can occur with larger meals.”

Although some producers do have their hay analyzed, the technique might not be ideal or accurate, says Macon. But having a laboratory with an expansive database analyze hay is a crucial step in managing insulin-dysregulated horses, and both she and Sundra recommend it.

“Owners only need to test one batch at a time (i.e., same cutting or load of hay), not each bale,” says Macon.

Lean senior metabolic horses are much more difficult to manage than overweight animals because they need calories to maintain or put on weight, but they still need lower NSC concentrations.

“Most senior horses will experience sarcopenia (progressive loss of skeletal muscle mass), especially those with PPID,” Macon says. “We therefore need to feed quality, bioavailable amino acids. Ration balancers work very well for this.”

Sundra agrees, saying a senior metabolic horse’s diet needs to address both muscle maintenance and safe calorie intake. Her tips include:

• Manufacturers often formulate senior-horse-specific feeds to provide higher-quality protein (including the amino acid lysine) to help combat age-related muscle loss/sarcopenia;
• Calories (energy) should come from safe, low-NSC sources, such as beet pulp without molasses, fats, and oils (e.g., rice bran or flaxseed oil) rather than high-starch grains; and
• Forage should still be the foundation of the diet, with an emphasis on low-NSC hay or a soaked hay to reduce NSC content (be sure to discard the soaking water so the horse doesn’t consume it).

Including Exercise in Treatment

For horses with metabolic issues, especially those that are overweight, exercise should be a fundamental feature of management alongside nutrition. In fact, a combination of diet and exercise resulted in a greater improvement in insulin sensitivity in obese ponies compared to diet restriction alone (Bamford et al., 2019).

According to a survey by Herbst et al. (2024) of 2,700 owners of aged horses, 79% engaged in little structured exercise.

“I was involved in this project and, even though we know exercise is beneficial, the reality is that getting owners onboard is extremely challenging,” says Macon.

The following exercise recommendations come from the European College of Equine Internal Medicine (ECEIM) consensus statement on EMS written by Durham et al. (2019, tinyurl.com/yjnjn4dw):

In nonlaminitic ID horses, minimum recommendations include low-to-moderate-intensity exercise to achieve heart rates of 130 to 170 bpm for more than 30 minutes, more than five times a week;

In previously laminitic horses with recovered and stable hoof lamellae, minimum exercise recommendations involve low-intensity exercise on a soft surface to achieve heart rates of 110 to 150 bpm for more than 30 minutes, more than three times per week, while riders/trainers carefully monitor for signs of lameness.

However, in addition to owner commitment and the laminitic discomfort that limits a horse’s ability to exercise, OA might also contribute.

Arthritic Metabolic Horse Exercise

Among owners caring for aging horses, even without metabolic conditions, OA is a leading concern. In a recent survey of 2,717 U.S. horse owners, researchers found that 30% of horses had veterinarian-diagnosed OA (Herbst et al., 2024). Common methods of managing OA include administering non-steroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone or “Bute” or intermittently giving intra-articular (IA) steroids such as betamethasone.

Medication Effects on EMS Horses

François-René Bertin, DVM, PhD, an associate professor in large animal internal medicine from the Department of Veterinary Clinical Sciences at Purdue University College of Veterinary Medicine, in West Lafayette, Indiana, recently demonstrated that phenylbutazone does not increase insulin secretion in ID horses (Kemp et al., 2024).

Hypothesizing that NSAIDs might increase insulin secretion through prosteglandin E2 (PGE2, principal mediator of inflammation in diseases such as osteoarthritis) inhibition in horses, Bertin et al. administered either phenylbutazone intravenously for nine consecutive days or a saline placebo to nine healthy horses and seven horses diagnosed with ID. Horses then underwent testing to measure circulating insulin and glucose levels and, unlike in humans, insulin concentration decreased.

This suggests that in horses with ID, Bute decreases ID-associated inflammation and improves tissue insulin sensitivity, (crucial for glucose uptake and metabolism) leading to decreased insulin secretion.

“Those effects are rather mild but give us some insight about the role of inflammation in the development of ID,” says Bertin. “These data should not, however, suggest that phenylbutazone is a safe long-term treatment for (horses with) HAL. Instead, phenylbutazone can provide short-term pain relief without increasing insulin in metabolic horses with HAL.” 

Studies of IA corticosteroids do not bring equally good news. Instead, researchers widely report potentially harmful effects of corticosteroids even after a single joint injection. For example, in multiple studies, authors report significant increases in circulating insulin and glucose concentration following a single IA dose of triamcinolone, a commonly administered steroid for managing OA in horses.

Page and colleagues conducted a pilot study to determine the metabolic effects of the corticosteroid betamethasone in five healthy and three ID horses (Page et al., 2025). They injected 9 milligrams of betamethasone into each horse’s front fetlock joint before performing an oral sugar test and measuring adrenocorticotropin—ACTH, a hormone the pituitary gland releases—and cortisol levels (excessive ACTH amplifies cortisol secretion from the adrenals).

They found IA betamethasone had systemic effects on the horses, suppressing both ACTH and cortisol. 

“While it is unknown whether the temporary suppression of ACTH and cortisol is of significant detriment to horses, cortisol is an important hormone in stressful situations, so that raises the potential that these horses may not be able to respond properly to those situations,” Page explains. “There is also the concern that these drugs may cause a temporary immunosuppression, although work to better understand this is ongoing.

“While we were not able to make very many specific conclusions in this preliminary study, we did note that the metabolic effects of betamethasone were similar, albeit shorter lasting and smaller, than triamcinolone,” he adds. “As a result, we again recommended continued caution using corticosteroids in ID and/or laminitis-prone horses.”

Page says the group plans to expand on their work into other IA medications and larger groups of ID horses, given the importance of targeted treatment options for this horse demographic. In the meantime, for those looking for a noncorticosteroid alternative, Page and colleagues demonstrated that autologous protein solution (APS) administered IA did not exert any metabolic effects compared to triamcinolone in healthy horses, suggesting it could be a potential treatment option in ID horses (TheHorse.com/1132877).

Medications to Consider

Pergolide Veterinarians recommend treating PPID horses with pergolide. The 2023 Equine Endocrinology Group reports that clinicians should start with an initial pergolide dose of 2 micrograms/kg (0.5 mg for a 250 kg pony and 1.0 mg for a 500 kg horse) once daily (tinyurl.com/2a9a2wh7).

Practitioners might also consider prescribing cabergoline, a human drug Cabergoline used to treat different types of medical problems that occur when the body produces too much of the hormone prolactin.

Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2is) When indicated, SGLT-2is might benefit horses with ID. These medications increase urinary excretion of glucose, which in turn decreases the amount of glucose in the circulation. As a result, horses need less insulin to control blood sugar levels. Some published studies support the off-label use of various SLGT-2is, including canagliflozin, ertugliflozin, and velagliflozin, in horses.

“While SGLT-2is can be a valuable tool in managing severe hyperinsulinemia, these medications are typically reserved for cases that have failed to respond to dietary interventions or for severely affected horses where immediate insulin reduction is necessary,” says Sundra. 

She went on to describe four scenarios where she recommends an SGLT2i:

1. Short-term during transition to a low-nonstructural-carbohydrate diet;
2. Emergency use following accidental overconsumption of NSC-rich feed;
3. Preventively prior to corticosteroid administration; and
4. When managing chronic, severe, resistant equine cases.

“Some horses remain persistently hyperinsulinemic despite strict dietary control,” Sundra says. “In these refractory cases, an SGLT2i may be considered for longer-term management to maintain lower insulin levels and reduce the risk of laminitis. However, this should be closely monitored by a veterinarian, as long-term effects and optimal dosing strategies are still under investigation.”

Veterinarians prescribe these medications off label, relying primarily on clinical experiences for evidence of their effectiveness.

“In Australia and the U.K., ertugliflozin is most commonly used in clinical practice,” says Sundra. “The case studies we have published used a dose of 0.05 mg/kg once daily, but some animals might be controlled on lower doses.

“SGLT-2is should be carefully considered within the context of individual risk factors, and their administration should always be part of a comprehensive management plan that prioritizes nutrition, exercise, and overall metabolic health,” she adds.

Combining Pergolide, SGLT-2is Recall that many horses with insulin dysregulation also have PPID and could therefore need treatment for both conditions.

“There are no known interactions between the SGLT-2i ertugliflozin and dopamine agonists like pergolide or extended-release cabergoline,” Sundra explains. “However, it’s worthwhile mentioning that dopamine agonists can sometimes cause a temporary decrease in appetite, so if a horse is already on ertugliflozin and pergolide or extended-release cabergoline is being introduced, I always advise stopping the ertugliflozin for a few days to ensure the horse continues eating to reduce the risk of hyperlipemia (elevated lipid concentrations in the bloodstream).”

Critically Assessing Quality of Life

As one can imagine, it’s not easy managing chronic laminitis in addition to other age-related co-morbidities such as OA. Researchers have reported the prognosis for PPID is poor, with only 50% of horses surviving more than 4.5 years after being diagnosed (Johnston et al., 2025).

As difficult as end-of-life care can be to discuss, preplanning avoids last-minute emergencies and allows your older horses to live their final days with dignity. To successfully navigate the end-of-life phase, owners need to be able to critically assess their horses’ quality of life. In other species various quality-of-life tools are available. In dogs, for example, “The HHHHHMM Scale” (tinyurl.com/3drssxd2) takes the animals’ pain, happiness, mobility, and day-to-day engagement into consideration.

No comparable scale yet exists for horses, but in 2022 Long et al. collected data from 14 published studies on equine welfare that might help owners make informed decisions toward the end of their horses’ lives. They recommend that quality-of-life assessment includes both behavioral parameters to assess the horse’s mental state in addition to the physical state. They further suggest evaluating behavioral and physical parameters over time, stating that assessing quality of life remains an ongoing process, not a single event. 

Ideally, owners partner with their veterinarians to make this delicate decision together, ensuring horses’ best interest is always paramount, regardless of the emotional attachments.

Take-Home Message

Sundra says the greatest challenge in managing aging horses is ensuring a good quality of life while addressing the complexities of aging-related conditions.

“Chronic diseases occurring in older horses, such as OA, PPID, and ID, require proactive management to prevent pain, mobility issues, and laminitis,” she says. 

Nutrition and preventive care play a critical role in managing these diseases in our older horse populations. Early detection and intervention for conditions such as PPID and ID can significantly improve long-term treatment outcomes. “A precision-medicine approach, tailoring care to each horse’s needs, is key, as a one-size-fits-all strategy is unlikely to be effective,” says Sundra. 

This article is from the Older Horse 2025 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

Learn about this common condition from farriers and horse owners who have managed it

Thrush, an infection of the horse’s hoof tissue known for the black, necrotic (dead), stinky material it causes, is one of the most common hoof issues horse owners encounter. According to the 2020 American Farriers Journal Farrier Business Practices survey, more than half of farriers see a case of thrush each week during the year. Another 20% see thrush monthly, while 8% only deal with it a few times a year. For some farriers, thrush is only a seasonal concern when rains create persistent muddy conditions.

“Thrush thrives in dark, damp, warm environments,” explains Mike Isles, CF, APF-I, owner of MFI Farrier Service, near Saratoga, New York. “The bottom of the horse’s hoof is a petri dish for thrush.”

The hoof’s underside doesn’t get much light because it’s in constant contact with the ground, which is a natural host for millions of microorganisms. When mud, muck, and manure pack into the hoof and remain there, anaerobic bacteria can flourish, infecting the frog tissue and eating away at it.

Unsanitary living conditions and excessive hoof dampness are primarily to blame for thrush, so keeping the hooves clean and giving the hoof time to dry is essential.

“The biggest thing with thrush is to clean out the horse’s feet,” says Isles. “Ideally, once a day, but at least whenever you see your horse, especially if you’re using a topical treatment for thrush. Medication needs to get on the tissue, and if the hoof isn’t clean, the dirt is just soaking up the treatment.”

Thrush might sound like a straightforward condition that can be remedied with good horsekeeping skills. But mud, dirt, and manure are not the only culprits.

“Thrush is a bit of an enigma,” says Steve Kraus, CJF, head of farrier services at the Cornell University College of Veterinary Medicine, in Ithaca, New York. “It’s interesting because some horses can live in terrible conditions and never develop it, while horses in good conditions can. So, thrush is not necessarily caused by bad health care or bad conditions but aggravated by it.”

Horses that have compromised immune systems are susceptible to thrush, says Kraus. Horses with genetically weak hooves or horses that have an inability to absorb key trace minerals such as zinc, which is needed for healthy hoof tissues, might also be more likely to develop thrush, he added.

A Deeper Look at Thrush

Despite the frog’s small size, it plays a critical role in keeping horses sound. A healthy frog absorbs concussion and helps with load bearing. In healthy hooves frog tissue expands and contracts with each step, pushing dirt and debris out of the collateral sulci—the grooves on either side of the frog.

Thrush develops in any part of the sulci (the central sulcus—the groove in the center of the frog toward the heel—or the collateral sulci) when there is chronic tearing of the frog tissue, which allows anaerobic bacteria to invade, Kraus explains. Uneven hoof loading created by unbalanced conformation damages the frog tissue. A horse with an upright club foot or contracted heels can develop thrush because the deeper sulci collect more debris than those in a hoof with a flatter angle. A steep hoof angle is also likely to develop thrush due to the frog atrophying from lack of stimulation, he adds.

“I think you’re more likely to see thrush in horses with poor conformation,” says Kraus. “For instance, a horse that toes out lands on the lateral toe and then loads a medial heel, tearing the frog tissue with each step. That leaves an opening for an invasion of microorganisms. A healthy foot that loads the heel properly and stimulates good frog pressure doesn’t do that.”

Kraus also points out that thrush is distinct from another type of hoof infection called canker. While thrush is a destructive, necrotic process (the bacteria kill the tissue), canker is a proliferative process whereby bacteria cause abnormal growth of the horn, the hard, outer layer of the hoof.

Treating Thrush

Thrush can be mild, moderate, or severe. Knowing what to look for and treating at the first signs of infection is critical for preventing it from progressing further.

“My new farrier was great about showing me what to look for and how to treat it,” says New Jersey-based horse owner Heather Wallace. Her gelding battled thrush and white line disease (another type of opportunistic infection, whether bacterial or fungal, of the area just in front of the epidermal laminae, which connect the hoof wall to the coffin bone) for two years despite living in a dry lot with a sand base.

Conversely, a hoof with thrush has a gooey look to it with pitting or pockets in the frog. Thrush can also cause a frog to disintegrate and create the unmistakable odor horse owners notice when caring for affected horses’ feet.

“In the early stages of thrush, it can be challenging to identify because a pocket of thrush can look like a pocket of mud, dirt or debris,” Isles says. “In some cases, a horse will be sensitive to the hoof pick, and if the owner is really digging into the hoof, it might bleed.”

Even if you’re unsure about whether your horse has thrush, Isles recommends using a topical thrush treatment product of your choice and pointing out the condition on your next farrier visit.

“If the frogs appear too soft, or the heels look like they might be thrushy, I hit it hard for a few days (with a topical treatment),” Wallace says.

There are many topical options from which to choose. An effective one has active ingredients mixed with a stain so it sticks to the tissue, says Kraus. He prefers povidone-iodine products and recommends applying them once or twice a week in mild to moderate cases.

It is not uncommon to hear someone suggest using bleach (sodium hypochlorite), but beware because it can do more harm than good.

“Bleach kills the microorganisms, but it burns the tissue; you can do more damage to the tissue,” he explains. “However, chlorine dioxide, a stabilized version of chlorine, is a bacterial killer just like bleach but doesn’t harm tissue, and that is available under multiple brand names.”

In moderate to severe thrush cases, farriers might use copper sulfate as a treatment, but they must do it carefully. The Environmental Protection Agency¹ and the National Pesticide Information Center² caution users about health risks associated with the product.

Wallace says it took trial and error to find products that worked best for her horse.

“I use iodine from time to time but found that applying Absorbine Hooflex Thrush Remedy every few days is a great preventative,” she says. “If the frogs appear too soft, or the heels look like they might be thrushy, I’ll use Dry Cow (mastitis treatment ointment) instead and hit it hard for a few days.”

While Wallace’s horse lives in a dry pasture, it has been an extremely wet year that has made even the driest lots muddy, so thrush is rampant, requiring frequent applications of topical treatments. Her efforts are paying off. During a recent visit, her farrier complimented her on her horse’s progress.

“Routine has made the biggest difference,” she says, but it was a hurdle at first. She hired someone to pick his hooves and apply the treatment when she can’t be there. “The most frustrating thing is that no matter how hard I work, if I treat the thrush and it goes away, there’s always a chance it comes back.”

When Thrush Progresses

In most cases a combination of routine farriery and topical treatment based on the individual horse’s needs can be enough to cure thrush. But in some scenarios it becomes a complicated situation of bacterial infection invading sensitive tissues within the hoof. In these cases working with a veterinarian is necessary.

Take-Home Message

Luckily, horse owners can manage most cases of thrush with topical treatments and routine farrier care. But in some situations more intervention might be necessary. Owners dealing with thrush in their horses’ feet should contact a veterinarian if it doesn’t clear up easily.

References:

1. Reregistration Eligibility Decision (RED) for Coppers; U.S. Environmental Protection Agency, Office of Prevention, Pesticides and Toxic Substances, Office of Pesticide Programs, U.S. Government Printing Office: Washington, D.C., 2009: 11.

2. General Fact Sheet: Copper Sulfate. National Pesticide Information Center, 2012; npic.orst.edu/factsheets/cuso4gen.html.

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Pain in horses is a complex state. Laminitis exemplifies this complexity, involving multiple overlapping pain pathways that can be difficult to manage.

“It is so complex that we continue to struggle with keeping on top of it in cases of laminitis due to our lack of safe, efficacious protocols,” said Alonso Guedes, DVM, MS, PhD, Dipl. ACVAA, during his presentation at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11, in Orlando, Florida. Guedes is professor of anesthesia and pain medicine at the University of Minnesota’s College of Veterinary Medicine, in St. Paul.

“Our inability to manage the severe, debilitating pain is the single most common reason for electing euthanasia in cases of laminitis,” he added. Laminitis is a painful condition in which the sensitive tissues anchoring the coffin bone inside the hoof capsule—called the lamellae or laminae—become inflamed and compromised. In advanced cases this damage can cause the coffin bone to rotate or sink as the internal support fails. Guedes described the multiple mechanisms involved in the onset of pain in horses with laminitis, including:

• Mechanical disruption of the lamellar tissues that cause nociceptive pain (the traditional acute pain many of us think of);
• Inflammation of the lamellae that causes inflammatory pain;
• Systemic inflammation with the release of cytokines (proteins important in cell signaling), such as tumor necrosis factor-alpha (TNF-a). “This cytokine increases neuronal excitability, increasing the firing rate of sensory pain neurons,” Guedes said.

Laminitic horses also suffer from changes in peripheral neurons that transmit signals between the central nervous system and the rest of the body. Changes in those fibers, the A-delta (d) myelinated fibers, and C fibers likely contribute to neuropathic pain. “Neuropathic pain is difficult to treat, it’s not very responsive to NSAIDs (non-steroidal anti-inflammatory drugs) or opioids, and the changes to the nerve fibers start early in laminitis,” he explained. Indeed, the significant overlap between nociceptive, neuropathic, and inflammatory (both local and systemic) pain is what makes laminitic pain so complex.

Assessing Laminitic Pain in Horses

Laminitic horses often show telltale signs—weight-shifting, a sawhorse stance, and appearing depressed at the back of the stall—but Guedes said there aren’t any validated methods for assessing laminitis pain in horses.

Subjectively, veterinarians can use a visual analog scale (VAS), which is essentially a line extending from 0 (no pain) to 10 (could not be more lame/painful). This method is fairly reliable between laypeople and veterinarians; however, people spending time with the horse might adapt to the horse’s behavior and misassign the grade, said Guedes. In other words, chronic pain can become a horse’s “new normal.”

Analgesic Options for Laminitic Pain in Horses

Guedes said there is no doubt multimodal analgesia is more efficacious than a single modality. “A single modality can’t treat all the different types of pain,” he said.

But other than NSAIDs, what options do veterinarians have?

Tramadol

“(Tramadol) inhibits mu-opioid receptors as well as serotonin and norepinephrine reuptake in pain pathways, and it decreases levels of TNF-a,” said Guedes. “So, even by itself tramadol has multiple mechanisms of action.”

In one study, researchers examined the effect of 5 mg per kg of body weight of oral tramadol twice daily for seven days. Using force plates they measured the horses’ discomfort by how often horses off-loaded their limbs, shifting weight from foot to foot. The researchers noticed only a transient decrease in off-loading and, by Day 7 of treatment, the horses began off-loading again at baseline levels. In a second study using 10 mg/kg, however, scientists identified more sustained pain relief with no adverse effects.  

Ketamine

Ketamine blocks N-methyl-d-aspartate (NMDA, an amino acid derivative) receptors, which amplify pain signals. “Even with a stimulus that shouldn’t produce very much pain, NMDA receptors enhance it,” said Guedes. “Ketamine blocks the NMDA receptors located in peripheral nerve endings contacting the laminae and within the spinal cord, modulating pain signals.”

Ketamine might also suppress TNF-a production. Researchers on one study evaluated a combination of ketamine and tramadol in 15 chronic laminitis cases. They administered ketamine at a rate of 0.6 mg/kg intravenously every six hours for the first three days of the study. Again, using the force plates, the investigators found that the horses decreased their off-loading frequency for the entire seven-day treatment period and the first three days beyond cessation of tramadol.

Gabapentin

Guedes explained that gabapentin blocks voltage– gated calcium channels in nerve fibers transmitting pain signals toward the brain and from the brain to the spinal cord. Veterinarians typically treat horses with 20 mg/kg, which can be effective, but researchers on recent studies in horses use doses  as high as 120 mg/kg without producing adverse events.

Others

Researchers studying an oligofructose model of laminitis (not clinical cases) found that  delivering local anesthetics via continuous peripheral nerve block with dilute bupivacaine yielded positive results and reduced the animals’ off-loading frequency.

Alternatively, liposomal bupivacaine delivered via abaxial nerve block (placed at the base of the proximal sesamoid bones, which are located at the back of the fetlock, to numb the structures below the fetlock) provided 24 hours of analgesia in an experimental model of hoof pain.

Scientists are examining soluble epoxide hydrolase (sEH) inhibitors in human clinical trials for neuropathic pain. Guedes said some preliminary work conducted in horses with laminitis has yielded promising results.

Take-Home Message

Veterinarians should recognize the complexity of laminitic pain in horses—including the nociceptive, neuropathic, and inflammatory components—and take a multimodal approach to pain management.

Researchers recently demonstrated that shoeing options can change the way a horse moves his back and neck, with potential consequences on his performance, health, and welfare.

Sébastien Caure, DVM, IPSAV, Dipl. ECVS, a veterinarian at the Livet Equine Veterinary Hospital Center, in Livarot-Pays-d’Auge, France; Renée Weller, PhD, of the University of Calgary, in Canada; and their colleagues placed reflective markers along the back and neck of six mixed-breed, sound, and barefoot riding horses who received regular trims. All the horses had been at rest at pasture for at least a year. The researchers filmed the horses walking and trotting in a straight line across a freshly dragged outdoor sand arena with seven types of hoof treatments each:

• Bare front and hind feet
• Bare front feet/shoes on hind feet
• Shoes on front feet/bare hind feet
• Shoes on front feet/shoes on hind feet
• Shoes on front feet/egg bar shoes on hind feet
• Shoes on front feet/wide-toe shoes on hind feet
• Shoes on front feet/reverse shoes on hind feet.

All shoes were composed of a lightweight metal (aluminum or steel) and weighed between 180 and 260 grams (6 to 9 ounces)—about half the weight of traditional steel shoes—to reflect real-life conditions in both equitation and racing. The horses rested in a stall for at least two hours between each treatment.

Shoeing’s Affect on Equine Neck and Back Flexion

Using computer analyses of the markers on the video footage, the team calculated joint angles along the spine from the poll to the lumbosacral area.

Compared to shod horses, they found barefoot horses displayed lower neck carriage with increased flexion along the lower neck and withers and a more horizontal thoracolumbar area (less flexion of the spine under the area at the back of the saddle), Caure said. The equine back has a limited range of motion from the saddle area to the tail, and some horses are naturally more flexible in the back than others. The neck, meanwhile, is highly flexible—which might be why two-thirds of sport horses experience instability and osteoarthritis of the lower neck, Caure said.

Wearing shoes only in the front led specifically to higher neck carriage and greater flexion in the thoracolumbar region at the back of the saddle area. That could be due to naturally greater weight-bearing on the forelimbs compared to hind limbs, or because the great mass of horses’ rumps dampens the effect of shoes, Caure explained. The fact the front feet are simply closer to the neck might also play a role, he added.

“You can really increase the expression of your horse’s head and neck and forelimb movements by shoeing him just in the front,” he said. While that might benefit upper-level dressage scores, it’s probably not ideal long-term due to excessive use of the joints, he added.

Likewise, the three types of orthopedic shoes used in the hind limbs triggered a higher neck carriage in both the walk and trot. That might be because the shoes have 200% of the surface area of standard shoes, the researchers reported.  

Wide-toe and reverse shoes increased flexion of the C3 joint (the third cervical vertebra) near the poll. Eggbar and reverse shoes—the two that cover the heel—on the hind limbs led to a flatter thoracic angle and increased dorsal/ventral flexion of the lumbosacral area. Eggbar shoes also increased thoracolumbar flexion as the hind feet touched the ground at a walk.

In addition, Caure said eggbar shoes on the hind feet helped horses push off with their hind limbs more symmetrically, which he said can be therapeutic in rehabilitating horses recovering from hind-limb lameness.

By contrast, having shoes on only the back feet had no significant effects on back and neck joint angles, he said.

Take-Home Message

Barefoot horses displayed a lower neck position than shod horses, and those shod on the front feet only carry their necks higher with greater flexion of the thoracolumbar area at the back of the saddle space. Orthopedic shoes on the hind limbs also led to higher necks and more thoracolumbar flexion. Veterinarians, farriers, coaches, and riders should keep these effects in mind when assessing, treating, and training horses, said Caure. “Lots of people—whether they’re riders, trainers, or surrey jockeys—say that their horses ‘feel’ different when the shoeing format changes,” he said. “Our study shows that they’re right. Shoeing significantly affects the way the upper body moves, a lot more than we ever thought.”

The study, “Effects of different shoeing conditions on equine cervical and back kinematics during walking and trotting on a soft surface,” appeared in the Journal of Equine Veterinary Science in November, 2024.

How to prevent shoe loss caused by farrier error, rider issues, management style, or horseplay

The environmental conditions might be wet, dry, slick, or muddy. The horse might be working, playing, stomping, or standing. Under any circumstance, a loose or lost horseshoe can be an inconvenient nuisance. Steve Kraus, CJF, a professional farrier of 55 years and head of farrier services at Cornell University Equine and Farm Animal Hospital, in Ithaca, New York, says horseshoe loss typically has one of three causes:

1. Farrier error.
2. Rider or management issues.
3. The horse.

A clear understanding of how or why a shoe came off is the key to keeping future shoes on your horses’ feet.

Farrier Error

When a horse loses a shoe, some owners might instinctively blame the farrier for subpar work, says Eric Wilt, a professional farrier of more than 30 years and the farrier science manager at Hocking College, in Southeast Ohio. In certain instances they’re right. Kraus and Wilt explain that a multitude of farrier errors can cause shoe loss, including:

• Performing a poor trim job prior to nailing on the shoe.
• Also in that vein, fitting the shoe to the wings (the flares on the horse’s feet that should be removed before placing the shoe), causing the hoof to work unevenly and, thus, loosening the nails.
• Placing a shoe that is too large for the foot such that the horse can easily step on it and rip it off.
• Driving nails too low into the hoof wall to hold the shoe on securely.
• Fitting the shoe too tightly, resulting in the hoof wall spreading over the shoe and the nails shearing.

Any shod horse’s shoe will loosen over time. Horses move, and hooves grow, expand, and contract. These factors come into play in determining a shoe’s life span on the hoof. Wilt says when he is getting ready to shoe a horse, he considers hoof health and conformation as well as the horse’s way of going.

Tips to Reduce Farrier Error

Aside from skill, experience, and a good eye for balance, being able to shoe horses properly with little to no error requires a few basic elements to help the farrier work more efficiently, says Wilt:

• A competent handler or a horse that ties well.
• Good lighting so the farrier can see the entire hoof.
• Level ground to work on so the farrier can properly evaluate horse stance and hoof placement.
• Clean hooves to ensure proper hoof balance and shoe placement.

Rider or Management Issues

A horse’s job, where he spends most of his time, and what he does daily play huge roles in potential shoe loss. When evaluating rider issues causing shoe loss, Kraus points out three issues he sees:

1. Riders that work horses excessively on the forehand, causing them to become unbalanced. The horse’s front feet cannot get out of the way of the hind, and he steps on a front shoe with the hind foot.
2. Riders that move the horse forward, then check the horse abruptly, resulting in the same.
3. Riders that turn the horse at a canter on the wrong lead, so he steps on the outside heel of the front shoe with a hind foot.

Kraus estimates 80-90% of shoe loss due to rider error consists of front shoes being stepped on by hind feet.

Even drivers can cause shoe loss in harness racing, says Wilt. On the racetrack, the driver might have to keep the horse “doubled up” (maintaining a strong pull on the lines to keep the horse from pacing or trotting too fast). Because racing Standardbreds must move at an extended gait, this restraint will not allow the horse to extend his forelimb stride. So, a hind foot might grab a shoe off the diagonal front foot. This can also occur when going slow or jogging on the track, because the horse might switch from a trot to a pace and the hind foot might grab a shoe off the opposite front foot.

Kraus and Wilt say working a horse in any discipline when he is sore or not properly conditioned for the job can result in fatigue, sloppy movement, and interference resulting in a pulled shoe.

Management issues that can cause horseshoe loss are vast. Frederick Wright, a graduate of Cornell University’s Farrier School, has been a practicing professional farrier in the Hartford, Connecticut, area for about five years. He says there is definitely a season for lost shoes, with wet, muddy ground being the worst. Exposure to excessive wet and muddy conditions allows the hoof to become soft and, therefore, the nails no longer hold tightly. Wright says when horses walk in deep mud, the front feet are not moving out of the way fast enough before a hind foot catches a front shoe. And when hooves are saturated with water, shoeing them is like driving a hot nail through butter and expecting it to stay put, says Wilt.

Kraus notes other issues, including:

• Hooves becoming dry and cracking in dry and arid conditions.
• Stomping at flies, leading to the foot around the nail breaking down and the shoe loosening.
• Inadvertently raking the clinches down in the opposite foot while stomping flies.
• Catching a shoe on wire fencing.
• Poor nutrition leading to improper hoof growth and quality.

Tips to Reduce Rider or ­Management Issues

Overreach boots can help with front shoe loss, says Kraus. When fitted correctly, overreach boots contour to the heel bulbs and can be adjusted for a tight fit with the Velcro closure. Kraus says most bell boots do not fit securely enough and, in deep mud, snow, and sand, tend to rise upward, leaving the heels of the shoes exposed.

Quarter boots for pacing racehorses will prevent the hind foot from interfering and grabbing the diagonal front foot. Quarter boots are firm rubber boots designed to stretch around the hoof to protect the coronary band to the bulb of the heel, Wilt explains. They come in lefts and rights, with the tall side of the boot also protecting the medial (inner) side of the hoof. He cautions that these boots are designed to be worn only during training and racing.

Grab boots are another type of hoof protection for racing harness horses. They fit similarly to the quarter boots, except they are thicker and lower to the ground. They function like a bumper around your horseshoes, says Wilt. These are also only to be worn during workouts and racing.

Duct tape can be the trick for short-term turnout. Wilt says duct tape works well when you are just letting your horse relax and blow off a little energy between racing or training sessions. His formula for tape placement is as follows: Pull some tape out of the roll and position it so both heels are in the middle of the tape. Then wrap the tape around the front of the hoof (staying out of the hairline) and back down to line up with the tape you started the process with. Repeat this about three times around the hoof and cut the tape.

Pulling shoes during the off-season. If the horse has some down time, it can be better for him to go without shoes for that period, says Wright. Wilt agrees, noting that pulling the shoes and giving the horse a pasture trim can save you the time and costs of replacing lost shoes and repairing damaged hooves until the horse gets shod again.

Mud pads or high-traffic pads can be constructed as a pasture management measure to help keep mud to a minimum where horses congregate. A properly constructed pad can provide a sturdy surface for the horses to stand on and will reduce the formation of mud in that area. You can use a variety of techniques and materials when constructing a mud pad. Several university cooperative extension services provide literature and step-by-step instructions on constructing a mud pad area within your paddock or pasture (i.e., bit.ly/40B720W).

Fly leggings or bands might help reduce stomping due to flies. Leggings typically fit loosely and provide a screen or mesh barrier between your horse and the flies. Leg bands contain citronella to repel flies and attach loosely (a two- to three-finger fit) around the horse’s leg just above the fetlock. As with any product, you’ll need to follow the manufacturer’s recommendations for fit, use, and maintenance to see positive results.

Hoof supplements might be beneficial if you determine the horse’s diet is not optimal for hoof health, says Kraus. Equine nutritionist Amy Parker, MS, from McCauley’s Feeds, in Versailles, Kentucky, says hooves rely on an adequate supply of essential nutrients. The most common mistake is feeding less than the minimum required amount of a feed as directed by the manufacturer, which can lead to deficiencies, particularly in trace minerals and vitamins, she says. If all nutrient requirements are being met, then a hoof supplement containing biotin (minimum of 15-20 milligrams per day), the essential amino acid methionine (minimum of 2,500 milligrams per day), and zinc (minimum of 175 milligrams per day, but make sure you don’t feed more than 500 grams in the horse’s total diet) might help. Because you are affecting new hoof growth and not the hoof that is already on the ground, notes Parker, hoof supplements must be fed for many months before expecting results.

Horse-Caused Shoe Losses

Horses will be horses and can have too much fun running, bucking, and kicking, accidentally stepping on their own feet and pulling shoes, says Wright. Kraus says other potential horse-related shoe losses include:

• Nervous horses that aren’t paying attention to hoof placement might step on themselves and their shoes.
• Horses with behavior issues such as stall wall kicking, weaving, or pawing might loosen shoes.
• If a horse gets cast in a stall, he might pull a shoe while scrambling to get up.
• A horse that sticks his foot through a fence could pull the shoe off as he brings it back in.

Horse conformation can play a role in shoe loss. For example, long legs and a short back might allow the horse to overstep onto the heels of the front feet, while base-narrow hooves stand closer together, so the horse might step on the inside branch of the shoe. A base-wide, toed-out horse in front might also step on the inside heel of the shoe. Upright hoof conformation can also increase a horse’s likelihood of shoe loss.

Tips to Reduce Horse-Related Shoe Loss

A different turnout or pasture group can sometimes mitigate rambunctious running. Finding a group for your horse that elicits lower energy might limit shoe loss due to excessive play.

Wilt says the real headache with shoe loss is not being able to replace the shoe if a foot has been shredded due to heavy clinches. Cutting the clinches off allows the shoe to come off easily and without hoof damage if the horse does grab it. Even without heavy clinches the shoe stays tight.

Wilt explains that the art of trimming horses involves knowing the difference between how much foot can come off and what must stay.

Take-Home Message

Simple management or riding changes might be all you need to reduce the chances of your horse losing a shoe. Farriers must take all conditions into consideration, says Wright, including the horse’s disposition, routine, and environment and the barn’s management style when determining the best plan for limiting shoe loss.

Lameness arising in the front feet accounts for most soundness issues in horses. However, it has been and continues to be difficult for veterinarians to diagnose a specific injury or source of pain within the foot because the structures can be tough to capture with imaging equipment. Over time, as medical knowledge has expanded, radiography has improved, and MRI has been incorporated into equine practice, we’ve learned a lot about the hoof capsule’s complex anatomy and physiology. The more we understand, the more injuries we can identify. This knowledge has opened doors to many treatment options in the veterinarian’s toolbox. With an accurate diagnosis, the veterinarian can formulate a proper treatment plan and provide an accurate forecast on the horse’s ­prognosis.

In spite of these advances, it’s still important for veterinarians to complete a thorough clinical exam. Visual and hands-on assessment of the horse can provide important clues as to the problem. This information often yields a wealth of knowledge that will help guide the need for diagnostic imaging.

History and Signalment

Knowing the horse’s age, breed, and use, as well as the duration of lameness and how quickly it came on, can help the veterinarian formulate a list of possible correlating problems. For example, a 6-year-old Warmblood show jumper coming up lame following a recent class might be dealing with a soft-tissue injury. Alternatively, a 17-year-old Quarter Horse used for team roping with intermittent forelimb lameness over several months might be dealing with a joint or bone-related injury.

Lameness Exam Findings

A veterinarian can learn much and narrow down possible problems simply by completing a thorough clinical exam. Clues that can help include:

• How the horse moves and travels on different surfaces (packed dirt vs. loose sand);
• How the foot lands and takes off from the ground during travel;
• The lead on which the lameness is most pronounced;
• Response to hoof testers; and
• Response to flexion tests.

Additionally, veterinarians can learn a lot by evaluating hoof capsule conformation and health. Distortions in growth, weakness of the hoof walls, contraction of the heels, and uneven wear of the wall or shoe can result from pain or injury in different parts of the foot, how the horse compensates, and predisposing factors to specific injuries.

Finally, they might be able to determine the cause of lameness with specific diagnostic nerve blocks. Using a local anesthetic drug, the veterinarian can desensitize different parts of the foot to detect the location of pain within the hoof capsule. For example, the commonly used palmar digital nerve block desensitizes the sole and back third of the foot, whereas a navicular bursa block generally targets that structure—which cushions the bone from the deep digital flexor ­tendon—alone. Following a nerve block, the vet assesses the horse to see if he travels differently.

Based on these exam findings, the veterinarian can use digital radiography to assess suspected bony problems, then pursue more advanced imaging if ­necessary.

High-Tech Diagnostics

Magnetic resonance imaging has been labeled the “gold standard” for veterinarians to image the horse’s foot. It can provide detailed information about soft tissue, bone, and fluid within the hoof capsule. It can often help veterinarians identify abnormalities they may not otherwise recognize using other diagnostics. Evaluating the horse’s foot using MRI is noninvasive, safe, and can be done with good accuracy either in a standing sedated horse or a horse lying down under general anesthesia. Though MRI is a great option, it does pose some limitations. It’s expensive, and in some parts of the country MRI unit availability is limited. Additionally, MRI imaging requires interpretation by a trained professional and often reveals more than one abnormality. For this reason veterinarians often look for other clues to help pinpoint a horse’s problem before pursuing an MRI exam or, later, to help determine the significance of the MRI findings.

Take-Home Message

In summary, front foot lameness is common and continues to frustrate horse owners and challenge veterinarians. Fortunately, owner-provided information and a thorough lameness exam can help practitioners start meaningful investigations. MRI has improved our understanding of the horse’s foot and serves as a valuable tool but is not an absolute necessity.

Abscesses are a common lameness cause. What if your usual fix fails?

When your horse comes up three-legged lame, you’ll be forgiven for having a moment of panic. Chances are, it’s just an abscess. You’ll get it to rupture or drain, and your horse will be sound soon.

A hoof abscess typically consists of a pocket of infection located between the sole and underlying sensitive tissues in the hoof. Clinical signs include lameness (sometimes severe), heat in the affected hoof, and a strong or bounding digital pulse—as felt in the digital arteries at the back of the fetlock.

Why is it so painful? There are nerve endings in those sensitive tissues, of course. And everything is surrounded by a hard hoof wall. When the horse puts weight on the hoof, the infection has nowhere to go, and it hurts.

How Hoof Abscesses Form

The infection arrives by way of the hoof. Poor hoof quality is an abscess risk factor.

“If there’s a crack or crevices that bacteria can get up into, that’s a great way for abscesses to start,” says Craig Lesser, DVM, CF. Lesser, who trained as both a farrier and a veterinarian, completed a podiatry fellowship, and is a shareholder at Rood & Riddle Equine Hospital in Lexington, Kentucky.

Stone bruises, thin soles, or hot nails during shoeing are other known causes of abscesses. Hot or close nails are when a farrier drives a nail too close to sensitive tissues.

Often the infection occurs in the white line, where the hoof wall and sole meet, says Richard Mansmann, VMD, PhD, hon. Dipl. ACVIM-LA of Equine Podiatry & Rehab Consult Practice, in Chapel Hill, North Carolina.

Muddy, wet conditions can soften hooves and make them easier to penetrate. During abnormally wet summers, “we see a lot more abscesses,” notes Steve Kraus, BS, CJF, head of farrier services, senior lecturer, and section chief at Cornell University College of Veterinary Medicine, in Ithaca, New York.

“If we have a very dry summer, we see less of them because the feet are tougher,” Kraus says.

Conformation flaws such as toeing out can predispose a horse to abscesses because they place uneven forces on the hoof, he adds.

In this article we’ll focus on steps to take when faced with an abscess, especially one that lingers beyond typical treatment times.

Step 1: Treat the Initial Abscess

OPTION A: Manage It Yourself

When experienced horse owners know they’re dealing with an abscess, many choose to treat it themselves. They’ll soak the hoof in warm water containing Epsom salts and follow by wrapping the hoof.

Lesser suggests applying an Animalintex poultice pad to the sole, then a roll of Conform (absorbent stretch bandage), a cohesive bandage such as Vetrap, and duct tape.

After the abscess ruptures—and you’ll know when it does because it stinks, plus the lameness improves almost immediately—Lesser recommends a few days of non-steroidal anti-inflammatory (NSAID) drugs while continuing to soak and pack the foot. He says he continues to pack with an Animalintex pad until drainage stops, then switches to packing with povidone-iodine.

Lesser is adamant NSAIDs should come after the abscess ruptures, not before. “What these do is they shrink and consolidate the abscess and actually make it a lot harder to find,” he says. Though you might want to give your horse pain relief, he urges you to think of the big picture. “That anti-inflammatory actually will shrink the abscess and just make it slower to rupture.”

Your vet might advise you differently.

OPTION B: Get a Professional Out

Some horse owners prefer to have a vet or farrier look at the hoof before attempting to pack and soak it. Both will try to pin down the precise location of the abscess.

Kraus uses a thermal scanner to compare heat in the sound and unsound feet. During a visual inspection of the hoof, he’ll look for black spots or other obvious signs of where pathogens (disease-causing organisms) might have entered. Mansmann says he uses a wire brush or a hoof rasp to clean the hoof, making it easier to identify these spots.

Farriers and veterinarians often squeeze the hoof with hoof testers, which look like tongs, to see if the horse reacts. Kraus says he goes “around the clock” of the horse’s sole three times to see if the horse jerks his foot every time in the same place.

When they find a crack or entry point, professionals have various tools, including hoof knives, to open the abscess. Opening the abscess can get the drainage started. However, Mansmann and Lesser both discourage digging any further into the horse’s sole.

“I want to investigate that abscess up the wall because the wall is nonpainful,” Mansmann says.

After the vet or farrier gets the drainage started, it’s time to soak the foot and pack it for a few days to help it heal.

If your horse won’t leave his hoof in a bucket to soak, you might try Kraus’ trick: cutting off the top of a used IV bag, filling the bottom with an Epsom salts solution, putting the horse’s hoof into the solution, and then taping the bag around the leg to soak. The idea is to clean out the drainage site of pus and debris.

Step 2: Your Horse Is Still Lame. Now What? Call the Vet.

If you’re diligent about keeping the site clean and dry, abscesses typically heal quickly.

“You can see this thing heal up right before your eyes,” Kraus says. Relief can sometimes be immediate, though other horses might need a few days before they’re noticeably moving more soundly.

“(By) that three-day mark of not making consistent forward progress, I start worrying that maybe there’s something else going on,” Lesser explains. He defines progress as the horse being mostly sound at the walk within three days, with drainage being “minimal to none.”

The three-day deadline isn’t strict. “As long as every day we’re making progress in the right direction, I’m okay with giving us more time,” Lesser says.

If your horse isn’t improving and is still lame four or five days after the abscess first ruptures—or if the abscess never ruptures—our experts say you need to call your veterinarian and get some radiographs. Laminitis is the big fear. This happens when the lamellae (or laminae)—the Velcro-like tissues that hold the coffin bone in place within the hoof—become damaged and inflamed. In severe cases these tissues can separate, causing the coffin bone to rotate downward or sink.

Step 3: Hoof Radiographs

A horse that’s still lame even after a ruptured abscess needs radiographs. The images help the veterinarian ensure the problem isn’t something else, such as a coffin bone fracture, unilateral laminitis (in one foot of a pair), or another type of infection that can occur in the horse’s hoof, Lesser says (more on this in a moment).

If it’s not an abscess and you delay treatment, the problem can get very expensive, he adds, and some of the problems can be life-threatening.

For radiographs, he takes four views. This allows him to evaluate the entire coffin bone, checking for rotation and looking for subsolar abscess space beneath the coffin bone or going up the dorsal wall.

The X ray can show an abscess if bacteria within are producing gas. If it just contains pus, the abscess won’t show up because the fluid is the same density as the sole, Lesser says. If the X ray does show evidence of the abscess, that can guide treatment.

Step 4: Possible Post-Radiograph Diagnoses in the Horse’s Hoof

Radiographs allow the veterinarian to rule out other painful hoof conditions such as, again, laminitis; septic pedal osteitis, which is a coffin bone infection; keratomas, which are benign tumors; a sequestrum, where the body treats a dead, broken-off bone piece as a foreign object; or an actual foreign object in the horse’s hoof. Keep in mind that metal will show up on hoof radiographs but wood won’t.

Quittor, an infection in and around the collateral cartilage, found on either side of the coffin bone and believed to aid in hoof expansion and shock absorption, “often gets blamed on being a recurrent foot abscess as well.” It will show above the coronary band, Lesser says.

The most common nonabscess finding in situations like these is septic pedal osteitis. Radiographs will show a lucency—a dark spot—on the horse’s coffin bone.

The best news comes when the vet finds absolutely nothing.

“You know, 90% of the time the vet is going to take radiographs and say, ‘Hey, there are no changes on the bone, I think we’re okay,’ ” Lesser says.

Step 5: Treatments and Rehab for the Horse

Assuming your horse’s diagnosis didn’t change and the problem is still an abscess, you’re likely going to be soaking and packing again. At this point, Lesser switches the poultice he’s using.

“I reach for what we call an overnight poultice, which is a bran-mash-based poultice we can leave on the horse for 24 hours. That really helps us get drainage,” he says.

The overnight poultice helps get the horse’s foot extra wet so the abscess can rupture on its own—preferably not through the coronary band, Lesser says. But the important part is the abscess ruptures. If it happens in the coronary band, “you’re likely going to have a defect that’s going to have to grow out.”

It takes a year for the hoof to fully grow out, but the horse should be sound while that’s happening, Lesser says.

Your veterinarian or farrier might suggest shoes and/or pads while the horse recovers. “It’s just like a wound anywhere else, except it’s a place that’s very dirty,” Lesser says.

After the abscess stops draining, Lesser packs the site with povidone-iodine to dry out the tract and encourage the hoof to cornify (harden) quickly and prevent bacteria from entering. Some veterinarians prescribe antibiotics after the lingering abscess ruptures, though Lesser says he does that only with bone changes.

Step 6: Preventing Hoof Abscesses

Abscess prevention begins with good basic hoof care. “It starts with consistent trims,” says Lesser, who also suggests shortening the trim cycle could prevent hooves from cracking.

Mansmann agrees. “When in doubt, shorter is better on the cycle,” he says.

Shoes and pads might help protect the bottom of the foot.

Consider, too, how you might adjust the horse’s routine to help keep abscesses from developing in the first place. “In those wet, nasty environments, sometimes avoidance is the best thing,” Lesser says. That could mean “making sure horses’ hooves have a chance to dry out and also trying to avoid those deeper muddy areas.”

Take-Home Message

Any hoof abscess in horses can be frustrating to manage. One that won’t heal can be even more trying. Involve your vet and farrier to get an accurate diagnosis, and be prepared to treat the horse for as long as it takes. Time, patience, and dedication can all help resolve that aggravating abscess.

This article is from the Spring 2025 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

Hoof wall defects are common in sport horses presenting with lameness and loss of use. Successfully managing these horses requires an understanding of why the hoof wall cracks, said Stephen O’Grady, DVM, MRCVS, of Virginia Therapeutic Farriery, in Keswick, during his presentation at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11, in Orlando, Florida.

Why Do Quarter Cracks Occur in Horses’ Hooves?

Quarter cracks in the hoof arise from overloading one side of the horse’s foot, generally the inside—toward the midline. “You won’t see a quarter crack without hoof capsule distortion,” said O’Grady. “And that distortion is going to be caused by an asymmetrical landing, where the lateral (outside) side of the horse’s foot contacts the ground first, then overloading the medial (inside) aspect of the foot. Over time, when the hoof wall can no longer take the excessive loading, it cracks.”

Hoof capsule distortion means the capsule changes shape from what is considered normal or healthy. That distortion relates to the horse’s conformation and how the foot lands on the ground.

Most horses with hoof capsule distortion have a rotational deformity, which means the bone alignment is straight, but they have a narrow chest, and their limbs rotate laterally.

Corrective Shoeing for Quarter Cracks in Horses

“Again, if you have a quarter crack, you have a distorted foot,” said O’Grady. To manage this, take the shoes off for 10 to 14 days and trim the heels so the heels and frog are on the same plane.

“Once everything is on the same plane, there is load sharing by all the structures, and the heels drop down and relax,” O’Grady said. He typically puts a spider plate on these horses. This shoe type protects the heel and redistributes the load to the lateral aspect of the foot.

O’Grady also recommended moving the shoe laterally with an extension. “The shoe can be placed tight or flush on the medial side but then has a one-quarter- to three-eighths-inch extension on the lateral side,” he said. “This moves the center of pressure to the better side of the foot.”

Take-Home Message

Hoof wall defects, such as quarter cracks, can lead to lameness in horses, especially if left untreated. Quarter cracks occur when a horse unevenly loads one side of the hoof as he travels. Farriers can manage quarter cracks using corrective trimming and shoeing, which can help balance the pressures placed on the hoof.

By Amy Rucker, DVM, with Megan McCracken, DVM, Dipl. ACVS

The navicular bone—also known as the distal ­sesamoid—is located within the foot and acts as a fulcrum, altering the angle of the deep digital flexor tendon (DDFT) just proximal to (above) its insertion on the bottom of the coffin bone (third phalanx). Thirty years ago we attributed any heel pain lameness to “navicular syndrome.” Now, with better imaging techniques, we can identify and treat a multitude of navicular-associated issues that fall under the term podotrochlosis, often before bony changes are visible on radiographs (X rays). Injuries can occur to the DDFT, the navicular bone, or a variety of other soft tissue structures within the hoof capsule. How we treat the lameness depends on the information we obtain with our history, physical exam, and imaging findings.

The horse’s history of lameness might vary depending on his stage in the disease process. Acute lameness might be evident in one foot. If the pathology is advanced, the horse might exhibit a shortened stride with both front feet while trotting straight, with inside-leg lameness evident while turning either direction. My favorite way to observe a possible navicular horse is to have the owner trot the horse in hand in a tear-drop shape on sloped ground. The horse might be sound trotting away, then be lame as it turns on the uneven ground. Often a navicular horse is not positive to flexion of the distal limb (fetlock/pastern/coffin joint).

When I look at a foot, I think about what part of it is carrying the heaviest load or has the most force placed upon it. I evaluate the angle of the foot and pastern, the length of the toe and heel, sole depth, the strength of the frog and heel bulbs, whether the horse’s conformation predisposes crushing of the medial (inside) or lateral (outside) heel. Some veterinarians use hoof testers to evaluate for pain, but I find those unreliable due to variations in hoof mass and dryness. I palpate the foot and note excessive fluid/effusion of the coffin joint at the coronary band or DDFT sheath above the heels or thickening of the tendons and ligaments in the pastern area. After examining a horse and watching it in motion, we “block” the lameness out by temporarily anesthetizing local nerves or joints. Most navicular cases improve with a palmar digital nerve block, anesthetizing the heel and sole region. Some require a low ring block to anesthetize the entire navicular apparatus. When the injured area is no longer painful, the horse moves sound, and we know which area of the leg is causing pain, we move to imaging it with radiographs.

Beau, a Tricky Case With a Positive Outcome

Beau was an 8-year-old Quarter Horse gelding purchased for a novice rider as a proven Western performance horse. He was advertised on the internet and had a successful show career with consistent recent competitions. The trainer and rider traveled across several states to try Beau, fell in love with him, and had a prepurchase examination done, where he was deemed sound on physical exam and radiographs. Some of the X ray views offered limited information due to positioning of the foot and amount of exposure and clarity. However, Beau lived in an area without an option for a second opinion exam, so the buyer completed the purchase. 

Beau arrived sound and stayed sound for months before an intermittent left front lameness developed. Initially, the trainer would notice a subtle lameness, but Beau would be sound by the time I performed an exam the next day.  Eventually, I localized the subtle lameness to the foot via nerve blocks and injected the coffin joint with hyaluronic acid and triamcinolone. (These two drugs have different mechanisms to reduce synovitis, or joint inflammation. We also know the steroid triamcinolone will diffuse from the coffin joint into the navicular bursa—the small fluid-filled structure that pads the navicular bone so the DDFT can move over it smoothly.)

Beau’s lameness resolved after treatment, but only for several weeks. When the lameness returned I referred Beau to a hospital for diagnostic imaging. A palmar digital nerve block resolved his consistent left front lameness, and radiographs revealed bony changes of the navicular bone.

At this point, financial limitations would send most horse owners home with recommendations for shoeing changes and other general treatments and a plan to return to work in a couple of weeks if sound. Sometimes, however, we can look beyond the radiographic navicular bone changes and determine whether the acute lameness is due to a different issue, such as a collateral ligament injury to the coffin joint. In this case we performed an MRI on Beau to further evaluate the foot, which allowed us to tailor treatment to his specific issues.

Magnetic resonance imaging enables us to gain additional valuable information about bone and soft tissue. Beau’s MRI showed some of the navicular bone changes visible on the radiographs in more detail. The radiographs had identified a cystic lesion in the navicular bone, and the MRI revealed the lesion was a full-thickness flexor cortex erosion. The scan showed evidence of fluid or edema within the navicular bone, indicating more active or acute injury. The MRI also enabled us to carefully evaluate the soft tissue structures within the foot. Many of these critical structures cannot be visualized with ultrasound, so MRI is often the only way to identify injury. It is especially useful and critical when radiographs are normal because it allows interventions early in the podotrochlosis case.

In Beau’s case we found a core lesion, or central tear, in the medial lobe of the DDFT, as well as fibrillation, or roughening, of the tendon surface. We also saw evidence of inflammation in the navicular bursa (bursitis). The changes to Beau’s navicular bone appeared chronic and probably predated his recent lameness episode. The soft tissue injuries are the likely source of the more acute lameness. As we gain more information about the navicular region, we realize how complicated and interconnected the bone and soft tissue structures are here. With Beau, the roughening of the flexor surface of the navicular bone caused by the chronic erosion likely contributed to his DDFT injury.

These structures’ complicated interplay highlights the need for careful coordination between veterinarian and farrier. As a result of the MRI, we were able to develop a detailed treatment plan tailored to Beau’s injuries. He was started on a rest and rehabilitation program to enable healing of the DDFT injury. This included stall rest and hand-walking. Initially, the hand-walking was only on firm ground. Gradually, we introduced walking in an arena with 6 inches of noncompacted footing. The program slowly progressed to riding at the walk, small paddock turnout, slow introduction of trot work, and a gradual return to full work and turnout. During the months of recovery, the ground conditions were strictly controlled: Beau was never exercised or turned out in uneven or deep footing.

When treating soft tissue injuries it is important to give them time to heal and to increase work gradually to encourage the greatest strength in healing. Avoiding sudden exaggerated movements that might cause re-injury is critical. In addition to the rest and rehabilitation plan, we treated the inflammation in Beau’s navicular bursas with triamcinolone injections. Beau also received bisphosphonate injections. Bisphosphonates have been shown to increase comfort in horses with osseous changes to their navicular bones by inhibiting bone breakdown and resorption.

We also devised a podiatry plan to reduce breakover and tension on the DDFT. Consistent, careful farrier work is critical to success with these patients. Typically, horses with flexor cortical erosions tend to have poor prognoses for return to work and prolonged soundness. But due to the diligent care of his owners, veterinary team, and farrier, Beau returned to performance. If this plan had not led to Beau returning to soundness or if he re-injured himself, we could have pursued additional treatment options. These include navicular bursoscopy, where we use a small camera and instruments to visualize the navicular bursa and remove proliferative synovium, fibrous tissue, and any adhesions that might be present. Another option would be injecting the DDFT lesion directly with platelet-rich plasma or stem cells—either in conjunction with a navicular bursoscopy or with MRI guidance.

Take-Home Message

As veterinarians we do the best we can with radiographs, but MRI provides a more accurate look at pathology, including bone inflammation (not just the bone remodeling evident on X rays). Beau likely came to us with the navicular cortex lesion in his left front and was able to perform until he developed associated lesions in the DDFT and navicular bursa. (Beau’s right front foot had similar bony changes but no soft tissue lesions, and he remained sound on that foot.) 

Beau’s MRI dictated a six-month rehabilitation program in a controlled environment. Unfortunately, many horses with Beau’s initial exam findings and radiographs have their coffin joints and/or navicular bursas injected with medications and return to work when sound (or are turned out in paddocks or pasture with uneven footing), and activity creates further injury. My goal with horses is to maximize their ability to work for a lifetime. In Beau’s case we have made every effort to heal his acute lesions and returned him to work at a lower level.

Beau is still ridden in performance classes but is no longer doing cattle work because we question his ability to stay sound with sudden changes in speed and direction. “Finished,” show-ready 8-year-old horses that can be ridden by an amateur usually come with some orthopedic baggage. I hope our team approach allows Beau and his baggage to continue their journey with a happy owner for years to come.

How to feed your horse for strong and healthy hooves

Nutrition impacts everything from performance and temperament to growth and metabolic rate. Hoof quality is no exception. It can take up to a year for a full new hoof to grow, so what your horse eats today could impact his soundness much further down the road. In this article two equine nutritionists—Lynn Taylor, PhD, and Ashley Wagner, PhD—shed light on the do’s and don’ts of feeding for optimal hoof health.

The Recipe for Healthy Hooves

Your horse’s diet plays a crucial role in the quality and durability of the horn that makes up his hooves. Horses require certain nutrients in specific amounts and ratios to grow and maintain strong hooves. However, even the perfect diet is not enough by itself to grow good feet—­several other factors come into play. Management, exercise, metabolic rate, hoof care including trimming and shoeing, overall health, genetics, and climate (moisture levels, in particular) can all affect the appearance and strength of horses’ feet—and not always for the better. The bottom line is hoof health requires a very holistic (whole horse) approach.

The Hoof Is a Living, Breathing Organ

You’ve probably noticed those well-defined horizontal ridges that encircle some horses’ feet, but do you know what they are or how they came to be? Growth rings, as they’re known, show how the hooves have responded to the horse’s diet and health over time. They can appear following a period of systemic illness or reflect changes in nutrition—for example, when a horse consumes rich grass in the spring or suffers a bout of starvation. Monitoring the appearance of your horses’ hooves regularly will help you track progress and identify potential nutrition-related problems.

Keep in mind that the hoof grows slowly (about one-third of an inch per month), from the coronary band down and from the inside out. This slow growth rate means months will pass before your horse’s current health and dietary status starts to manifest in his feet. Taylor, a professor of equine science at Centenary University, in Hackettstown, New Jersey, and the owner of a private equine nutrition consulting business, says that in some cases she’s had to wait more than 18 months to see real changes. This extended interval is, in her experience as a consultant, the No. 1 issue horse owners face when adjusting diet to improve hoof quality. For example, they might add a new supplement but give up before the product has had time to produce visible results. Patience and persistence are key.

Feeding the Feet: Ingredients That Build Strong Hooves

Energy

Starting on a very basic and fundamental level, horses grow strong and healthy hooves by consuming enough energy. Here’s why this is so important: A horse that burns more calories than he consumes will save these precious energy-packed calories for vital organs and bodily functions, while external structures such as hooves and hair get the short end of the stick. Balance, however, is key. A horse that consumes an energy-rich diet that is too high in the nonstructural carbohydrates starch and sugar is at an increased risk of developing laminitis (a debilitating hoof disease that occurs when the laminae suspending the coffin bone within the hoof capsule fail). The same can be said of a severely overweight horse; obesity increases the chance of developing metabolic disturbances similar to diabetes in humans, which can also lead to laminitis.

Protein

The healthiest horses have balanced diets, meaning they receive all the necessary nutrients in correct amounts and ratios, with no imbalances, excesses, or deficiencies. Certain ingredients affect hoof health specifically, and protein is high on that list. This is primarily because the hoof horn is composed of an insoluble protein called keratin.

“Keratin provides the unique combination of strength, hardness, and flexibility of the hoof capsule,” says Wagner, who also runs an equine nutritional consulting business from her home base in Cheriton, Virginia.

Like all proteins, keratin is made up of amino acids, which the horse digests and uses to build and maintain various body tissues. Specific amino acids exist naturally in the hoof and help ensure its proper structure and function. These include cystine, arginine, leucine, lysine, proline, serine, glycine, and valine, as well as lower amounts of methionine, phenylalanine, and histidine. That’s a lot of ingredients to remember, so a good recommendation is simply to feed a diet containing all 10 essential amino acids, because adding only certain ones to the diet has the potential to throw it off balance. What makes certain amino acids “essential” is the body’s inability to produce enough of them naturally. The horse must, therefore, ingest them in his diet in the form of protein. While protein is essential for hoof health, beware of excesses. Overfeeding protein is a waste of an expensive ingredient and can be detrimental in hot weather because digesting it generates extra body heat and increases water requirements. This can be problematic for high-performance horses that travel and exercise in hot, humid conditions, because these athletes are already predisposed to dehydration and heat stress.

Fat

This nutrient by itself doesn’t improve hoof quality. However, it contributes greatly to energy intake, indirectly supporting hoof health. Feeding fat also helps maintain a barrier in the hoof, keeping bacteria and fungi out. Fat is a safe and effective energy source for most horses and benefits many structures beyond the hoof.

Biotin

Nutritionists consider vitamin B7, better known as biotin, to be the single most important vitamin for hoof health. Biotin contains sulfur, an element that contributes to the strength of the bonds between collagen strands in connective tissues, including in the hoof wall. Several studies going back decades have shown biotin to be effective at restoring the strength and elasticity of a hoof wall with structural defects (Kempson 1987; Wintzer 1986). The good news is biotin exists naturally in grass, concentrates, bran, and yeast, so your horse is probably already getting the recommended dosage of 15-20 milligrams/day (that’s for the average 1,100-pound horse). Because biotin is a water-soluble vitamin (as opposed to a fat-soluble one), the body simply excretes any excess, eliminating the risk of toxicity and making it very safe to feed. Some horses, however, respond better to biotin supplementation than others.

“It is not a silver bullet,” Wagner explains. “Biotin seems to be beneficial specifically for horses with brittleness of the hoof due to deterioration of the stratum externum (the outermost layer of the hoof wall).”

Gut health

Another ingredient in the healthy hoof recipe that you might not immediately consider is the beneficial bacteria in the digestive tract. “Supporting a healthy gut microbiome is critical because the microbes in the hindgut produce B-complex vitamins, which may assist with blood flow to the hoof,” Taylor says.

Wagner even recommends considering a general gut health supplement. “If there are gastrointestinal issues in digestion and absorption or with microbial dysbiosis (imbalance), then the utilization of the nutrients fed is also reduced,” she says.

Minerals

Of the key minerals, zinc plays an important role in keratinizing and maintaining hoof strength. Research has shown that weak hooves are sometimes associated with low zinc levels in the blood (Harrington et al., 1973). Horses also need calcium to bind cells to each other in the horn. Feeding the correct calcium-to-phosphorus ratio is a tenet in equine nutrition, because excess phosphorus can interfere with calcium absorption and cause an array of health problems. It’s important when considering hoof health, because a lack of calcium can weaken the hooves.

Indeed, just like amino acids, “minerals function in groups,” Taylor says, “and changing the amount fed of one or two can disrupt the absorption and utilization of other minerals.”

Feeding too much zinc, for example, will compromise copper and iron metabolism. Selenium helps build strong hooves, but excessive amounts actually compromise the horn’s quality, as can too much of the amino acid methionine. It’s all about finding an equilibrium in the nutrients.

“Always make sure the horse’s diet is balanced,” Wagner urges. “An unbalanced diet can negatively impact many areas of health and condition, including hoof health.”

When to Turn to Supplements

Owners, veterinarians, and farriers have reported anecdotally that many nutritional supplements help with brittle feet and hoof cracks, but independent scientific research only supports those containing biotin and methionine. In 1990 a research team from the University of Edinburgh, in Scotland, added a biotin/methionine product (Farrier’s Formula) to the diets of 18 horses with either hoof cracks or flat, bruised feet. All the study horses had improved hoof horn structure (as assessed on a microscopic level) six weeks after supplementation began. These changes were visible to the naked eye, as well. Once they’d grown quality horn, none of the horses relapsed during the two-year experimental period.

Taylor and other nutritionists usually find that horses with good feet don’t tend to show much improvement with supplements, most likely indicating that their basic diet is already meeting all the hooves’ needs. This suggests that your money is best spent making sure your horses’ diets are complete and balanced and feeding nutritional hoof supplements only to those with weak or cracked hooves. And, as always, consult your veterinarian or equine nutritionist to discuss adding any supplement to your horse’s diet.

Take-Home Message

“Horses are individuals and, whether they are shod or barefoot, all have individual hoof health needs,” Taylor says. “There is no ‘ideal’ diet that should be applied to every horse, but every owner should look carefully at the hoof in the context of overall health, environment, exercise, and diet.”

And keep in mind that today’s diet is tomorrow’s hoof—so give your horse the best chance at long-lasting health and soundness.

Laminitis is an extremely painful condition for horses that can take extensive management to resolve. Therefore, preventing the development of this disease is important for equine welfare. Endocrinopathic laminitis is the most common type of laminitis that originates from a hormonal disturbance or imbalance.

“The term the industry is moving toward to describe this type of laminitis is hyperinsulinemia-associated laminitis (HAL),” says Andy Durham, BSc, BVSc, CertEP, DEIM, Dipl. ECEIM, MRCVS, RCVS, European Specialist in Equine Internal Medicine at Liphook Equine Hospital, in Hampshire, U.K. “This term is more specific, as it is telling you what that hormonal imbalance is.”

Horses that develop HAL can’t control their insulin, so they have high circulating blood insulin levels either at rest or when challenged with sugars/starches in the form of a meal or an oral sugar test, adds Amanda Adams, PhD, associate professor at the University of Kentucky’s Gluck Equine Research Center, in Lexington. The high insulin levels are what trigger the events in the hoof that lead to laminitis. “It is thought that the insulin binding to the insulinlike growth factor causes stretching and damage to the laminar tissue in the hoof.” Researchers are still working to understand how high the insulin level must be and for how long for HAL to occur.

Understanding how to prevent endocrinopathic laminitis is one of the best ways for owners to ensure better welfare for their horses.

1. Identity Your Horse’s Risk Factors

Three main categories of factors make horses more likely to develop HAL: Having PPID (formerly known as equine Cushing’s disease) or equine metabolic syndrome (EMS) or being on glucocorticoid drugs (steroids), says Durham. All three of these factors stimulate blood insulin levels and work through the same mechanisms.

“These risk factors are not mutually exclusive,” he adds. “For example, if you have a fit Thoroughbred on glucocorticoids, the risk of HAL is quite low, but if you combine these risk factors and have an EMS pony on steroid medication, that risk will be much higher.”  Identifying these risk factors early can be key to mitigating risk. Adhere to the following recommendations if you know your horse is at risk.

2. Reduce Your Horse’s Risk

Maintaining your horse’s healthy body condition and a diet low in nonstructural carbohydrates (NSCs) can reduce some of the risk. An active horse is at a decreased risk of HAL, says Durham. Therefore, if you have an obese horse that could be at risk for developing insulin dysregulation (ID), our sources recommend adapting his diet and increasing exercise before serious health consequences arise. Consult your veterinarian and equine nutritionist to develop an optimal plan for your horse if you suspect he is at risk of HAL.

Horses suffering from HAL need to be managed to lower their blood insulin levels. “This is not a one-size-fits-all; it will vary for each individual case,” says Adams. “Start with diet changes and exercise, provide a low-nonstructural-carbohydrate diet, remove the horse from pasture, add exercise, and consider additional dietary restriction if required.” For dietary management, she recommends consulting an equine nutritionist who has experience managing horses with insulin dysregulation.

3. Test Insulin Levels Regularly to Prevent Endocrinopathic Laminitis

“The favored explanation is that normally insulin does not interfere with the insulinlike growth factor receptors in the hoof; however, when you have elevated levels of blood insulin the receptors can be stimulated, which interferes with the laminae and disturbs that laminar attachment,” says Durham.

Thus, practitioners recommend monitoring these horses’ insulin levels regularly with bloodwork. “For horses that are at a higher risk of developing HAL, it is a good idea to consider yearly or biyearly wellness exam bloodwork to diagnose insulin dysregulation or monitor insulin levels over time,” says Adams.

The best practice is to rely on blood insulin levels as a guideline to management and not simply focus on a diet that is less than 10% NSCs, adds Durham. If you have a high-risk horse (e.g., overweight, predisposed breed, diagnosed with EMS or PPID), discuss regular testing with your veterinarian.

Sugar does not cause laminitis; rather, insulin does, and because every horse responds to dietary sugar differently, their responses to dietary adjustment will vary, says Durham. Therefore, following that 10% NSC threshold might not be completely reliable. After making dietary management changes, even in consultation with an equine nutritionist, it is optimal to retest blood insulin levels to ensure the updated program has adequately reduced the blood insulin level in that horse, he adds.

“Less than 10% NSC content of the diet for insulin dysregulated horses will work for most, but may not work for all of them; therefore, relying on testing their blood insulin levels to ensure the NSC level of the diet is low enough is ideal.”

4. Consider Pharmacological Treatments

When management changes are not successful, practitioners might recommend pharmacological treatments for reducing the risk of HAL in your horse, says Adams. “These might include levothyroxine, metformin, SGLT-2 inhibitors, or GLP-1 analogues.”

Take-Home Message

Understanding the risk factors of HAL and knowing if your horse is at risk is essential. Although sugar plays a crucial role in insulin release, blood insulin testing is vital when making management changes. Adjusting diet and exercise to promote lower blood insulin levels can make a significant difference in preventing endocrinopathic laminitis in high-risk horses.

Care considerations and tips for making the switch to 24/7 turnout

If you’re considering changing your housing system to 24/7 pasture, you’re not alone. As scientists reveal more equine welfare benefits of keeping horses out full time, owners are opening their minds—and their barn doors—to a more “natural” way of life for their equids.

Free to roam, graze selectively, and interact with herdmates, horses on 24/7 pasture have more opportunities than stalled horses to meet their ethological (behavioral) needs, researchers say. Not limited to leisure horses, breeding stock, or retirees, pastures can make great homes for horses of all breeds and disciplines, the exception being those at risk of laminitis.

But good pasturing isn’t just about turning horses out and letting them adapt to whatever they encounter. There’s plenty of management left for us to do—and it’s not always as obvious as it might seem.

“People who practice group housing understand that it actually demands much more of the caretaker (than traditional housing),” says Jan Ladewig, DVM, PhD, professor in Animal Welfare and Ethology at Copenhagen University’s Department of Large Animal Sciences, in Denmark. “It requires more knowledge about horse behavior in general, as well as more knowledge of each individual horse.”

Katie Sheats, DVM, PhD, Dipl. ACVIM, assistant professor of equine primary care at North Carolina State University, in Raleigh, agrees. Her university keeps a teaching herd on pasture 24/7. “There’s a misconception that it’s easier,” she says.

From skin and foot care to nutrition and mental state, we continue to have an important role in overseeing the health and welfare of our pasture-kept horses.

Hydration

Water is “the most important nutritional component,” Sheats says. Like stalled horses, those at pasture need a constant source of clean, readily available water.

“If they have still water in a large tub, it has to be checked daily,” she says. “First and foremost, you have to make sure it’s still there.”

Horses’ water consumption can change according to weather conditions and workload, and tubs—whether plastic, metal, fiberglass, or concrete—can break or leak.

Clean water can also turn filthy in a hurry, depending on how frequently you empty it, sunlight exposure, and what falls into it, she adds. Leaves and branches can rot over time, and wild animals can fall in and drown. Animal decomposition can contaminate the water with bacteria that can provoke serious diseases in horses such as botulism.

Algae can build up over time in still-water tubs and, while a small amount is rarely a problem, if water becomes unpalatable, horses might stop drinking, putting them at risk of dehydration. “It is recommended to scrub buckets and tubs once a week,” says Sheats, who keeps her own two horses on a home pasture 24/7.

Automatic waterers can relieve handlers of constant cleaning and refilling duties, she says. But they and the pipes that feed them can pose their own challenges, such as freezing in winter. “It’s good to check them twice a day to be sure they’re still running,” she says.

Another issue: Most automatic waterers don’t give feedback on consumption (a few do). “If you can’t see how much the horse is drinking, you’ll need to keep an eye on his hydration status by ensuring his skin springs back quickly when pinched and gums feel moist,” Sheats says.

Nutrition

Equine diets are very individualized. Hard keepers might need access to more abundant, richer forage, whereas easy-keeping “fat little ponies” might do better “kept on pastures that have been grazed by other animals so that they have to work more—and take more steps—when grazing,” Ladewig says.

Most horses in light to moderate work living on pasture 24/7 typically do well on their natural forage diet complemented by trace minerals and a ration balancer, says Sheats. But, she adds, this will depend on pasture grass, geographic location, and time of year. “In our region,” Sheats says, “it is common to supplement pastured horses with hay, because pasture acreage is often too small or stocking density is too high to maintain an adequate supply of nutritious grasses year-round.”

Growing horses, hard-working athletes, and pregnant/nursing mares might also need more calories than grass alone can provide. Because each pasture and animal is unique, evaluate individual nutritional needs on a horse-by-horse basis.

“The best you can do is pay attention to the condition of the horse—in other words, noticing if their ribs are standing out or if they are completely buried in a layer of fat,” says Ladewig.

If your horse falls into the “layer of fat” category, you’ll want to intervene, because obesity can increase horses’ risk of joint issues, laminitis, and other health concerns, says Patricia Harris, MA, VetMB, PhD, Dipl. ECVCN, MRCVS, RCVS, head of the Equine Studies Group at the WALTHAM Petcare Science Institute, in Waltham on the Wolds, U.K. She and her team have studied strip grazing as a useful tool for restricting weight gain in pastured horses.

With strip grazing handlers keep horses in a fenced-off section of a larger pasture, and they move the fences over by about a foot every day (keeping the same size fenced-in area). This keeps equids grazing all day on overgrazed areas, with a strip of ungrazed, more nutritive grass consistent with their dietary needs, says Harris.

Grazing muzzles can be a useful alternative, provided they fit correctly and you check them regularly. Many horses, however, learn to graze very efficiently through them, so monitoring body condition remains critical.

On the flip side, horses on poor-quality pastures (especially in winter) and underweight horses need additional forage and/or complementary feed. The goal is to ensure they have enough free-choice forage to meet their needs for chewing and consuming most of the day and night.

Hoof Care

Horses at pasture might not need shoes as much as their stalled counterparts because they move around more normally than when they’re standing all day, our sources say. Without shoes, blood circulation in the foot increases, allowing the hoof wall and sole to thicken, says Ladewig. If you remove your pastured horse’s shoes, however, note that it can take several months to more than a year for this thickening, particularly of the sole, to occur.

Removing shoes, at least the hinds, is also safer for horses sharing the same living space, he adds, as shod horses can cause more damage when they kick.

However, don’t cut back on farrier visits, says Sheats. “People often think, ‘Oh he’s outdoors and barefoot, so he can go longer, maybe eight weeks, between trims,’ ” she says. “But it depends on the horse. In some cases waiting eight weeks between trims can lead to overgrown toes and flat feet.” 

Rather, more frequent trims, every three to four weeks, can help restore and maintain a healthier hoof for barefoot pasture horses, she explains.

If a horse works on hard or rocky terrain, has certain foot/limb conditions, or performs in a concussive discipline such as show jumping or eventing, though, he probably needs shoes even as a pasture horse, says Ladewig.

Ideal pasture footing is firm, grassy ground, Sheats says. But even in optimal enclosures high-traffic areas often get muddy, which can lead to hoof cracks, white line disease, and other foot ailments. Owners can improve footing in high-traffic areas with ground stabilizers and good drainage, she says. When pastures get muddy, establish a rotation schedule and temporarily fence off sections to give them a chance to recover from constant treading.

While it’s important to pick horses’ feet every day—especially to check for injury or lodged rocks—the most critical thing is daily observation, Sheats explains. “You need to notice if he’s not walking normally so you can intervene right away, and you need to know when was the last time he was walking normally, because that’s important information to tell the farrier and vet,” she says.

Preventive Care

Healthy adult pasture horses typically need twice-annual wellness exams and preventive care visits, says Sheats.

“These visits are the best way to keep a horse in optimum health by preventing vaccinatable diseases, maintaining oral health, identifying issues that require correction (i.e., performance problems, weight gain or loss, hoof issues, dental abnormalities), assessing maintenance of chronic health conditions (e.g., pituitary pars intermedia dysfunction, equine asthma), and achieving early diagnosis of a new disease that may have insidious onset,” she explains. “At these visits the veterinarians can also answer management-related questions and provide owners with access to additional resources.”

Skin and Thermodynamics

Away from the protective cover of the barn roof, horses’ skin and hair get a lot of exposure to the elements. Moisture is the main concern, which can put horses (especially those in warmer climates) at risk of developing the bacterial disease rain rot, says Ladewig. Still, healthy coats usually have an oily skin coating that helps ward off moisture, he adds.

Regardless of coat quality, horses should always have access to shelter or shade trees so they can choose to get out of the rain, wind and other severe weather, or sun. Regular grooming—one or two times a week—can also remove dirt and air out the skin, helping prevent bacterial growth. If your horse does develop rain rot, keep him indoors or put a rain sheet on him during wet weather while he heals.

Shelter is also critical for protecting horses—especially those with white hair and pink skin—from sun exposure. In addition, it can give them a break from flying insects. You might need to apply sunscreen and insect repellent to sensitive horses more frequently. 

Blanketing horses can disrupt their natural thermodynamics, Ladewig says. If they’re kept outdoors and left unclipped, most horses grow enough hair to stay warm in winter, especially if you provide them with adequate supplemental forage, which helps them produce heat through the “internal combustion” of digestion. Blankets also deny horses the insulating effect of piloerection—raising of the hairs by skin muscles when it’s cold out.

Body-clipped horses, seniors, and more cold-sensitive breeds such as Thoroughbreds and Arabians, however, might need blankets during particularly cold and windy days, Ladewig says. Lethargic or shivering horses might be too cold and, if they have body temperatures lower than 99.5 degrees Fahrenheit, need a blanket. Just remember to remove blankets regularly to check for rubs and body condition, says Harris.

Herd Dynamics

Releasing a group of horses together in a pasture can be dangerous if not done correctly, our sources say. It’s an art that requires careful observation and knowledge of individual horses and their relationships with each other.

Horses develop complex hierarchies over time, and the best situation is when the groups are stable, says Sheats. “It’s the introduction and removal of a horse from a group that can upset the structure and create problems,” she explains.

When introducing a new horse, group him with one or two “calm” herd members, separately from the others, for a few days before putting everyone together, suggests Ladewig. Generally speaking, larger groups and larger pastures allow for more peaceful hierarchy establishment after this initial introduction to a few horses—probably due to the extra space that lets them distance themselves when needed, he adds.

Ensure lower-ranking individuals can access food, water, and shelter without the risk of getting trapped, our sources say. Keep food and water away from fences, and offer them at several locations set far apart from each other. Avoid shelters with only one door; they should either be fully open on one side or have two doorways so lower-ranking horses can escape when needed.

Good Security

Stalled horses rarely end up loose on a road because they have so many barriers keeping them in. But pasture horses often have a single line of fence stopping them from free-roaming, so regular fence checks are critical, says Sheats.

“Walk the perimeter or drive it every day,” she recommends. “Better yet, have a double perimeter, especially if your farm is near a busy road.”

Falling trees, wind, and the horses themselves can down fences, and a second security fence can keep them safe, she says. For electric fences, regular maintenance includes checking the current and controlling grass/weed growth under the bottom strand, because this can interfere with the electrification. “I have a current detector box that informs me if there’s an issue, so that simplifies things,” Sheats says.

Never leave your horses more than a day without having someone check on them, she says. Even if they’ve got unlimited food and water, they still need someone to look out for their health and safety in case of injuries, fence failures, or sudden illnesses such as colic.

“At the very least, someone needs to come close enough to make a visual inspection, make sure they’re ambulating normally, appear to have a good appetite, and that their water is okay,” says Sheats.

Take-Home Message

It takes time and effort to maintain horses on 24/7 pasture in groups, says Ladewig, but knowing your horses are happier and healthier outdoors is worth the work.

Q: What management changes should I keep in mind for a horse with a history of equine metabolic syndrome (EMS) and laminitis? Is there anything I need to keep a closer eye on than I would with another horse?

A:  A horse that has chronic laminitis will often have thin soles and poor hoof integrity. So chronic horses—those that have already experienced coffin bone rotation or displacement—will be more predisposed to having sore feet. Chronic laminitis cases usually require external appliances (such as shoes) to maintain comfort. If the horse is footsore, make sure to pick his feet out regularly. I know that sounds simple, but make sure they don’t have packed mud, dirt, or rocks that apply pressure to their sole. You would be surprised how many times regularly picking feet does not cross peoples’ minds.

If you have a horse that’s been diagnosed with EMS (characterized by increased fat deposits, insulin resistance, and laminitis risk), be really diligent with watching for changes in the grass. If they are muzzled, make sure the muzzle is staying on, and pay attention to their weight. It is easy to accidentally let them get overweight and not realize small but significant weight increases when you see the horse every day. Watching their overall body condition score and trying to maintain that at a healthy rating (of 4 to 6 on the 1-to-9 scale) is important. 

Any kind of slow feeding option can also help. Haynets can limit the amount of hay they are eating at one time, and paying attention to those small management changes makes a difference. Using a drylot and limiting access to grass is important. Once they are diagnosed with EMS, it isn’t something that ever truly goes away. You can manage it, but as soon as you stop managing it, the primary cause is still there, so the insulin levels just go right back up. That is something we run into a lot—we treat the horse and get the body condition score to a healthy point, and then the owner feels that the horse is doing really well, and they turn them back out in the pasture. And then two months later we are right back to the start, treating the same thing again. They did not fix the horse, they just maintained the horse. Caring for a horse with EMS is a long-term management situation, and staying ahead of potential issues is better than needing to treat problems once they occur.  

Q. Can how a horse is shod improve how he moves in the show ring?

A. Shoeing can improve how a horse moves in the show ring in many ways. When we can consider horseshoes’ impact on movement, we must consider three factors: conformation, hoof trim, and type of horseshoe. We should examine them separately so we can understand how each factor contributes to the whole.

Conformation

Once a horse reaches maturity, there is very little shoeing can do to safely alter a gait related to limb conformation. Trying to alter a less-than-ideal gait can add extra stress on joints, bones, and hooves, so any benefit will be short-lived and ultimately not appropriate for the horse’s health. The same can apply to hoof conformation to a certain degree. In these cases, we need to assess the hoof to discover if a hoof abnormality is due to excess hoof length or inappropriate trimming, which are very fixable, or if a permanent conformation problem exists. An example of the latter is a club foot. These horses tend to have one foot at a lower-than-ideal angle and a club foot with a very upright conformation. The difference in angle between the feet makes it impossible for the two legs to move similarly. Trying to alter the angles can lead to similar pressures on limbs, joints, and hooves as we see when we try to alter gait in a poorly conformed horse. We can try to make them closer to ideal, but usually the change is negligible. Many horses do very well with mismatched feet, but the difference in stride length may have negative effects on hunter or dressage scores.

Trim

The key to any shoeing job is how well the hoof is trimmed. The goal is to trim the foot to match the conformation of the leg and offer maximum weight-bearing support under the limbs. Some farriers, usually under the instructions of a trainer, will try to alter the trim (e.g., raising or lowering the heels) to make a stride more appropriate for a discipline. This can give a short-term fix, but when we alter where the hoof should be, we are adding pressure and stress to focal parts of the hoof. This excess force can lead to such problems as quarter or toe cracks, sheared heels, and flared walls. No matter how hard we try, we can’t use trim to overcome the forces of conformation.

Shoe type

That leaves us with the horseshoe type and placement, which is where we can make a safe difference. For example, aluminum shoes are much lighter than steel shoes and can have a significant impact on stride. A heavier shoe causes the horse to raise his knees higher to position to limb to land appropriately. If you desire your horse to have a long, flowing stride, a lighter shoe can reduce knee action. We always have to consider what a horse does for a living, however. Having a jumper land on aluminum shoes might not provide the support he needs, whereas a hunter jumping lower fences might move better with lighter shoes and might not require the hoof and limb support that steel offers.

We can also influence stride by where we position the breakover of the shoe in the toe region. The breakover is the moment the hoof rolls over and the toe is just about to leave the ground. A shoe placed just back of the hoof might break over a bit quicker than one that is flush with the toe of the hoof or slightly ahead of it. A few years back, we used to set hind shoes back on jumpers so they wouldn’t overreach and pull off front shoes. We have since learned that the quick breakover behind can put strain on the stifle, and we have returned to fitting hind shoes to the natural, more pointed toe, which allows the horse to dig in to propel itself forward.

When shoeing horses we need to consider the horse’s job and conformation. We should strive to shoe the horse according to his hoof and leg conformation while considering what he does for a living. Like riding, the more we can get out of the way, the better we can let the horse’s natural abilities shine.

Do you have performance horse health questions? Send them to editorial@thehorse.com. 

Review the latest research findings on horseshoes and hooves

Fewer than 200 evidence-based papers have been published on hoof care in the past 40 years, says Patrick Reilly, Grad. Dip., chief of farrier services at the University of Pennsylvania School of Veterinary Medicine, in Kennett Square. Of those, only a fraction focus on how horseshoes affect a horse’s hoof.

Reilly explains that most of what scientists know about the interaction between shoes and bones in the feet comes from research completed in human athletes. As a subject in a University of Delaware biomechanics study, he learned that wearing shoes changes the function, bone density, and structure of the foot.

“That is really similar to what I think is going on with horses,” he says. “Do horseshoes change the structure of the foot? Probably. I don’t think anybody has a problem saying that, but that doesn’t make horseshoes inherently bad.”

Vanessa Dahl, MS, a PhD student in animal science at the University of California, Davis, School of Veterinary Medicine, agrees.

“Shoes have a purpose in protecting a horse’s foot,” she says. “We ask horses to do jobs or athletic events that go beyond the wearing down of hoof under natural circumstances, so shoes help to protect them from that excessive wear.”

She adds that modern breeding trends focus on athletic capability rather than hoof quality. As a result, the genetic selection for good hoof quality tends to be poor. So, in the case of protection, shoes can significantly impact keeping horses sound, especially those with poor hoof quality.

Reilly and Dahl say much more research is needed to better understand how horseshoes influence the hoof and a horse’s gait, but here’s a look at what studies reveal.

Studies Exploring the Impact of Horseshoes on Hooves

One of the primary concerns critics have regarding horseshoes is their potential to restrict the natural expansion and contraction of the hoof during locomotion. Researchers on these four studies sought to understand this connection.

1. “Heel movement in horses: comparison between glued and nailed horseshoes at different speeds” (tinyurl.com/5n6h5pth)

In 2010 a research team in Japan examined whether shoes affected heel movement. They evaluated different shoe types but focused on direct-glue aluminum shoes, finding that glue-on shoes “restricted heel movement, suggesting possible interference with shock absorption and blood pumping in the hoof.”

“Did the glue-on shoe affect heel movement in horses?” Reilly asks. “The answer was absolutely. But I would also say there are a lot of horses that compete in direct glue-on shoes.”

When Reilly direct-glues a shoe, he tends to do so for short periods. He limits their use to two to three shoeing cycles and then gives the horse a break or uses other footwear, such as flexible polymer shoes, to circumvent the issue.

“We can create problems by immobilizing the foot and not letting it deform enough,” he says. “The trouble is when all that strain builds up in the hoof, it has nowhere to go and eventually starts damaging some of the tissue in the hoof. That’s an extreme case, and common sense says that (with) different horses, different feet, and different amounts of heel movements—there is a happy medium.”

2. “The effect of horseshoes and surfaces on horse and jockey center of mass displacements at gallop” (tinyurl.com/4f5c24tz)

In 2021, researchers at the Royal Veterinary College (RVC), in the U.K., released findings after investigating the impacts of horseshoes on horses and jockeys when the horses were galloped on different surfaces. The RVC summarized key findings on its website, and they include:

Vertical (dorsoventral, extending from the back to the underside) displacements differed most significantly among the tested conditions.

The artificial track surface resulted in increased vertical displacements compared to turf, possibly due to greater hoof sinking on impact and increased push-off.

Aluminum shoes and barefoot conditions produced similar vertical movement changes, while Glushu (a type of glue-on shoe) and steel shoes yielded different patterns, likely due to differences in shoe mass.

The artificial surface and steel shoes resulted in the least forward-backward (craniocaudal) jockey movement, suggesting they might provide greater stability.

The researchers also found relationships between horse and jockey displacements across different shoe-surface combinations:

The largest difference in vertical displacement between horse and rider corresponded to the smallest difference in craniocaudal displacement (GluShu on artificial surface).

The opposite was true for aluminum shoes on turf.

Generally, displacement patterns differed between artificial and turf surfaces, suggesting that different shoe-surface combinations might require the horse and rider to adjust or compensate to maintain stability during a stride cycle.

“Differing surfaces can really change the mechanical effects of the shoeing,” Reilly says. “The horse’s hoof interacts differently with the ground, changing the traction and distribution of load across the sole and frog.”

He emphasizes that we are a long way from understanding what is ideal or correct in farriery but should remember that hoof balance changes in different ground surfaces. Last year he published the paper, “The influence of different horseshoes and ground substrates on mid-stance hoof orientation at the walk” (tinyurl.com/4nkj779n). He and his co-authors found the hoof angle at mid-stance of a walking front limb increased by almost 5 degrees in soft footing.

Rider feedback is important because there aren’t enough answers yet, he says.

3. “Short communication: changes in gait after 12 weeks of shoeing in previously barefoot horses” (TheHorse.com/1121612)

In 2023, a team at the University of Connecticut published a paper in which they explored how fullered shoes (the groove around the nail holes) and plain stamp shoes impacted movement. At the study’s start researchers took baseline measurements of 14 horses. The measurements included a lameness score and inertial motion sensor measurements on the symmetry of each horse’s gait before the study began and then after trimming and shoeing.

“Shoeing previously barefoot horses using industry-accepted farriery protocols increased maximum hock angles at the trot and reduced lameness scores,” noted a written summary from the university.

“Overall, the findings suggest that hind-limb shoes may be helpful to athletic horses,” farrier Katelyn Panos, a co-author on the study, told The Horse. “Open communication between the farrier, veterinarian, trainer, and owner is critical.”

4. A Study of Movements and Forces With and Without Shoes

During the Tokyo Olympics two show jumping horses competed barefoot. Both were part of the gold medal team from Sweden, and one claimed the silver medal in the individual competition. That has sparked a deeper discussion on the ability for horses to perform barefoot.

Preliminary data from a study led by Lars Roepstorff, DVM, PhD, a professor at the Swedish University of Agricultural Sciences, in Uppsala, are highlighted on the university’s website: “Traditional iron shoes change the hoof’s ability to expand. The shod hoof cannot expand or contract as much as the barefoot hoof, because the shoe inhibits lateral movement. It could mean that the blood flow in the hooves is inhibited, the blood flow is important for the hooves to be healthy and damage-free. However, to be able to draw such conclusions, further studies are required.”

Roepstorff led a team of researchers using high-speed cameras to study a group of horses ridden over fences with and without shoes on the same indoor surface. However, in interviews Roepstorff cautions that whether a horse should go barefoot or be shod is a complex question. The answer, he says, depends on the individual horse, on the riding surfaces, and other factors. 

“With the advent of so many new shoe types and materials that have come on to the market, as well as different ways to attach them to a hoof that allows the hoof to move more like a barefoot hoof does, I think we’re starting to see some real progress in shoes that protect the foot while allowing the hoof to mechanically behave like an unshod hoof,” Dahl says.

How Do Horseshoe Nails Affect the Hoof?

Horseshoes are one part of the equation. Nails are another. While a master’s student, Dahl investigated shoe-wear patterns of racehorses training and racing at four California racetracks. She aimed to find out if natural wear patterns, caused by the hoof expanding and rubbing against the shoe under load, differed between dirt and synthetic racing surfaces.

“The biggest standout from that study was that the closer the nails were to the heels of the shoe, the smaller the wear patterns became,” she says. “This indicated that the hoof wasn’t moving as much when nails were closer to the heels. While it’s common knowledge among farriers to not nail past the wide part of the hoof (medial/lateral aspect), it was a little surprising to see this practice happening at the racetracks.”

From her initial observations, Dahl launched the study “Hoof Expansion, Deformation, and Surface Strains Vary with Horseshoe Nail Positions” (tinyurl.com/mj769zu2) to test how much the nails impact hoof expansion and distortion compared to an unshod hoof.

One unexpected finding, she says, related how the proximal quarter (along that wide part of the hoof mentioned earlier and higher up the hoof, toward the coronet band) responded with the addition of just nails at the toe compared to nails at the toe and the quarter.

“The nails at the toe I expected to have the least effect on hoof wall distortion, as this was the least restrictive of the nail placement options,” Dahl says. “Additionally, the nails at the toe and quarter locations were essentially the same as where nails are placed for normal shoeing (from the wide part of the hoof toward the toe). I also expected the hoof to move somewhat similarly to an unshod hoof as the heels were still free to expand.”

However, under both conditions, the proximal quarter expanded more than either an unshod hoof or a hoof under the most restricted condition with nails at the toe, quarters, and heels. In fact, the proximal quarter of the unshod and more restricted feet responded similarly, which Dahl and co-authors attributed to not restricting the distal part of the hoof (closer to the ground) or restricting it in a more uniform manner.

“This tells us that even under normal shoeing conditions with the nails placed at the quarter toward the toe, having a shoe attached with nails alters the hoof’s mechanical behavior, at least at the proximal end of the quarter,” she says.

To a degree, nails fix a hoof into place with the shoe, which is necessary to keep it in place, so the horse doesn’t just twist or slip out of it. However, shoes tend to loosen by the end of the shoeing cycle because the hoof wall wears at the nail holes with each load, causing them to widen, says Dahl.

“Nail placement is an important factor as nails placed closer to the heels can restrict the heels in a manner that changes the strains the hoof wall experiences by reorienting them, indicating that over time, the nails could pull heels forward and be a potential cause for developing an underrun heel,” she says. “It’s also possible that normal shoeing could affect forces at the coronet band (located) at the quarters, potentially leading to additional hoof problems, though those types of changes should be further investigated to better understand whether that additional expansion is detrimental or not.”

What Horseshoe Research Do We Need Next?

How horseshoes impact hooves is complex. Ultimately, the goal is to find a balance between protecting the hoof and preserving its natural biomechanics.

“I would love to see longer-term studies testing different shoe types, trimming methods, and shoe attachments to measure just how all of these components affect the hoof conformation over time,” Dahl says.

Those are just a few of the questions Reilly and a team of researchers will explore further, thanks to a generous grant from the Morris Animal Foundation. The project will include observations from a dozen farriers across North America who will collectively follow 20 horses. The farriers will take photographs and perform gait analysis at the start of the study and then again after each trimming and/or shoeing cycle over one year. “Hopefully, we can see what the link is between hoof morphology (the shape and structure) and hoof care and gait symmetry,” he says. “Ideally, we’ll be able to answer questions like, ‘Are horses more symmetric early in the shoeing cycle or later in the shoeing cycle? Do feet grow at different rates at different times of the year?’ In my mind, this is the type of information we need more of.”

This article is from the Research Roundup 2024 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

Q: Is it okay to feed my horse peppermints and sugar cubes? I’m concerned about the amount of sugar they contain. If it is okay, how many is too many?

A: Simple sugars, such as the sucrose found in peppermints and sugar cubes, are absorbed by the horse’s small intestine as glucose and fructose. Glucose causes release of insulin to facilitate the entry of glucose in to cells. Fructose (not to be confused with fructans) is metabolized differently. Only metabolized in the liver, fructose is more lipogenic than glucose, meaning that it’s more likely to lead to production of fat.

Most concern about sugar and starch intake has stemmed from our increasing knowledge about insulin resistance (IR), laminitis, polysaccharide storage myopathies (PSSM), and equine gastric ulcer syndrome (EGUS). Horses with IR release more insulin than is normal in order to remove glucose from their blood stream. As a result, while circulating glucose tends to be normal, circulating insulin is elevated. High circulating insulin creates an increased risk for developing laminitis. Horses with PSSM store glycogen (the storage form of glucose) abnormally in their muscle tissue, and diets high in starch and sugar cause increased production of volatile fatty acids in the gastric stomach causing a more acidic environment and a greater likelihood of a horse developing EGUS

I think it’s important to put the questions of sugar in treats in perspective of a horse’s typical daily non-structural carbohydrate consumption. If we assume a 1,200-pound horse eating 2% of body weight as dry matter from hay a day, and that the hay contains 10% moisture and 10 % nonstructural carbohydrate (NSC) on a dry-matter basis (a value often used as the recommended upper NSC level for horses with metabolic issues, such as IR and PSSM), this horse is consuming 1,090 grams of NSC (starch and simple sugars) per day.

A pure sugar cube weighing about 4 grams is 100% sucrose. The popular round, red-and-white peppermint candies have a human serving size of three pieces (about 15 grams) and of that between 8 and 10 grams are sugar. Traditional peppermint candy canes are heavier at 18 grams and provide about 12 to 14 grams of sugar. You can see that in the context of the above horse’s daily diet these are tiny intakes of sugar. However, there are some important considerations.

When feeding a horse hay, you’re also feeding it proteins and minerals that help buffer stomach acid. Additionally, hay’s fiber component impacts the rate at which the NSC reaches the small intestine and is absorbed. The sugar in sugar cubes dissolves quickly and will move with the liquid fraction of the digesta, which moves more rapidly than larger fibrous particles. This means that that the sugar will likely be absorbed relatively soon after it is fed. This makes it potentially more likely to cause a spike in blood glucose than the NSC contained within hay.

Feeding a healthy horse three or four sugar cubes is unlikely to cause a significant glucose spike; however, for a horse with uncontrolled IR, PSSM, or a laminitis history, feeding sugar cubes isn’t a risk worth taking. Skip the sugary treats, too, if your horse is overweight, especially if he has a cresty neck. After all, every calorie counts and calories from treats mean feeding fewer calories from “real” food. Human research shows that tissues in insulin resistant people are more sensitive to insulin after exercise. This may or may not be the case in horses, but if it is, then your horse might be better able to handle the sugar in these treats when they are given shortly after work.

For the otherwise healthy horse, consuming a candy cane or a few peppermint candies is unlikely to have any major impact.

Adhering to your veterinarian’s carefully designed laminitis-care plan is critical to your horse’s welfare and well-being

Getting a laminitis diagnosis is a double gut-sinking whammy. Your horse is in severe pain, and you’re looking at an intense period of very stringent care—which is usually followed by a lifetime of cautious management to prevent a relapse.

Horses that have suffered a bout of acute laminitis need one week of strict stall rest for every day their feet were sore, says Andrew van Eps, BVSc, PhD, MACVSc, Dipl. ACVIM, professor of equine musculoskeletal research and Dean W. Richardson Endowed Chair of equine disease research at the University of Pennsylvania School of Veterinary Medicine’s New Bolton Center, in Kennett Square. They also generally need pain medications and anti-inflammatories. And if the laminitis was metabolic in origin—as most cases are—the horse probably also needs food restriction to control insulin and lose weight without exercise. Once these horses are finally clear to start the progressive path back to exercise, they need constant weight monitoring with special diets, limited grazing, and, if their health allows it, regular workouts.

For veterinarians the diagnosis might also be a tough one to make. Giving the bad news is almost always complicated by the fact these medical professionals must then transfer the greatest load of their patients’ care duty over to their owners. That often means their painstakingly designed laminitis-care plans don’t get followed correctly.

“We recognize the problem, and then we try to manage the problem, and the owner then becomes critical in enacting the plan,” van Eps says. “But it’s just very difficult for people to do that.”

It’s not that owners don’t want the best for their horses; on the contrary, it’s often because they want the best for them that they deviate from these highly restrictive plans, says Tamzin Furtado, PhD, of the University of Liverpool’s Institute of Infection, Veterinary, and Epidemiological Sciences, in the U.K. “People are genuinely worried about their horses’ emotional well-being,” she says.

Add the fact that managing laminitic and laminitis-prone horses is usually time-­consuming, intense, and expensive, and it’s easy to understand why this often preventable disease keeps recurring, our sources say.

The Counterproductive Guilt Complex

The biggest reason owners don’t follow laminitis management plans is they feel sorry for their horses when limiting turnout and grazing, for instance, van Eps and Furtado say. Our sources know exactly what that feels like, because they’re horse and pet owners, too.

“We’ve all been there, and it’s just so horrible having to do these things,” Furtado says. “We don’t want to be horrible! And the horses look miserable, and so then we feel guilty, and we just don’t want to (follow the plan) anymore.”

As for van Eps, he struggles with guilt over restricting the diet of his easy-keeper dog—even though it’s vital for managing her arthritic pain. “It’s difficult when they’re standing there at the food bowl wondering when dinner’s coming or if that’s it,” he says. 

People naturally want to overfeed as an expression of love and care, he explains. “It’s almost an innate thing we have, isn’t it?” he says. “So with laminitis, we have to work against that, because feeding—especially in the recovery phase—is so important.”

Calming medications, such as trazodone, can help ease the stress of stall rest and, hence, the owner’s guilt about it, van Eps adds.

“Vets are clearly thinking about the well-being of the horse,” Furtado says. “What’s important is for vets and owners to have a good conversation about the horse’s emotional well-being and to view things more holistically.”

Understanding the Seriousness of Laminitis

Laminitis is generally a preventable disease—and so are its flare-ups in chronic cases—but owners often inadvertently avoid taking the management steps that would prevent occurrences of the painful, life-threatening condition, says van Eps.

“The brutal truth is that the reason a large number of horses and ponies have laminitis is because of the way we manage them,” he says. “It’s not some act of God or mystery. It’s because they’re fed too much carbohydrate-rich food, and they don’t get enough exercise. People think that if they’re fat, they’re happy. They think overfeeding them is doing them a favor, when it’s the opposite.”

Laminitis often creeps up as horses put on weight gradually, and owners tend to overlook the subtle warning signs, he explains. Similar to humans who smoke for decades and suddenly get lung cancer, overweight horses face a silently approaching killer.

“It’s an incrementally building, slow-simmering problem that’s additive over time, and then a straw breaks the camel’s back,” van Eps says. “And then it’s too late to return them to their previous level (of) activity and, in some cases, it’s too late to get them back to a point where they’re ever going to have a good quality of life.

“I think people don’t always realize the gravity of the situation,” he adds. “With laminitis, you err on the side of caution, because once the damage is done, it’s done. So it’s really important to weigh up the long-term good versus the short-term frustration.”

Time and Money Challenges

Managing a laminitic or laminitis-prone horse requires significant time and financial resources. During an acute flare-up horses need frequent care, attention, and supervision while on stall rest. Over the long term they need as much exercise as they can get, along with regular body condition monitoring, low-carb forage, grazing restrictions, and therapeutic foot care.

These challenges alone can lead owners to stray from the management plan, says Furtado. “All these things take time and money, and sometimes people really get bogged down even just trying to make the right hay choices,” she says.

Busy owners can try recruiting help from fellow horse people or barn staff willing to pitch in on a volunteer or pay basis, she says. Once the horse can exercise again, owners can share the horse with another rider or hire a professional to keep up a regular exercise routine.

People can also think outside the box for solutions, she adds. “I’m a big fan of creative ideas that are fun for the horse and the rider,” she says. For example, Furtado takes one of her ponies on a lead when she goes running.

“But the biggest time saver that people can do is set up their fields in ways that the horses exercise themselves, like track systems,” she says. “That’s a really good way of managing weight.”

As for stall rest, Furtado suggests owners try to multitask, setting up a place to read or work in or next to the stall. This keeps the horse company and offers horse-human bonding opportunities, she says.

Media, Social Media, and Peer Pressure

Another reason some owners don’t follow their veterinarian’s laminitis treatment plan is because they’re getting pressure from other people, our sources say. Whether they fear judgment or find themselves influenced by nonveterinary “experts,” owners can make dangerous decisions based on misguided beliefs.

“It’s a massive, massive issue,” Furtado says. “I mean you literally can’t do anything right for doing things wrong.”

To start, both social and commercial media promote unhealthy body condition for horses, says van Eps. Just as advertisers have been criticized for portraying unhealthily thin or Photoshopped human models in their print and online ads, the horse world tends to present plump, round horses as ideal.

“These ‘desirable’ traits can really play into horses’ health,” he says. “As a 2-year-old, this animal may be fantastic and look fantastic, and it’s not until it’s a 10-year-old that it’s a train wreck,” he says. 

Owners already dealing with laminitis might receive online criticism from people accusing them of letting their horses get too thin or compromising their welfare by keeping them confined—even though these owners are following proper veterinary advice, Furtado says.

“People think that if they can see the horse’s ribs, they’ll be judged for not feeding their animal,” van Eps says. “But really, they should be congratulated for keeping the animal in a condition that’s healthy.”

On the flip side, owners might get shunned when their horses develop laminitis in the first place—which is also counterproductive, Furtado says.

Van Eps says he encourages the media, individuals and groups active on social media, equestrian associations, and judges to promote healthier equine body condition to horse owners and to accept responsibility for their roles as influencers. “Vets are definitely already on board,” he adds. “I haven’t come across one vet who doesn’t already feel strongly about this.”

As for owners of laminitic and laminitis-prone horses, they can enjoy the positive aspects of their horses’ care, such as bonding time and providing enrichment, Furtado says. “It’s a really nice way of showing everybody, ‘Actually, I am doing the best thing for my horse, and I’m working with professionals in their best interest,’ ” she says.

Monitoring Programs: A Helpful Solution?

Veterinarians might have more success getting owners to follow laminitis prevention and care programs if it were easier to monitor and visually assess signs of the disease, says van Eps.

When horses have soft tissue injuries, for example, owners tend to respect the rehabilitation program—often because those injuries and their healing progress are easy to follow through imaging.

“We’ve got a good handle on tendon and ligament damage because we can image that tissue in a way where we can come up with very specific recommendations,” he says. “With the lamellae of the foot, it’s not that simple.”

Veterinarians can’t, for example, ultrasound the foot to determine whether it’s healed enough for exercise. “We’re still guessing a little bit,” he says.

That lack of certainty might lead to a weaker message from the veterinarian about the importance of restricting movement. Positron emission tomography (PET scanning), however, is showing promise in revealing the functional status of laminitic tissue. “I think that’s going to give us a better handle on when that tissue is ready to be strained again,” he says.

Veterinarians can also use laboratory tests to pinpoint high-risk horses, says van Eps. Taking insulin and leptin levels can reveal insulin dysregulation and “fatness,” respectively. Some labs—such as his own at Penn Vet—can also measure adiponectin, which is a marker produced by fat cells. Animals with metabolic syndrome usually have low ­adiponectin.

“Adiponectin is a measure not just of fatness, but ‘bad fatness,’ ” van Eps says. “So it’s probably the most useful marker of metabolic health and laminitis risk in horses and ponies.”

Combined with body condition scoring, veterinarians could incorporate these tests into annual or biannual wellness checks to “bring numbers into metabolic health” that provide a more concrete way for owners to recognize the issue and the need to change management, says van Eps. “That might inspire people to have some sense of accountability and feel like they’ve got goals to aim for at the next checkup,” he says.

Collaboration, Not Compliance

The problem of owner compliance might be linked to the term itself, Furtado explains.

“This phrase always makes me cringe slightly because it suggests owners are just being lazy or ignorant or that they can’t be bothered,” she says. “Of course, that is sometimes the case. But more often, it’s a tricky situation … and we need to be supportive in helping people find management options which fulfill horses’ needs (while) keeping both the horse and the human happy.”

In human medicine, researchers have determined patients follow medical plans better when they feel like they’re based on collaborative decision-making rather than just being told what to do, Furtado says. This sets a good example for equine veterinary medicine as well. While veterinarians have expert health knowledge that owners do not, owners know their horses in ways the veterinarians do not.

“Clinicians need to take into account the individual situations of owners and what’s important to them in order to find solutions that work for both,” Furtado says. “The two together, working out what the best way to move forward is.”

Take-Home Message

Laminitis and its subsequent flare-ups are usually preventable, but prevention requires management programs that go against many owners’ preferences, resources, and social influences. As a result these owners often stray from veterinarians’ management plans—and their horses end up having laminitic episodes despite their best intentions. To remedy these frustrating situations, veterinarians can provide concrete veterinary analyses and risk assessments, and they can look for customized solutions for each case through collaborative decision-making with the owner.

The do’s and don’ts of feeding horses with 4 common health conditions

The sneezy, runny-nosed gelding in the barn sleeps on special dust-free bedding. A laminitic pony next door wears custom wedged shoes, and the ulcer-prone Thoroughbred across the aisle lives on a panoply of medications. Veterinary care, pharmaceuticals, and management play crucial roles when addressing disease. But we often overlook an equally powerful player: nutrition.

Many studies have proven a direct link between diet and disease in horses. Moreover, research shows many maladies have a nutritional component, meaning adjusting the diet can improve the condition. Here we’ll describe feeding practices that can help—or hinder—horses with four common diseases.

1. Gastric Ulcers

For decades scientists have known that stomach ulceration is prevalent in horses of all disciplines (McClure et al., 1999). Racehorses top that list, with up to 80-100% of those actively racing having gastric ulcers (Sykes et al., 2015). Even pleasure horses get ulcers—as many as 40-60% are affected. Luckily, we can adjust the diet to help. What to feed:

Free-choice forage Unlike humans, horses continuously secrete digestive enzymes and acidic juices in the stomach, including hydrochloric acid—a compound corrosive to eyes, skin, and mucous membranes. Horses have evolved to consume small amounts of fiber-based feeds around the clock, justifying this constant gastric fluid production. Offering free-choice forage helps prevent ulcers because fiber helps buffer the acidity. Otherwise, in the absence of feedstuffs to digest, gastric juices have nothing but the stomach lining itself to break down, leaving it inflamed, eroded, and ulcerated.

Alfalfa This and other legume hays are valuable sources of protein and calcium, making them particularly effective at buffering the stomach from its own acidic contents. Researchers have shown feeding alfalfa can help prevent and manage gastric ulcers (Lybbert, 2007).

Gastroprotective supplements Choose those backed by science, and offer them judiciously based on your vet’s advice.

What to avoid feeding:

Lots of concentrates Feeds high in nonstructural carbohydrates (NSC) increase volatile fatty acid (VFA) production. While VFAs are essential for fermenting fiber in the hindgut (the cecum and large colon), an abundance of VFAs in the foregut damages the stomach’s protective mucosal lining, leaving it prone to inflammation and ulceration (Nadeau et al., 2003).

Low-fiber diets The bulk of the equine diet should be forage; horses consuming < 1% of their body weight in forage daily are at increased risk of gastric ulcers.

Straw This grain crop byproduct has long been blamed for ulcers when fed in large amounts (Galinelli et al., 2019) or as the only forage source (Luthersson et al., 2009). But in a 2021 study researchers couldn’t correlate good-quality wheat straw as 50% of horses’ daily forage allowance with ulcer development. This suggests good-quality straw might be a suitable dietary component but should not replace hay or grass as forage sources.

2. Metabolic disorders

These include insulin dysregulation (ID), equine metabolic syndrome (EMS), and the hoof disease laminitis. Obesity is the top cause of metabolic dysregulation, so diet has the single biggest impact on prevention/management. What to feed:

Enough to meet nutritional requirements Don’t starve obese and laminitic horses out of fear that eating will kill them. If you restrict a horse’s feed intake too much, you could end up dealing with an array of secondary health problems: gastric ulcers, colic, nutritional deficiencies, weight loss, muscle wasting, and behavioral issues, to name a few.

Low-NSC forage Prioritize good-quality hay over grass, as fresh grass generally has high sugar levels. Depending on the severity of your horse’s metabolic dysregulation, your vet might recommend limiting grass intake or steering clear of it altogether. “If blood insulin concentrations are high, test the hay to ensure NSC levels are low enough that you can safely feed it to your metabolically challenged horse,” says Nicholas Frank, DVM, PhD, Dipl. ACVIM, a professor of large animal internal medicine at Tufts University’s Cummings School of Veterinary Medicine, in North Grafton, Massachusetts.

Soaked hay Soaking hay for 30 minutes (and tossing the water before feeding) reduces its sugar content. This simple practice can be an effective way to reduce NSC intake. “If you soak the hay for longer periods of time (two-plus hours), however, you are likely to leach vitamins and minerals out of the hay,” Frank cautions.

Ration balancer instead of concentrates If your horse doesn’t need extra calories from grain, you can complement his forage-based diet and meet his vitamin and mineral requirements by feeding a small amount (about 1-2 pounds daily, depending on body size) of a ration ­balancer. 

Frequent small meals If he does need concentrates to meet calorie needs, break his rations into small meals (< 1.1 gram/kilogram of body weight per meal) to avoid hyperinsulinemia, or high levels of insulin in the blood (Vervuert et al., 2009).

Fat for additional calories Unlike NSC, dietary fat is not associated with an increased risk of developing laminitis. Fat does not contribute to ID or EMS, either.

What to avoid feeding:

More calories than necessary, based on the National Research Council’s Nutrient Requirements of Horses. A calorie surplus can lead to obesity and fuels metabolic disorders. Overweight horses should operate at a caloric deficit to shed excess pounds. Consider all dietary components—forage, concentrates, and supplements—when calculating total daily caloric intake.

Lots of concentrates, because the starch and sugar rush translates to an insulin spike that can lead to ID. “The degree to which the diet needs to be managed depends upon the severity of ID and whether blood insulin concentrations decrease when initial management changes are made,” says Frank. “The severely affected animal with profound hyperinsulinemia has to be handled carefully, and all feeds must be low in NSC.”

Lots of sugar-rich treats Let’s not forget those peppermints—in abundance, they, too, can contribute to ID in at-risk horses.

What about horses with equine Cushing’s disease (pituitary pars intermedia dysfunction, PPID)? This is often, but not automatically, associated with ID.

“If he does not have ID, the horse with PPID can be fed like a regular senior citizen,” Frank says, noting that PPID horses tend to be older than 15. But the horse with both conditions needs a diet adapted first and foremost to ID. Therefore, when planning your PPID horse’s diet, Frank recommends starting by assessing his insulin status (via blood test) to determine whether he also suffers from ID.

3. Respiratory problems

Management and medication are the primary ways we manage equine respiratory conditions such as equine asthma, but certain dietary adjustments can also help horses breathe easier. What to feed:

Fresh grass, assuming your horse doesn’t have pasture-associated asthma. “One of the advantages of fresh pasture is it generally contains high levels of two important antioxidants: beta-­carotene (a vitamin A precursor) and vitamin E, which is known to prevent inflammation,” says Laurie Lawrence, PhD, professor of equine science and nutrition at the University of Kentucky, in Lexington.

Soaked or steamed hay to reduce dust and mold particles that irritate your horse’s airway mucosa.

What to avoid feeding:

Round bales, which are notorious for being dusty in the middle.

Hay directly on the ground, especially in a dirt lot, which increases your horse’s inhalation of dirt particles.

Pro-inflammatory ingredients “Diets that are high in some types of fat may be high in omega-6 fatty acids that are more pro-inflammatory than omega-3 fatty acids,” Lawrence says. Cereal grains such as corn and oats contain much higher levels of omega-6 than omega-3, a ratio conducive to inflammation. In a horse with inflamed airways, it’s vital to ensure the diet contains more antioxidants than pro-inflammatory agents, even though researchers haven’t yet confirmed ideal numbers and ratios, says Lawrence. “If the horse is consuming plenty of fresh grass and receiving concentrates, his antioxidant status is probably good,” she says. “However, if hay is his main forage source, adding a ration balancer fortified with trace minerals or a vitamin supplement that provides at 500 to 1,000 IU of vitamin E per day might be beneficial in terms of their antioxidant intake.”

4. Dental problems

Horses of any age can have difficulty chewing their food because of sharp, loose, or broken teeth. Here’s how to make mealtime easier for them. What to feed:

Soaked grain It’s easier to slurp soup than chomp hard feed.

Processed forage like hay cubes/pellets, instead of long-stemmed hay that requires extensive chewing. Soak before feeding.

What to avoid feeding:

Dry beet pulp To avoid choke, soak this highly digestible, easy-to-chew fiber source thoroughly. Choke can affect any horse fed insufficiently soaked beet pulp.

A grain-only diet Don’t skimp on forage because your horse struggles to chew hay. Again, turn to alternative forage sources. Complete feeds can also help horses that have trouble chewing long-stemmed fiber.

Take-Home Message

A holistic approach to disease management includes nutrition. Your veterinarian and nutritionist are well-informed when it comes to formulating a diet that can alleviate—or, at the very least, not aggravate—your horse’s particular condition. And for the healthy equid, provide a diet designed for long-term health.

Take a few simple precautions and management approaches to help your horse weather winter safely.

Looking out upon a wintry farmscape it’s common to see equine forms silhouetted against the snow, huddled against the wind. Or, you might glimpse the glow of lights from a barn housing blanketed equine charges. In northern climes winter generally is a time of slowed activity for both horse and rider, but attentiveness to horses’ health and management is just as crucial during these chilly months as it is during the warmer ones.

How should you prepare your horse so he will thrive in winter and emerge from it in robust condition, ready for a busy riding season? Let’s look at some steps you can take to protect your horse’s body systems.

Protect and Support Equine Respiratory Health

Horses evolved as plains animals, well-equipped to deal with wind, cold, and snow. Nonetheless, horse owners like to protect their charges from the elements, often building complex stabling structures to keep them sheltered and warm.

“When horse function was equivalent to automobiles, we put them in the barn at night after being out all day plowing fields, transporting people, pulling wagons,” says Eileen Fabian Wheeler, PhD, professor of Agricultural Engineering at Pennsylvania State University. “Now the situation is the opposite: Many want to keep their horses in the stable 23 hours a day with one hour a day in work. It seems we have lost perspective on the purpose of a horse stable.”

Ammonia in Horse Barns

One of the downsides to stabling around the clock in winter stems from poorly ventilated structures: “Closing a stable up tightly traps stale air pollution inside with accumulation of urine ammonia, endotoxin particulates from manure, dust, and molds from hay and bedding–these pollutants challenge the equine respiratory system,” says Wheeler.

So if you plan to keep your horses stabled this winter, keep in mind that inhaled ammonia can destroy their airways’ epithelial lining and contribute to the development of respiratory diseases such as inflammatory airway disease (IAD) or recurrent airway obstruction (heaves), says Wes Elford, DVM, an equine practitioner from Randolph, Wisconsin.

First determine whether your barn’s ammonia levels are high, and then take steps to improve air quality. Wheeler recommends smelling the air as you enter the stable: “Ideally, you’ll enjoy a light essence of hay and horse rather than wrinkling your nose at a pungent urine odor,” she says. “If you smell ammonia, then it’s already too high. While it’s desirable to keep ammonia levels less than 10 ppm, the human nose won’t detect its odor until at least 20 ppm.”

She further stresses the importance of considering a horse’s usual breathing zone when assessing air quality; respiratory pollutants are greatest at foot level and especially in stalls. “It is not uncommon for the working aisle of a stable to have much better air quality than the stalls,” she says.

Air Quality and Ventilation

You might be inclined to don five layers of clothing and want to seal up the barn for warmth, but Wheeler notes that “even during the worst winter days, cold, dry fresh air is desirable and comfortable for horses. While horses’ body heat warms air in a closed barn, unfortunately humidity, which is also trapped, makes the barn damp, dank, and feeling colder.”

Elford acknowledges the difficulty in keeping barns open in inclement weather: “While we need to keep water pipes and waterers from freezing, a complete exchange of air is necessary for ­sufficient ­removal of air pollutants. Heating waterers and burying pipes protects from ­freezing.”

Barn air quality benefits from ventilation year-round, via small slots or openings along the building’s perimeter that ­allow fresh air to enter and stale air to leave. Opening doors and windows further amplifies air circulation for improved respiratory health.

Horse traffic and footing maintenance in indoor arenas introduce dust to adjacent stalls. During winter Wheeler suggests oiling footing with high-grade, Vaseline-based petroleum (not motor oil) to weigh down and glue particles together so they don’t loft. “Watering the footing,” she says, “increases the likelihood of it freezing into hard lumps, which is dangerous for riding. This also increases humidity in the building, which impacts structural soundness by rusting metal and rotting wood.”

Another means of reducing harmful particulate dust levels is to store hay and bedding in a separate structure. This decreases environmental dust from horse and people activity, especially during feeding time. It also eliminates the fire hazard created by combustible hay.

Wheeler adds, “Turn horses outside when cleaning stalls to decrease exposure to aerosolized particles of molds, dust and endotoxin.”

Respiratory challenges also come in the way of pathogens; immunizations against respiratory viruses (e.g., influenza, ­rhinopneumonitis, and strangles) help prevent infectious upper airway diseases in horse herds. Veterinarians recommend boostering these vaccines in both autumn and spring. Work with your veterinarian to ensure your horse’s immunizations are up-to-date prior to winter; this, along with clean, well-ventilated barns, can help prevent respiratory illness.

Outdoor Shelter

Full-time turnout (paddock and/or pasture) is the most healthful way for a horse to live, even in cold climates. “The best housing for horses in winter is no housing at all, or at most a wind break,” says Elford. Wheeler also likes using run-in sheds: “The design should provide a dry location and reduced wind speeds. Surrounding ‘sacrifice’ paddocks with an engineered surface that sheds precipitation and is easily cleaned of manure provides a safe environment where being at liberty is the goal rather than grazing.”

Heading into winter, check that your sheds are in good repair, with roofing in place, nails safely embedded in wood, and no protruding sharp edges. Ideally your run-in should offer protection from the elements from at least one direction, with the solid side facing the prevailing winter wind; a three-sided structure open to the south allows drying, says Wheeler. “A shed design works best if at least eight feet high and with exits no less than 10 feet wide to allow two horses to pass,” she says. “Consider also the location of structural support posts–horses find it difficult to transition from bright to low light levels and could clobber themselves on the posts.”

To Blanket or Not to Blanket

Unless your horse needs his coat clipped for activities such as showing or foxhunting, most veterinarians recommend letting his coat grow out naturally during winter. For horses with a full body of hair, says Elford, blanketing is not usually necessary. “Horses have an innate ability to withstand cold and wind with no more than a windbreak,” he says. Furthermore, blankets tend to compress a wooly coat’s layers, which compromises their insulating properties, notes Wheeler.

That said, “show and performance horses may need (clipping and) blanketing to control winter hair growth so they can exercise without getting too sweaty and so sweat dries easily,” Elford says. If you’ll be blanketing such a horse this winter, ensure that your blankets are clean and in one piece before the weather turns. Consider a partial rather than a full clip for the benefits of easily cleaned sweaty areas and heavy hair coat in other areas.

Turnout

While turning a horse out is ideal for his general health, doing so in questionable winter footing is not always a safe bet. “It’s dangerous to turn horses out when the ground is frozen in ruts created by hoof prints or vehicular traffic–I have seen coffin bone fractures as a result of a horse stepping into a frozen rut,” says Elford. “Also, following a thaw, ‘lakes’ of (pooled) water then freeze overnight with pastures turning into ‘glare ice.’ This increases the risk of fractured legs and split pelvises.” Plan ahead to have a safe, dry area to keep horses in times like these when traction is at a minimum. Alternatively, keep some form of gravel or even kitty litter available to put onto unavoidable icy areas.

Exercise and Hoof Care

To keep your horse in moderate fitness and ready for more intense conditioning come spring, keep him in light exercise during winter. Besides benefiting musculoskeletal and mental health, Elford remarks, “Exercise is also important to maintain intestinal motility.” Turnout and/or consistent light riding both provide exercise.

In preparing your horse’s feet for winter, Elford recommends removing shoes if the horse isn’t worked heavily. However, “if you intend to ride consistently, particularly on trails, and feel the need for shoes,” he says, “then shoeing with snow pads helps clear snow from the bottom of shod hooves–this minimizes stumbling over ice balls.”

He describes methods to increase horseshoe traction on packed snow and ice: “Drilled-in studs about 1/4 to 1/8 of an inch long or borium-tipped horseshoe nails provide grip without causing excessive, unyielding hoof grab.”

In cold weather take time for warming up and cooling down. “Walking is an effective warm-up,” says Elford. “The cool-down is hardest because once a sweaty horse stops work, he can quickly chill. Evaporation of sweat pulls heat from a horse’s internal core—this compounds the chill of winter air. A horse damp from a workout can be blanketed immediately upon pulling tack. In addition, continue walking him a short while to maintain muscle (blood) circulation; this helps avoid muscle cramping while skin and muscles cool down gradually. Once he’s dry, the blanket can be removed unless the horse has been clipped.”

And while you might feel like frigid air assaults your airways during the first few minutes of a winter run, Elford notes he has never encountered a horse with a respiratory or breathing problem caused by exercising in cold weather. A horse’s long nasal passages warm the air as it is inhaled. Toweling off frosty muzzles and other wet areas after a ride, however, helps reduce the slight risk of frostbite before turning the horse out again.

Digestive Health

Water intake is especially important in winter to maintain hydration and avoid impaction colic. “Drinking is encouraged by providing warm water through heated buckets or stock tanks with heaters,” says Elford. “Water heating systems should be grounded since horses can sense low voltages and may refuse to drink. Use PVC pipe coverings over electrical wires to prevent a horse from electrocuting ­himself.”

Prior to winter make sure you’re well-stocked with good quality hay, particularly in the event of supply shortages due to drought. “In winter a horse’s diet doesn’t need to change,” advises Elford. “We’ve been told that additional calories help to keep a horse warm but it’s best to increase calories in winter by offering more hay, not grain, as fermentation of forage in the hindgut generates internal warmth. Forage also doesn’t create a carbohydrate load in the hindgut that could cause laminitis (inflammation of the sensitive laminae that connect the hoof to the coffin bone).”

Elford recommends feeling a horse’s back, withers, and ribs routinely to track body condition and adjusting rations accordingly. Make sure your horse has a healthy fat covering over his ribs (body condition 5 or 6 out of 9) rather than entering winter months in too lean a ­condition.

In addition, good dental care maximizes the nutrition horses get from their feed. “Teeth should be checked at least yearly, particularly for the middle-aged and older horse; most horses need dental work and floating once or twice a year,” notes Elford. Completing routine work on any questionable dental issues by late autumn gives your horse the best chance of maximizing his groceries during winter months.

Attention to digestive health also includes parasite control. Veterinary recommendations in northern climes include decreasing deworming frequency during winter months; however, consult your veterinarian about using fecal egg count tests to tailor this program to your farm.

Take-Home Message

In general, horses thrive best when there is room to move around in and fresh air to breathe–regardless of the season. Movement helps keep musculoskeletal tissues limber and healthy, and it keeps the digestive tract motile and the equine respiratory tract healthy. Taking a few simple precautions in addition to these basic, healthful approaches can help your horse weather winter safely.

Understanding and overcoming 7 common equine foot issues

Sometimes a severe, career-altering injury or pathology, such as a deep digital flexor tendon (DDFT) tear or coffin joint arthritis, causes your horse’s foot lameness. In other instances, usually less serious, the outer hoof structures themselves create the gimpy gait. Learning to recognize, treat, and prevent these (mostly) avoidable conditions not only spares your horse unnecessary discomfort but also helps you avoid lost riding time and incurring veterinary expenses. After all, you’d be the one footing the bill for your horse’s hoof problems.

To get some answers about seven common hoof capsule conditions, we’ve recruited two experts from the Virginia-Maryland College of Veterinary Medicine, in Blacksburg, Virginia: Lauren Trager, DVM, MS, Dipl. ACVSMR, clinical assistant professor of equine sports medicine and rehabilitation, and Travis Burns, MSc, CJF, TE, EE, FWCF, associate professor of practice and the chief of farrier services at the veterinary school.

Promoting Healthy Hooves

As an owner, you must work with the cards you are dealt—the feet that came with your horse. But unlike a conformation fault that’s set in stone, there’s a lot you can do with nutrition, management, and farriery to protect less-than-perfect hooves from the myriad issues we’ll discuss in this article. With all 1,200-plus pounds of your horse resting on the size equivalent of four upside-down saucers, it’s only natural you’d want to take the absolute best care of his hooves.

Starting with the basics, a balanced diet with adequate protein plays a crucial role in hoof growth and quality because the hoof wall consists mainly of a protein called keratin. Feeding enough biotin (vitamin B7)—the single most important vitamin for hoof health—also remains a top priority. Be patient with dietary adjustments and stick to the plan you have devised with your equine nutritionist or veterinarian, keeping in mind it can take up to a year for a horse to grow a whole new hoof.

Proper hygiene pays dividends in keeping hooves healthy and intact. Bed your horse’s stall well (a minimum of 4 inches in depth) and clean it at least daily, limit mud exposure, and pick his feet regularly—especially if he wears shoes, which can trap moisture and debris. Last, but certainly not least, regular hoof care by a skilled farrier can help prevent unbalanced, overgrown, or cracked hooves that open the door—or rather, the wall—to abscesses and other issues.

The Recipe for Hoof Problems

Despite the hoof’s tough, impermeable appearance, it functions as a living, breathing organ that responds and adapts to its environment. Unfavorable genetics, nutritional deficiencies, unsanitary living conditions, and lack of quality hoof care all contribute as risk factors for poor hoof health.

Specifically, prolonged exposure to water—such as standing in deep mud all day—or, on the contrary, excessive dryness—both weaken the horse’s hoof horn¹. “Research² shows that contact with manure and urine-soaked bedding also weakens the hoof wall and introduces bacteria and fungi into the frog and white line, compromising the health and integrity of the hoof capsule,” Burns says.

We’ve categorized hoof capsule ailments into seven distinct conditions: subsolar abscess, hoof bruise, hoof crack, white line disease, thrush, canker, and supporting-limb laminitis.

1. Subsolar Abscess

If you’ve ever found your horse suddenly three-legged lame, with a hot hoof and a bounding digital pulse, you’ve probably feared the worst—a fracture—and held your breath until a pocket of pus finally blew out the bottom of his foot. Subsolar—meaning under the sole—abscesses in horses are essentially just large pimples. But because these pockets of pus and debris remain tightly compressed inside the hoof capsule, unable to swell and expand outward like they would on the skin, they cause extreme pain. (Imagine having a pimple stuck under your nail. Ouch!) Putting weight on the abscessed tissue aggravates the pain and often causes a degree of lameness that frightens the horse’s caretakers.

“Despite the crippling pain they can cause, abscesses are generally only serious if they are not treated but instead allowed to undermine the hoof capsule for a prolonged period of time,” Burns says. “This creates the potential for the infection to spread to other parts of the foot.

In an ideal world, the farrier or vet locates and opens the abscess at the margin of the sole through the white line.

“This allows for faster healing than an abscess that ‘blows’ or erupts at the coronary band (where the hairline meets the hoof capsule), leaving a horizontal hoof crack that can take several months to grow out,” says Burns.

Soaking the hoof to soften it and packing it with drawing agents encourages a suspected abscess to emerge. Across various barns you’ll encounter different concoctions, often featuring Epsom salts and the drawing salve ichthammol. Some people also add the antiseptic povidone-iodine (Betadine) to kill bacteria. “A hoof abscess is an infection,” says Burns. “The pus, an agglomeration of dirt, debris, and microbes, invades the foot.”

But the traditional “soak, pack, then wait” method isn’t always the most effective or practical, experts say. “Most of the drawing agents do not work well on the hoof,” Burns says, reflecting on his experience. “In my opinion, if a horse owner has a suspected abscess, they should call their vet or farrier right away. Using hoof testers and a hoof knife, either professional should be able to identify, localize, and open an abscess quickly to provide relief to the horse. Once the pus can drain, the pressure is released, and the horse should become at least somewhat more comfortable within 24 hours.”

Trager agrees. “In my opinion, soaking the foot doesn’t actually help an abscess mature,” she says, arguing that moisture can be undesirable. “Now, if the horse has an abscess that’s already opened and draining, then soaking can help that process. Otherwise, I don’t find it particularly useful.”

2. Hoof Bruise

Horses with naturally thin soles are prone to hoof bruising if they step on hard, rocky ground. Thin soles—and the solar bruising that can come with them—challenge many Thoroughbred owners, though the condition affects all horses, whether shod or barefoot. Depending on the amount of hemorrhage, blood might pool under the sole, causing red or purple discoloration. If your horse sustains a hoof bruise, expect him to show signs of lameness and sensitivity to pressure on his sole, frog, and/or heels.

Hoof pads or boots might be necessary to relieve the horse’s foot tenderness and guard the sole from further damage. “With solar bruises, my first plan of action is typically to protect the sole by incorporating a leather or plastic pad (when shoeing),” Burns explains. “I also use soft silicone or foam hoof packing underneath to pad the bruised areas.”

If that’s not enough, the farrier then turns to a metal plate for a more rigid protective cover. Solar bruises typically take weeks or months to heal, depending on their severity, the promptness and effectiveness of treatment, and the horse’s general hoof health.

3. Hoof Crack

Hooves split and crack when they are too dry³, weak, or brittle. Cracks can also occur from uneven pressure distribution across the weight-bearing surface because of an unbalanced trim or sheared (uneven) heels⁴, for example. Hoof cracks can be quite painful and cause lameness. “The most concerning cracks are vertical, complete (top to bottom), and full thickness—through all three layers of the hoof wall,” says Burns.

Farriers can repair hoof cracks with strategic trimming, shoeing, and literal patching. In the long run you can help keep your horse’s hooves in one piece by applying a hoof hardener (for weak, brittle horn) or a hoof moisturizer (for dry, cracking horn). Your veterinarian or farrier can help you select the best option for your case, taking the entire horse, his environment, and history into account.

4. White Line Disease

Also called “seedy toe,” white line disease in horses involves the separation of the hoof wall from the underlying laminae. Abnormal or uneven stress on the hoof wall, either from poor hoof conformation or, again, an unbalanced trim⁵, typically plays a role. Opportunistic bacteria and fungi can infiltrate the fissures of the wall, leading to an infection that eats away at the hoof.

Treating severe, advanced white line disease often means taking aggressive measures. Veterinarians might pursue debridement surgery, followed by packing topical antimicrobial medication and iodine or copper sulfate-soaked gauze pads into the surgical opening. In some cases the horse needs corrective shoeing to support and protect the hoof during the healing process.

5. Thrush

Horse owners commonly encounter thrush. In fact, you’ve probably seen—and smelled—thrush before you even knew what it was. Researchers have shown a mixed bag of bacteria causes the putrid black discharge coming from your horse’s frog and sole⁶.

“Risk factors for the development of thrush include wet, unsanitary conditions, lack of movement, infrequent hoof cleaning, but also less-than-ideal hoof conformation such as contracted heels or an atrophied frog,” says Burns. “Additionally, horses that wear pads without antimicrobial hoof packing are more at risk for thrush” due to the moist environment.

Treatment for thrush has evolved in recent years because scientists have determined the active ingredients in many topical products—namely formaldehyde and gentian violet—can be carcinogenic to the humans who handle them. Alternative treatments now include copper naphthenate, cephapirin benzathine, chlorhexidine, and iodine.

6. Canker

As for canker, Trager explains it’s an infection characterized by a chronic, hypertrophic, moist dermatitis reaction that affects horn-producing tissues. “While thrush and canker are two different diseases, both can affect the frog and arise under the same moist, unsanitary conditions,” she says. “Long-standing thrush has even been implicated as a cause of canker due to the damage and degeneration it causes to horn cells.” Considering this, a horse with thrush could be more susceptible to canker, the veterinarian concludes, pointing to the need for further research on the apparent correlation between the two.

7. Supporting-Limb Laminitis

Laminitis occurs when the laminae, responsible for suspending the coffin bone within the hoof capsule, suffer damage and inflammation. In severe cases they detach, allowing the coffin bone to rotate downward or sink.

It often stems from systemic issues such as a carbohydrate overload or a fever associated with a body-wide infection. Supporting-limb laminitis, a less common form of the condition, primarily affects the hoof capsule.

“Support-limb laminitis occurs when a horse overloads one foot to offload another painful one,” explains Trager. Take, for example, a horse that has sustained a fracture to his right-hind cannon bone. The left hind leg will carry extra weight to support and offload the painful right hind. This can sometimes go on 24/7 for weeks or even months on end. The renowned Thoroughbred racehorse Barbaro faced this exact misfortune when he succumbed to supporting-limb laminitis in 2007 after successful surgical repair of his fractures.

“Support-limb laminitis happens because of laminar injury from hypoxia (low oxygen levels) in response to vascular derangement within the limb,” Trager says, blaming lack of movement of the horse’s supporting limb for the vascular stasis (blood pooling) within the limb. 

Trager describes the disease process. “Due to the decreased blood flow, small blood clots form in the vessels, eventually leading to laminar hypoxia,” she says. “This oxygen deprivation can cause the lamellar apparatus to fail, and the coffin bone to rotate.” She notes that while the horse might not be systemically ill with supporting-limb laminitis, the vascular derangement that occurs can affect much more than just the hoof capsule.

Take-Home Message

In many cases you can spare your equine companion from painful, debilitating hoof capsule problems with balanced nutrition, clean living conditions, regular hoof picking, and skilled trimming or shoeing. Dutifully applying these simple concepts to your horse’s care and management lays the groundwork for strong, healthy, and resilient hooves.

References

1. Bertram JEA, Gosline JM. Functional design of horse hoof keratin: the modulation of mechanical properties through hydration effects. J Exp Biol. 1987;130(1):121–136.

2. Munzinger K, Monhart B, Geyer H. The Influence of Environmental Factors on the Hoof of Horses. Anatomia Histologia Embryologia. 2005;34(1):36.

3. Pütz AC. (2006). Monitoring of seasonal influences, the effect of housing conditions and domestication on the horn quality of the equine hoof. Freie Universität Berlin. tinyurl.com/ymdszvak

4. Beasley B. Hoof Cracks in Horses. Merck Veterinary Manual. 2024. tinyurl.com/2uxswhud

5. Beasley B. White Line Disease in Horses. Merck Veterinary Manual. 2024. tinyurl.com/3v884tnj

6. Pelletier M, Draper J. Characterization and identification of bacterial flora from infected equine hooves. International Journal of Veterinary Science and Research. 2022;8(2):50–56.

This article is from the Winter 2024 issue of The Horse: Your Guide to Equine Health Care. We at The Horse work to provide you with the latest and most reliable news and information on equine health, care, management, and welfare through our magazine and TheHorse.com. Your subscription helps The Horse continue to offer this vital resource to horse owners of all breeds, disciplines, and experience levels. To access current issues included in your subscription, please sign in to the Apple or Google apps OR click here for the desktop version.

Horses and humans alike enjoy cooler riding weather in the fall, but it does remind us that winter is fast approaching. Here in the Northeast, short days, significant snowfall, and icy footing can make it a challenge to keep horses in consistent work. For those who are not planning to head south when the snow flies, here are some tips to keep your horses safe and healthy when riding them this winter.

Cold, inclement weather and poor footing in paddocks can make horses less likely to move around in turnout, leading to stiff muscles. It can also mean more time spent in stalls. A thorough warmup is important to minimize the risk of sustaining musculoskeletal injuries during exercise. This is especially important for older horses, those with prior soft tissue injuries or arthritis, and horses that are not being worked consistently during the winter.

Thicker hair coats mean horses are more likely to be sweaty after a heavy workout. It is very important to ensure that horses are cool and dry before blanketing and/or turning them out. If you plan to ride consistently, it might be worth clipping your horse to prevent excessive sweating. Make sure to blanket appropriately based on the type of clip performed. If you do body-clip your horse, you might want to use a quarter sheet during cold weather warmup and cool-down.

Footing can provide a real challenge for both turnout and riding during the winter. If you will be riding outside, footing can become quite hard in cold weather and can bruise feet, especially if your horse is barefoot and you are cantering or jumping. Snow might cushion the footing, but it can also hide dangerous icy patches. Indoor arenas are convenient for winter riding; however, some synthetic footings freeze in low temperatures and can become very hard and slick. Make sure to inspect your riding surface carefully prior to working your horse. If in doubt, stick to slower speeds.

Horses with shoes in snowy climates typically benefit from snow pads to prevent ice chunks from building up in their feet. In some situations farriers apply small corks (also called caulks or studs) to shoes for traction. It can be tempting to pull shoes on horses that aren’t in regular work over the winter. However, keep in mind that even the frozen, choppy footing in the paddock can cause foot bruises, particularly in horses with poor-quality or sensitive feet. Discuss winter shoeing strategies with your farrier in the fall.

If your horse wears a blanket, remove it regularly to give him a brief once-over. This will allow you to detect changes in body condition and check for blanket rubs. Older horses expend more calories to stay warm and might need extra feed. Adding blanket layers to thin horses can help them put on weight in some ­situations. Regardless of what your horse wears, provide him access to clean, frost-free water at all times­—especially right after exercise.

There have been few scientific studies looking at the effects of exercise in extreme cold weather on horses. Therefore, it is difficult to give specific recommendations about how cold is “too cold” to ride. Consider each horse’s fitness level, available riding facilities, and any pre-existing health conditions when setting winter training schedules. Cold air has been shown to damage the respiratory tracts of horses exercising heavily under experimental conditions. It is more likely that a horse with underlying inflammatory airway disease will be affected by cold weather.

In summary, make sure to provide an appropriate warmup and cool-down when riding. Pay close attention to turnout and arena footing, as well as your horse’s shoeing needs. Managing these details carefully will help your horse get through the winter injury-free.

Going barefoot can benefit hoof health, but consider management realities and athletic circumstances before pulling those shoes.

With today’s hectic lifestyle, it’s no wonder many people pursue a return to a more natural state—from the food they eat to the products they purchase. This desire for simplicity helps account for the back-to-barefoot trend many horse owners embrace, yet a one-size-fits-all approach rarely applies to hoof care. So what are the pros and cons of barefoot? How should owners best manage their barefoot charges? Let’s take a look at the ins and outs of going sans shoes.

To Shoe or Not to Shoe?

To answer this question, we’ll start by looking at how structures within the hoof are impacted. When the hoof contacts nonsandy ground, the footing that packs into the hoof (known as the dirt plug) stimulates the frog and sole and helps dissipate energy produced by the hoof’s impact with the ground, says Robert Bowker, VMD, PhD, professor and head of the Equine Foot Laboratory at Michigan State University, in East Lansing.

“When barefoot and on a conformable surface, the dirt plug loads the solar part of the hoof,” he explains, noting that biomechanics transfer the load directly to the frog, digital cushion (the soft tissue mass at the back of the foot responsible for shock absorption), and bone. In the shod hoof, on the other hand, the majority of the horse’s weight often (but not always) loads the perimeter hoof walls.

Bowker believes only a small percentage of the load should be on the hoof wall, with the sole, frog, and bars bearing the majority of its force. “The bone gets stronger by loading from (the) solar surface (sole, frog, and bars) as opposed to being suspended from the hoof wall, where the force is transmitted through connective tissues to the bone,” he says. The exact loading, however, depends on the shoes applied and the footing the horse is standing on.

Vern Dryden, DVM, CJF, APF, owner of Bur Oak Veterinary and Podiatry Services, in Lexington, Kentucky, explains that an additional physiological benefit of being barefoot is that the hoof capsule can expand naturally. “With a shoe, there is some restriction of the normal expansion of the hoof capsule, depending on the type of shoe and the method of application,” he says. When shod with a standard steel shoe, “the hoof capsule is restricted in those areas where the nails are placed—the further back toward the heel, the less expansion of the heel will occur.” He goes on to note that clips and glue-on aluminum shoes further restrict the hoof, whereas polyurethane shoes allow for more give and hoof expansion.

So if barefoot offers many benefits, when are shoes necessary or preferred? First, our sources remind us that shoeing serves the purposes of protection, stabilization, and therapeutic applications.

Both Dryden and Bowker note that certain disciplines might dictate shoes. So approach each horse as an individual, considering his job and his need for shoes to perform it effectively.

“The horse in work can wear down the hoof capsule quicker than the rate it is able to reproduce horn,” says Dryden. “A horse with a therapeutic need would call for some type of shoe application, such as a horse with an abscess in need of a treatment plate or some other hoof capsule distortion which would need stabilization. If a horse is compromised in some aspect, whether it be a laminitic horse, a horse with white line disease, or some other disease process, being barefoot is not necessarily the best thing.”

Dryden explains that many horses with laminitis (failure of the laminae, or tissues connecting the coffin bone to the hoof wall) can go barefoot if managed correctly, an approach that is routine in his practice; however, severe laminitic cases in which the coffin bone has penetrated the solar surface might require deep digital flexor tenotomy (transecting the tendon surgically to eliminate tendon pull on the coffin bone) and derotational shoeing (to return the coffin bone angle to its original position).

When dealing with a hoof disease such as laminitis (without coffin bone penetration of the sole), says Bowker, “The horse must be maintained on a conformable surface, such as pea rock or deep sand. You want to unload that portion of the hoof where pain originates.”

Trimming and Techniques

One of the downsides to maintaining a horse without shoes, cautions Bowker, is that the horse’s feet require more frequent management. “With the barefoot horse, a lot of people misinterpret it as meaning that the horse’s foot doesn’t need to be trimmed or attended to as frequently,” he says. “It means just the opposite—the foot should be looked at more frequently. I trim my horses every four to five weeks.”

If owners don’t trim their barefoot charges’ feet for eight to 10 weeks, the hoof will grow too long. “Then you get different structures loading at different times of the cycle; that’s when you start to have problems with the hoof,” says Bowker.

Dryden also encourages owners to maintain a four-week trimming schedule for barefoot horses. But getting the right trim requires an individual approach. “There are multiple ways to trim; you have to read the foot, taking knowledge from each methodology and applying it to that horse,” Dryden remarks. “I don’t think there’s any one hard and fast rule; not every foot is going to respond the same way every time.”

Environment’s Effect

External factors also play a role in whether your horse can go barefoot successfully. Dryden notes that a sandy or rocky environment can wear a horse’s hooves down to the point he becomes foot sore and can’t withstand the rough terrain. Conversely, in a wet climate, cracks caused by moisture can develop into white line disease, abscesses, or capsular distortions.

“In order to keep a horse in work and barefoot, the (arena or riding) footing needs to be forgiving—free of rocks and not too abrasive,” says Dryden. “Otherwise you won’t be able to maintain the horse barefoot. You have to be cognizant of your environment; you may need shoes or some sort of application to keep the foot protected.” For owners that choose to keep their horses barefoot yet need temporary protection, a wide variety of boots are available.

Stabling surface is just as important as riding terrain. Bowker explains that standing barefoot on hard surfaces, such as asphalt or cement, causes discomfort. And while not as obvious, diet is another consideration when horses are barefoot.

“Owners have to be aware of diet,” Bowker remarks. “In humans, for instance, diets with high sugar levels can cause secondary diabetes. The same is happening with horses: A diet that is too rich influences the overall health of the hoof (e.g., leading to conditions such as laminitis).”

Transitioning From Shoes

A best-case scenario for barefootedness is a horse that hasn’t been shod previously, notes Bowker. But if your horse is shod and you’d like to transition him to barefoot, he recommends removing the shoe and beveling (rolling) the hoof around the perimeter. Keep the horse on comfortable surfaces, such as grass or dirt, which he’s likely to seek out naturally. “The hoof will strengthen and adapt over a period of a few weeks,” notes Bowker.

Dryden allows a horse to make the barefoot transition when the hoof has adequate sole depth and wall quality. After applying a hoof-hardening product to toughen the solar region, he advises his clients to introduce barefoot turnout first with boots, increasing turnout time without hoof protection gradually.

On the other hand, if a horse cannot handle being barefoot and continually comes up lame, Dryden suggests providing protection via shoes as opposed to making him “tough it out.” When transitioning back to shoes, “if the horse does not have enough substantial hoof wall to nail to, you can apply alternative means such as glue-on or synthetic shoes,” he says.

Take-Home Message

Recent barefoot research includes a 2011 study by Hilary Clayton, BVMS, PhD, Dipl. ACVSMR, MRCVS, in which she evaluated a specific barefoot trim’s efficacy on horses with underrun heels and found improvements in hoof shape; and a study from the University of Queensland in which scientists evaluated environment’s effect on feral horses’ foot morphology. More research, however, is needed to prove the precise benefits of barefoot hoof care.

So whether you choose to shoe your horse or have him go barefoot involves answering a variety of questions central to your horse’s own situation. Bowker notes that horses will run into the same problems whether barefoot or shod if they are not managed properly.

“Be a knowledgeable horse owner,” he says. “Be proactive, ask good questions of your veterinarian and farrier. By being knowledgeable about the environment and having an idea of the functional physiology of the foot, you can use these aspects of foot care to your advantage during severe disease conditions, including laminitis and navicular syndrome.”

Applying consistent management practices and watching closely for problems can help even horses with less-than-ideal feet lead sound and productive careers

Many horse owners spend an extraordinary amount of time fretting over their horses’ feet, believing soundness is impossible because the animals’ hooves don’t match those depicted in anatomy textbooks. So says Maryland-based farrier Darren Greaves, CJF, who notes that the “ideal” foot is quite rare. In most cases, Greaves stresses that deviations from optimal angles and shape are not the end of the world. Rather, with consistent, proper care farriers and horse owners can manage most hoof types, and horses can function successfully in their designated capacities.

Greaves and Scott McKendrick, CJF, of Trenton, Utah, share the very basics of seeking hoof balance and recognizing common foot problems.

Striking a Balance

A balanced hoof allows the horse to travel across the ground better, and this hoof balance is a farrier’s primary concern when trimming and shoeing. Make sure the horse is standing square on flat, level ground while you evaluate hoof balance. Good foot balance (although it will vary among each individual horse) consists of:

1. Equal medial/lateral size and shape (the foot’s inner and outer quarters, or edges, land evenly when the horse walks);
2. Anterior/posterior balance, in which the foot can be divided evenly at the widest part of the hoof from front to back;
3. A straight hoof-pastern angle (there’s a straight line from the pastern down the front of the hoof wall);
4. Easy breakover (the toe is not too long and is squared, rounded, or rolled to allow for easier movement);
5. Adequate heel support (if shod, the shoe extends to the end of the hoof wall to support the back of the leg); and
6. A hairline (coronary band) that is parallel to the ground.

For maximum soundness, providing regular hoof care is a must. Generally speaking, horses that are not being ridden or are in light work can be trimmed every 10 to 12 weeks, but performance horses need regular hoof care every five to seven weeks. Of course, each horse is an individual and situations are unique. McKendrick points out factors that can influence trimming and shoeing schedules:

• Age Younger horses typically grow hoof wall faster than older horses;
• Climate Hooves grow slower in the cold winter months;
• Nutrition Horses that do not consume adequate nutrition grow less foot;
• Environment Hooves of horses kept in soft, grassy pastures exhibit less natural wear than those of animals kept on hard, rocky ground; and
• Exercise Regularly exercised horses tend to have healthier hooves.

The “Not So Ideal” Foot

Hoof imbalances, if not addressed, can lead to soundness issues. “All hoof and leg deviations from the ideal get worse with neglect of hooves and excess growth and can even become more deviated in their form and function,” McKendrick says. Greaves adds that hoof imbalances result from both foot and conformation defects. He says veterinarians and farriers can work to improve and possibly correct hoof imbalances in young horses caused by conformation defects within the first year of life. By the time the horse is 1 to 3 years old, he notes, more damage will be done in the long run by trying to “fix” the defect than by simply managing it.

Two major types of imbalances arise in hooves: First, the long toe-low heel imbalance is fairly common among all types of horses. In this case, the broken-back hoof-pastern axis (when the pastern is more upright than the toe) shifts more weight onto the heel and makes the hoof more prone to heel bruising, navicular (bone) problems, and/or deep digital tendonitis. On the other end of the spectrum, it’s common to see high heels with a dished toe appearance in young horses; these might be true club feet or more simple hoof imbalances. Careful trimming can help bring these feet into better alignment, but it might not fix the problem entirely.

Common Foot Problems

Our sources recommend keeping an eye out for seven specific problems when evaluating your horse’s hooves:

Hoof cracks are frequently caused by hoof imbalances, and farriers and veterinarians classify them by location: near the toe, quarter, heel, or bar. Horses with dry, brittle hooves or those whose feet are constantly changing from wet to dry conditions commonly develop cracks. Coronary band injuries can also be catalysts for hoof cracks. Most cracks are superficial, do not cause lameness, and grow out in time. However, if they become deep and reach the hoof’s sensitive tissues, they can cause considerable pain and require more intensive care.

Sole bruises appear as red spots or specks on the sole or frog. Trauma or excessive weight bearing of the sole on hard, rocky ground usually causes the bruises. Hooves that are trimmed too short can bruise easily, as well.

An abscess is an infection of the sensitive tissues of the foot. An existing bruise or penetrating wound can lead to an abscess. Bacteria become trapped under the hoof wall, multiply, and form a pus pocket. The pressure can cause significant pain that persists until the pus pocket ruptures. An abscess can cause mild to severe lameness and the hoof might feel hot to the touch. Veterinarians use hoof testers to locate the abscess so they can carefully pare away the sole and relieve the pressure. Otherwise, the pus will travel the path of least resistance and might break out at the coronary band or the heel bulbs.

Thrush, an anaerobic bacterial infection of the frog and/or its clefts (sulci), occurs frequently in horses housed in wet conditions. Owners generally recognize it as black, decaying material with a foul odor.

White line disease or gravel is a bacterial, fungal, or yeast infection of the white line (the portion of the hoof that delineates sensitive tissue from insensitive tissue). Impacted tissues also can emit an odor, and a painful separation or crack might form.

A hot or close nail occurs when a farrier shoes a horse and drives a nail too close to the sensitive tissues. The horse might become lame immediately and point his toe to take pressure off the painful area. Have your veterinarian remove the hot nail immediately and treat any infection in the area. To be safe, he or she might also administer a tetanus -booster.

Corns often result from bearing unequal pressure due to poor conformation or wearing a shoe that is fitted too tightly. These form where the heel and bars meet. Veterinarians and farriers usually describe corns as either dry or moist. A dry corn resembles a red bruise due to the tubular horn filling with blood, while a moist corn appears yellow because serum is present. Corns require time to heal, and lameness might linger until the damaged horn grows out.

Take-Home Message

Good management practices can go a long way in preventing or minimizing hoof issues, regardless of whether your horse’s hooves are “ideal.” Be sure to:

• Maintain optimal hoof balance in your individual horse by implementing regular trimming or shoeing schedules;
• Select appropriate shoes based on weather and footing conditions;
• Select and offer your horse proper nutrition; and
• Provide appropriate treatment if a problem occurs.

With consistent time and effort, even a horse with less-than-ideal feet can lead a sound and productive career.

Editor’s note: This article was written prior to Scott McKendrick’s passing in 2021.

Laminitis causes painful inflammation and breakdown of the structures connecting the coffin bone to the hoof capsule in horses’ feet. In more severe cases the coffin bone can rotate, causing extreme pain and lameness in the horse that might necessitate euthanasia. Researchers have suggested systemic inflammation might be linked to hoof inflammation, leading one team to study the efficacy of a new anti-inflammatory drug in treating laminitis.

“Horses can develop laminitis rapidly and from multiple causes, but the one common denominator is the development of an inflammatory cascade,” said Maimaiti Tuniyazi, doctoral student and research assistant at Jilin University’s College of Veterinary Medicine, in Changchun, China. Once this inflammatory cascade begins, veterinarians must stop it quickly to reduce the risk of the horse’s hoof structures degrading, he added. Therefore, Tuniyazi and his team set out to study the efficacy of methylated tirilazad, a novel anti-inflammatory drug that might be beneficial when treating laminitis in horses.

Studying Methylated Tirilazad’s Effect on Horses With Laminitis

Researchers studied 20 3-year-old Mongolian horses with no signs of digestive problems that had not been recently exposed to antibiotics, deworming medications, or been transported over long distances within three months of the study. They carefully monitored each horse’s diet to ensure it was balanced for his or her nutritional needs and offered local forage at 2% of body weight on a dry matter basis. They allowed each horse unrestricted access to water and did not provide any additional dietary supplements.

A computer program randomly assigned the horses to four groups: control (no laminitis), laminitis (with no treatment), prophylactic (laminitis with preventive methylated tirilazad administration), and treatment (laminitis with methylated tirilazad treatment).

The researchers then induced laminitis in each horse and applied the associated group treatment, closely observing each horse’s Obel score. The Obel grading system helps veterinarians classify and understand the progression of laminitis in horses during diagnosis and treatment. The researchers humanely euthanized any horses in the laminitis groups with an Obel score of III or greater.

In the prophylactic group the researchers administered intravenous (IV) methylated tirilazad for two days prior to inducing laminitis and at the time of induction. In the treatment group they administered IV methylated tirilazad at the first signs of fever or diarrhea (common signs of inflammation) and observable signs of laminitis (such as lameness). The researchers humanely euthanized the horses in each of these groups 72 hours after inducing laminitis to examine the hoof tissues.

Implications for Future Laminitis Treatment

Horses treated with methylated tirilazad showed reduced clinical signs of laminitis, such as improved lameness scores and laminar tissue structure. “For horses, (methylated tirilazad) offers a promising treatment that can significantly reduce the pain and lameness associated with laminitis, potentially restoring their mobility,” said Tuniyazi. “For horse owners, it could mean a reduction in the emotional and financial burden of managing a horse with laminitis. Veterinarians would gain a new, effective tool in their arsenal to treat this challenging condition, improving outcomes for patients, and potentially reducing the need for more invasive or costly interventions.”

Tuniyazi said he and his team believe potential applications for methylated tirilazad might include resolving laminitis episodes more rapidly and treating other conditions where an inflammatory cascade or inflammation and tissue damage are complicating factors. However, he noted that further research is needed to confirm these findings.

Take-Home Message

Laminitis can be very painful for horses and challenging and expensive to address. Researchers report that methylated tirilazad might provide an efficacious and cost-effective way for veterinarians to treat this crippling disease. However, they acknowledge they need more long-term research across different populations of horses to fully establish the role this new drug might play in treating laminitis.

The study, “Methylated tirilazad may mitigate oligofructose-induced laminitis in horses,” appeared in Frontiers in Microbiology in September 2024.

Editor’s note: The authors disclosed that Byrock Technologies Ltd., Ireland, provided financial support for the study.

Q: My 25-year-old gelding has pituitary pars intermedia dysfunction (PPID, formerly known as equine Cushing’s disease) and a history of laminitis. During the winter he struggles to maintain a healthy weight. I’m worried about feeding him too much due to his PPID and laminitis history, but it can be hard to help him maintain his condition through the colder months without additional feed. What can I do to help him maintain a healthy body condition score (BCS) during winter without putting him at risk of another laminitic episode?

A: When managing horses with PPID, it is important to monitor their weight consistently. It is great that you are proactive, looking at what you can implement to support your gelding before the cold weather arrives. Caring for these horses successfully depends on managing their nutritional and medical needs effectively.

Horses with PPID commonly struggle to maintain a healthy body condition, and they frequently struggle to sustain their muscle tissue. When a horse is underconditioned, it can be tempting to add extra commercial feed to his program. Be very cautious doing this, however, because PPID horses are at a greater risk of developing the painful hoof disease laminitis and are sensitive to starch and sugar in the diet.

Due to your gelding’s health and his history with endocrinopathic laminitis, you should most likely maintain him on a diet low in both starch and sugar but that still provides adequate calories.

Starch and Sugar in Horse Diets

The carbohydrates starch and sugar can be either hydrolysable or fermentable, depending on if the horse can break them down enzymatically. If not, the horse ferments them in the hindgut. The general rule of thumb for feeding horses with metabolic issues is to ensure that hydrolyzable carbohydrates (HC) make up no more than 10% of their diets.

If your gelding can still chew and consume hay properly, offering free-choice hay with less than 10% HC could help him maintain his weight during winter. Before feeding new hay to your horse, always have it analyzed. You cannot accurately estimate hay’s sugar content by looking at it, so untested hay can be risky for horses with metabolic issues. 

Along with hay, provide your horse a high-quality ration balancer, low in starch and sugar, at the recommended rate for his weight to ensure he gets the necessary vitamins and minerals daily.

Adding Calories to a Metabolic Horse’s Diet

To supplement his daily ration with additional calories, offer products such as forage pellets or cubes, unmolassed beet pulp, fat sources such as ground flax or oil, and low-sugar commercial feeds.

Occasionally, hay low in starch and sugar is overly mature and, therefore, provides less calories. In these cases you can offer soaked fiber sources such as hay cubes or beet pulp, which are highly digestible, for additional calories. Typically, older horses have an easier time chewing these.

Owners can also use oils and fats for horses with metabolic issues. These products are calorically dense but not digested the same way as carbohydrates and do not impact blood insulin. Introduce fats slowly because horses do not have a gallbladder (which stores and concentrates bile that aids in the digestion of fat). Camelina, flax, hemp, and ahiflower oil are all great examples of fat sources that can be added to increase your gelding’s calorie intake safely. You can also use powdered fat supplements available on the market.

Take-Home Message

Adding calories to a metabolic horse’s diet without risking a laminitic episode can be challenging. Always begin by ensuring you’re meeting your horse’s base nutrient requirements with a safe hay and high-quality ration balancer. From that point, consider using soaked fiber sources and fat to provide additional calories.

They might not carry riders on their backs, but they’re athletes just the same

The team of bays deftly maneuvers the water hazard, splashing through a sequence of arcs and figure eights, intermixed with hill climbs and descents back into the water. There may be four of them, but the horses turn in near synchrony with the guidance of their experienced driver and the help of the navigator leaning precariously to keep the carriage upright. Completing the hazard, they surge forward into the canter, headed toward the next challenge on course, a portrait of fitness, stamina, and agility.

Whether it’s pulling a plow or a buggy, going for a pleasure drive, participating in a parade, competing in pleasure classes in a breed show, or contending a combined driving event like the one described, driving poses health considerations both similar to and distinct from those encountered with your typical sport horse.

Basic Care

Rich Forfa, DVM, founder of Monocacy Equine Veterinary Associates, in Beallsville, Maryland, is an FEI veterinarian for combined driving and was part of the vet team for the 2010 and 2014 World Equestrian Games (WEG). Because the basic care for driving horses is similar to that of riding horses, Forfa reminds his clients to follow a wellness program that includes vaccination (with core and risk-based vaccines), deworming, dental exams, and attention to nutrition and hoof care, etc.

Thomas Daniel Jr., DVM, partner at Southern Pines Equine Associates, in North Carolina, was the team veterinarian at the 2000 World Four-in-Hand Championships, in Germany. He commonly sees combined driving clients in his area and advises them to have the vet out to assess soundness before moving into heavy training and after the ­competition season. This allows the veterinarian to see how the horse looks before embarking on a season’s worth of work, then evaluate how he handled it. They might use chiropractic techniques to help pinpoint any underlying back issues.

Daniel is also adamant about dental exams, because he tends to find more advanced dentistry problems in driving horses than in riding horses. Sometimes owners have incorrectly attributed these problems to other causes. “If you don’t maintain their mouths well, they’re going to have problems accepting bits and being able to respond to pressures on those bits,” he says.

A well-maintained mouth promotes not only bit acceptance but also efficient chewing and digestion. And it’s especially important for driving horses to be able to properly use the forages and feed they consume. Many of these are heavily muscled horses—draft horses and Warmbloods—that can be prone to equine metabolic syndrome and insulin dysregulation (abnormally high blood insulin levels), so Daniel cautions against overfeeding them.

Different driving activities require different amounts of exertion. Combined driving competitors must complete dressage tests, for instance, that are more physically demanding than the work performed by pleasure driving horses. And the explosions from trot into canter during the marathon phrase described can be hard on the hocks and stifles, says Forfa. So conditioning is crucial for preparing driving horses of any type—but especially combined driving horses—for the demands of their sport.

Daniel explains the differences he sees in high-level driving horses versus high-level performance horses under saddle: “Younger horses reach higher levels faster in driving,” he says, adding that while you don’t often see a 9-year-old horse show up in the Land Rover Kentucky Three-Day Event, plenty of horses that age compete in the world championships in driving. “And I see older horses maintaining that same high level of athletic endeavor for much longer periods of time than you do in other disciplines.”

Common Conditions to Watch For

Forfa finds most driving horses to be quite sound, which he says is often a result of the diversification in their training, which allows their musculature to become more developed. However, certain conditions and injuries do seem to pop up more than others. The most common issues he sees are hock and stifle injuries, bone spavin (inflammation in a lower hock joint), and sore stifles.

Arthritis, which develops from repeated wear and tear, can affect the pastern and coffin joints, often with age and use and due to conformation and how the horse moves. Forfa says any horse that has been used heavily for driving could develop arthritis, typically from age 14 onward.

Forfa has also seen ringbone (arthritic changes in the coffin and pastern joints) in some driving horses that have more exaggerated movement, such as Dutch Harness horses, Saddlebreds, certain draft breeds, and some Morgans.

Daniel says heavier breeds, such as draft horses, might also be more prone to sidebone (calcification of the cartilage at the sides and rear corners of the heel), but it doesn’t usually become a lameness issue.

He says he sees more hind-end lamenesses and soft tissue injuries than forelimb in driving horses. “I think the back half of them pays for the sport a lot more than the front end does,” he says.

Back issues, which can extend from the withers all the way through the lumbar area to the haunches, can be common among driving horses for several reasons. “These carriages are somewhat heavy, and when you start pulling uphill and (aren’t) fit enough to do that, they may strain the sacroiliac (part of the pelvis) area,” says Forfa.

For this reason Daniel cautions against only considering the lower legs as a cause of lameness. In his practice he sees issues that originate at the elbow level and above the stifle into the pelvis, back, and neck.

“With your riding horse, you get on that back, and so you’re pretty acutely aware of back problems because they’re not going to be able to get away with (hiding pain),” says Daniel. “But with your driving horses, it can be quite subtle.”

He says this might be why back issues in driving horses are often advanced by the time an owner calls a veterinarian.

And while neck issues aren’t common, they can occur from the wear and tear of driving or from an injury, such as from a crash, says Forfa.

Rarely, driving horses can suffer from “sweeney shoulder,” Daniel and Forfa add. This condition occurs when the harness placement pinches the suprascapular nerve (which innervates the shoulder muscles); chronic injury of these tissues eventually causes nerve paralysis. The result is muscle atrophy (wasting) over the scapula. Forfa sees sweeney most commonly in draft horses that pull plows or carriages in Amish communities.

Importance of Footing

“Footing always matters, but when you’re pulling a carriage, it matters even more,” says Daniel.

Forfa says the only tendon injuries he’s seen in driving horses have been footing-related, such as when a horse slips on the marathon course. “And it has always been related to something like coming downhill and tripping or going into an obstacle that was really, really muddy and deep,” he says. However, many combined drivers will pull out of the marathon phase if footing becomes too deep.

To best prepare driving horses for the terrain and surfaces they’ll encounter, Daniel recommends drivers find a farrier who’s familiar with driving horses, the demands of the sport, and the footing.

One such farrier is Jerry Trapani, CF, of Long Island, New York, who has shod and shown dressage and driving horses. He also shoes mounts that work on the roads, including the New York Police Department and United States Park Police horses in New York City. Trapani was a farrier at the 2010 WEG.

He says driving horses are more prone to concussive injuries from the force their legs and hooves sustain on roads and hard, packed footing.

Hoof Care and Traction

Trapani focuses on trimming to a natural angle based on the horse’s conformation. Shoes, of course, must be appropriate for the footing the horse will encounter. They should also provide proper heel support, fit the hoof properly, help balance the foot, and allow appropriate breakover, says Forfa. If driving horses are well-shod, they aren’t likely to develop foot soreness, he says.

“The biggest difference in shoeing the driving horse is giving them traction so that they feel safe on the road,” says Trapani.

One traction method is a rimmed shoe. “The rim fills up with dirt and sand, and it acts like sandpaper on the road, and then you can weld different materials onto the shoe, like borium or Drill Tech (carbraze, a mixture of tungsten and carbide),” he says.

Farriers commonly add studs or stud holes to driving horses’ shoes to improve traction and reduce slipping and sliding, especially during competition. A farrier can drill or hammer drive-in studs that stay in the horse’s shoes long-term. However, to prevent injury to himself or other horses, they only stick out a quarter of an inch, at most.

Temporary studs, such as screw-ins and snap-ins, fit into predrilled holes in the shoe as needed. Rubber, cotton, or foam plugs or blanks can prevent mud and dirt from becoming lodged in the holes and protect the threads so the studs fit well. Drivers often screw in studs just before competition, then remove them after.

Snap-in studs used by European drivers allow a driver to easily snap the stud into a predrilled hole in a matter of minutes.

Drivers should ask their farriers what type of studs—road, mud, grass, bullet, spike, etc.—would be best for their ­situations.

Leg Protection

Forfa says most drivers at least use bell boots to keep horses from grabbing a shoe or heel bulb when they overreach.

Tendon boots are also popular to protect the superficial and deep digital flexor tendons running down the back of the limb. Without protection, these delicate structures are at risk of injury in driving horses, both from leg interference and the carriage itself. So he recommends applying protection to all four legs, especially if driving multiple horses in a hitch, such as pairs and four-in-hands, because there is a chance of other horses ­overreaching, banging their legs together, or stepping on other horses in the hitch.

He cautions against applying polo wraps, though. “If they came loose, the carriage wheel could catch a piece of it that was flapping, and there could be a disaster,” he says.

Conditioning the Driving Horse

“The biggest (concern) in the care of driving horses would be getting these horses properly fit for the sport,” says Forfa, who adds that it can take four to five years to move a combined driving horse up the levels.

“You can get soft tissue damage from slipping and overexertion or if you work a horse too hard and they’re not fit,” says Trapani.  “You have to train them in an interval training situation and develop their muscles, breathing, and respiration and strengthen the tendons and ­ligaments.”

An unprepared horse—or even one that is prepared but is working in high ambient temperatures—can struggle with heat on marathon day. So during this phase, Daniel is careful to look for horses that might be overheating; he has seen body temperatures as high as 109 degrees Fahrenheit during vet checks.

You must consider the effects of the weight of the harness and carriage and the horses’ heavy muscling, as well, because at the higher levels many of these are Warmbloods. Also be careful not to overface a horse by moving him up the levels before he’s physically ready.

“When you start these young horses, they need to be trained with a lighter ­carriage first,” says Forfa, adding that often young horses will only pull a two-wheeled vehicle or a light four-wheeled vehicle initially. “And then as they get fit and more balanced, they’re able to carry the weight and pull the weight better,” he says.

Conditioning is also very important for safety, especially when going downhill. “Some carriages don’t have brakes, and then you’re using the breeching of the harness, which means the carriage goes against the rump of the horse up against the semitendinosus (hamstring) muscle,” adds Forfa. “You have to come down the hill at a pace that the horse can hold the weight back.”

Forfa recommends riding driving horses a couple of times per week to teach or remind them how to carry themselves, with energy coming from behind, and to strengthen and balance their hind ends.

Daniel adds that it’s common for experienced upper-level combined drivers to either ride their horses for conditioning or to hire a rider. “It gives them a break mentally from driving,” says Daniel. “It’s a different task and requires different movements for them … . You can work the back of the horse a lot better under tack than you can in harness.”

Take-Home Message

Get guidance and advice from a veterinarian and a seasoned driver or trainer when developing a conditioning, nutrition, and preventive health program for your driving horse. With proper care, these athletes can enjoy years in harness.

Different but often related: Here’s how to address common heel conditions in horses

Think about the size of a horse. Now think about the size of his hoof. When you compare one to the other, it’s dazzling to consider how much something so small can carry. Then factor in the speed and height at which equine athletes perform—there’s no doubt your horse’s feet withstand enormous amounts of weight, strain, pressure, and impact. With each footfall the heels are the first part of the equine digit to hit the ground. Their sponginess and flexibility allow them to expand and absorb some concussion, dissipating shock before it travels upward. This mechanism helps protect bones and joints in the hoof capsule from the damaging effects of repetitive high-impact forces. With such an important role to fill, it’s easy to see why distorted, injured, or painful heels can hurt the horse’s overall performance and ­soundness.

One Region, Multiple Conditions

Too often, disparate causes of equine heel pain are clumped together under the dreaded term “navicular.”

“But prognosis and treatment for various caudal (toward the rear) hoof conditions are drastically different, so it is imperative to parse out the actual cause of the pain,” says Jaret Pullen, DVM, owner of JP Hoofworks, an equine podiatry veterinary service that serves the greater New England area. Much like you would treat a cut or blister on your heel differently than an injury to your calcaneus (heel bone), distinguishing between lameness stemming from the heels of the horse versus the deeper, more complex podotrochlear apparatus is crucial.

Step 1: Localizing Lameness

Before all else, your veterinarian must determine where the lameness is coming from. While seeking answers, ­practitioners conduct physical and lameness examinations, which generally involve hoof testers and wedge tests. Then they use regional analgesia (nerve blocks) and radiographs as needed.

Accurately and precisely locating the problem area is key, as our sources emphasize throughout this article. “On the one hand, general heel pain refers to the actual heel structures: heel bulbs, bars, digital cushion, and the palmar processes of P3 (the branches of the coffin bone that extend backward and to which the lateral cartilages attach),” says Pullen. “As for the navicular or podotrochlear apparatus, it includes much more than the navicular bone, as some may think. Along with the navicular bone and bursa, the podotrochlear region of the foot also contains suspensory ligaments, impar ligaments, and the distal end of the deep digital flexor tendon (DDFT).” These parts work together to create a pulleylike system; injury to or degeneration of any of them qualifies as podotrochlosis.

Getting a Podotrochlosis Diagnosis

The pathophysiology of podotrochlosis was first recognized in the late 1980s. Researchers knew the DDFT placing abnormal pressure against the flexor cortex (the underside surface) of the navicular bone caused remodeling. This bone remodeling is associated with edema (swelling) inside the bone, along with blood flow disruption and vascular bone pain responsible for the clinical signs observed, most notably lameness (Pool et al., 1989).

Fast forward to 2022, and veterinarians have made tons of progress when it comes to diagnosing podotrochlosis. Historically, the equine foot has presented unique diagnostic imaging challenges. That’s because radiographs provide very limited information about soft tissue structures, and ultrasound waves—which do allow a detailed look at tendons, ligaments, and synovial structures—cannot penetrate the rigid hoof capsule. The recent rise in accessibility of MRI has been a game-changer for veterinarians. This high-tech modality enables practitioners to precisely identify musculoskeletal structures—­including soft tissues—associated with pain and lameness in the equine foot.

“In fact, I typically will not make the call on podotrochlear syndrome without the aid of an MRI or nuclear scintigraphic (bone scan) study,” says Mark Silverman, DVM, MS, owner of Sporthorse Veterinary Services and Southern California Equine Podiatry Center, in Rancho Santa Fe. “I am hesitant to apply a label that will follow the horse through his career without solid data backing me up. Podotrochlosis is a complex disease that, in my opinion, is often overdiagnosed.”

We Have a Diagnosis: What’s Next?

Let’s say your horse does have a veterinarian-confirmed podotrochlosis diagnosis. What now? With a plethora of treatment options available, practitioners must communicate clearly with their clients, setting realistic expectations. “My typical protocol for addressing a horse newly diagnosed with navicular changes starts by having an honest conversation with the owner and trainer,” says Pullen. “It is important that everyone is on the same page. There are many routes we can take, all of which differ in price, effectiveness, and speed. Before proceeding, I want to understand the owner’s goals and finances, as well as how the horse is currently going.”

A few decades ago navicular syndrome was often a death sentence for a horse’s athletic career—even for the animal himself in advanced cases. But improvements in both diagnostic and treatment options have given hope to many horse owners. “This being said, it’s important to understand that podotrochlosis remains a degenerative condition,” Pullen says. “And while we can often improve and extend the horse’s soundness, we cannot reverse the pathology. Things will likely continue to get worse, following a timeline we often cannot predict.”

How To Help the Horse With ­Podotrochlosis

The focus of podotrochlosis management is to keep the horse comfortable, sound, and—when possible—in work. Among the many therapeutic options, corrective shoeing is almost always the veterinarian’s first recourse. “Often, when I find myself confronted with a case of caudal hoof lameness, I am almost glad to see shoeing that is contrary to what the individual horse appears to need,” says Silverman. That’s because therapeutic shoeing carries enormous potential to improve the soundness of a horse with podotrochlosis.

“I heavily rely on therapeutic shoeing and non-steroidal anti-inflammatory drugs (NSAIDs) as a first-line treatment,” adds Pullen. “Altering the biomechanics (through corrective shoeing) is one of the few options that actually changes some of the root causes of the inflammation. The overarching principle of most therapeutic shoeing is to shift pressure away from the compromised area to the healthier regions of the foot. In this case the objective is to shift the load away from the podotrochlear region, and we achieve this by reducing the tension of the DDFT over the navicular area.”

Beyond those initial steps, Pullen’s approach depends on the timeline and constraints with which he has to work: “For instance, if the patient is a performance horse, and return to work is imperative, I employ an aggressive, multifaceted approach incorporating joint and/or navicular bursa injections for immediate inflammation reduction. I also turn to bisphosphonates (Osphos or Tildren). These drugs will take a few weeks to reach full effect on bone metabolism, during which the shoeing changes, NSAIDs, and joint/bursa injections have had time to work,” he explains. “The bisphosphonates, which reduce painful bone remodeling, prolong the effectiveness of the shoeing changes and injections.”

Navicular bursoscopy (a surgical procedure in which the practitioner uses arthroscopy to debride the lesions and adhesions) might be indicated for some horses with DDFT tears.

Revisiting the Treatment Protocol: Second Opinions

When called in to provide a second opinion, rather than laying out a fresh game plan for a horse newly diagnosed with podotrochlosis, Silverman has a list of important questions to ask the referring veterinarian:

• What is the current medical approach?
• What is the horse’s current shoeing?
• Has the horse received intra-articular medication in the coffin joint and/or navicular bursa?
• Is the horse on any rheological agents to improve blood flow to the affected region or bisphosphonates to regulate bone density?
• Have other therapeutic modalities been used? What has been the horse’s response to those approaches?

“Unless the diagnostic findings are horrible, some combination of therapeutic changes should result in some degree of improvement for podotrochlosis cases,” says Silverman.

When the Heels Are Too Low

Underrun heels are a conformational fault that occurs when the heels grow forward rather than downward, becoming too low. Underrun heels, especially when combined with a long toe, accentuate the forces placed on the caudal foot, thus making the navicular bone and associated structures prone to podotrochlosis. This is especially true if the foot’s structure creates a negative palmar angle (NPA), meaning the back half of the coffin bone is suspended lower inside the hoof capsule than the front half, with the toe of the bone pointing up. Here’s what we know about underrun heels:

• They are a widespread problem. In a postmortem study of 90 racehorses of different breeds, researchers found that more than 97% of horses were affected to some degree (Balch et al., 2001).
• The same research team found the severity of underrun heels was a significant potential risk factor in racehorses with suspensory apparatus failure—a catastrophic event.
• The front feet are more likely to have underrun heels than the hind, an observation made by Peter Day, Dipl. WCF, farrier at the Royal Veterinary College, in Hertfordshire, England.
• It’s a genetic, heritable condition, meaning selective breeding has the power to affect its prevalence in future generations.
• Silverman’s recommendations for correcting underrun heels focus on taking the load off them. “Recruiting additional weight-bearing tissue to share the load with compromised heels is the direction I take with underrun heels,” he says. “I also assess the overall foot conformation and adjust the length of the foot forward of the heels.”

Underrun heels can become chronic, increasing horses’ podotrochlosis risk because of the excessive stress on this region of the foot. Farriers and podiatrists try to mitigate this risk through their shoeing efforts.

One type of corrective shoe might also have its merits for underrun heels. Chanda et al. (2021) found that a modified Z-bar shoe might protect the palmar structures of the foot (those rear-facing, from the knee down—the opposite of dorsal) and improve the soundness of horses with underrun heels that have already progressed to podotrochlosis.

When the Heels Are Uneven

The Merck Veterinary Manual defines sheared heels as “a severe acquired imbalance of the foot with asymmetry of the heels. One heel is higher than the other side; the higher side commonly has a more vertical hoof wall.” Hoof cracks, fissuring between the heel bulbs, and thrush frequently accompany the defective hoof conformation.

Pullen explains the intricacies of managing this relatively common deformity: “In correcting sheared heels, the main challenge is mitigating the abnormal load forces caused by the abnormal conformation of the horse. Often, one or more conformational flaws, or inappropriate trimming or shoeing, predispose horses to sheared heels.”

Outside appearances can be deceiving, so radiographs are crucial to guide a proper trim. Pullen’s takeaway point regarding sheared heels is, like most therapeutic farriery tactics, it’s all about shifting the weight away from compromised regions and onto structures that can handle the load more effectively.

Final Thoughts

Not all cases of heel pain are navicular syndrome, a condition now more appropriately termed podotrochlosis. However, hoof capsule deformities such as underrun and sheared heels can lead to podotrochlosis by placing abnormal and excessive forces on that region of the hoof. Proactive management of hoof anomalies is crucial to protecting the integrity of your horse’s feet and, therefore, his soundness and career longevity.​

Test your knowledge about the tricky world of PPID, EMS, ID, and more

There’s EMS. There’s ACTH. Then there’s TRH. OST. ID. And of course there’s PPID.

Oh, the acronyms of equine endocrine disorders. Who doesn’t get lost looking at all of them? That’s just the start, because the risk factors, diagnostics, and management approaches for these conditions can be pretty confusing, as well. Add in the fact that scientific knowledge about equine metabolic syndrome (EMS), pituitary pars intermedia dysfunction (PPID, formerly Cushing’s disease), and insulin dysregulation (ID) is advancing constantly, and suddenly you might feel like your own pituitary gland is going to explode due to the stress hormones from trying to figure all this out.

To help tease through the mess of letters and conditions, we’ve developed this—admittedly tricky—true-false quiz about some of the most common misconceptions concerning equine endocrine disorders. Test your endocrine IQ with the most up-to-date scientific knowledge provided by our sources: Dianne McFarlane, DVM, PhD, Dipl. ACVIM, professor and chair of the University of Florida’s Department of Large Animal Clinical Sciences, in Gainesville; and Cathy McGowan, BVSc, MACVSc, PhD, DEIM, Dipl. ECEIM, FHEA, FRCVS, professor of equine internal medicine at the University of Liverpool’s Department of Equine Clinical Science and director of veterinary postgraduate education, in the U.K.

Good luck! (Or should that be GL?)

1. Regardless of the endocrine disorder, ID means laminitis risk.

True.

Horses are considered to have ID when they produce too much insulin—a condition known as hyperinsulinemia. This leads to a diagnosis of EMS, which is often also characterized by obesity, according to Equine Endocrinology Group (EEG) recommendations and guidelines.

About 30% of horses with PPID also have ID, meaning they have both PPID and EMS, the EEG reports. That means if your horse has been diagnosed with PPID, it’s very important to test for ID, too.

Because ID can cause laminitis, McGowan says it is essential to run insulin tests on all horses with an endocrine diagnosis, whether PPID or EMS, to manage their laminitis risk.

2. PPID is an “older horse” disease.

True.

PPID is a slowly progressive, degenerative disease of dopamine-producing neurons in the hypothalamus, similar to Parkinson’s disease in humans, McFarlane says. It’s associated with long hair coats; muscle loss, especially along the topline; lethargy; reduced performance; abnormal sweating; recurrent infections; and suspensory ligament breakdown.

Although the mechanism of neuronal loss is unclear, it might be caused by age-related oxidative stress and accumulation of proteins that are misfolded (i.e., something went awry when the proteins translated into their native three-dimensional structure to become biologically functional), as occurs with Parkinson’s, says McFarlane. In any case, they’re certainly related to aging.

“We’re not expecting all horses to be 30 years old before they get PPID,” she says. “But most are going to be at least in their later teens. It’s very unusual to see a 10-year-old horse with PPID.”

In the rare case of a young horse having PPID, it’s considered more likely to be a spontaneous tumor, McGowan explains. By contrast, 20% of horses 15 years and over have PPID because of processes that accompany aging. “This is an aging-related disease; that’s no myth at all,” she says.

3. EMS is a fat horse disease.

Mostly true.

Certainly, obesity is the biggest risk factor for EMS, hallmarks for which are ID and, hence, laminitis, McFarlane says. Therefore, obesity is a common clinical sign of EMS.

But that doesn’t mean all obese horses have EMS, McGowan explains, as some horses are simply “healthy obese.” Likewise, it doesn’t mean all EMS horses are obese.

Even so, obesity is such a high risk factor that even overweight Thoroughbreds—a low-risk breed for EMS—can develop the syndrome. “Certainly, obese horses are more prone to EMS, so you can’t take obesity out of the equation,” she says.

Lean horses with EMS “are the hardest cases” to treat, McFarlane adds. “You have to be sure you’re getting enough calories (in them) while being very, very careful because you don’t want to get that insulin spike.”

4. Management affects EMS and PPID risks.

True … and False.

It’s true for EMS. While EMS might have a genetic component, how we manage ­horses—especially the way we feed them—can also place them at risk of developing the disease, says McFarlane. Even if they do develop EMS, good management can help control and even prevent its most devastating effect, laminitis, adds McGowan.

That’s especially true of “thrifty” horses that tend to hold on to weight even through the harsher winter months, McFarlane adds. Owners should carefully consider these horses’ rations with their nutritionists. “Too much sugar in the blood happens either because you’re feeding them too much sugar or the tissues are not taking up sugar,” she says. “So, diet is key.”

The same is not true for PPID: Researchers don’t currently have any evidence that management is related to risk, she explains. “We just don’t know enough to say whether there are things we do in caring for our older horses that might contribute to PPID risk,” McFarlane says.

5. You can see PPID by looking at the brain.

True.

The “PPI” in PPID is for pituitary pars intermedia—a section of the pituitary gland in the brain that enlarges in PPID-affected horses. Enlargement of the PPI is hard proof a horse has PPID, says McFarlane. Veterinarians can image the pituitary gland of a live horse using magnetic resonance imaging (MRI) and computed tomography (CT). 

However, “these imaging techniques are expensive and require general anesthesia and, therefore, are not practical methods to diagnose PPID in your old horse anyway,” McFarlane says. Positron emission tomography (PET) scans in humans can show the amount of functional dopaminergic neurons for diagnosing Parkinson’s disease, but horses’ heads are too big to fit into current PET scanners. 

6. An accurate diagnosis of insulin dysregulation requires fasting and an OST.

False.

The current expert recommendation for diagnosing ID is an oral sugar test (OST), in which horses receive a small dose of corn syrup or other sugar on an empty stomach about an hour or an hour and a half before the veterinarian draws a blood sample for insulin testing. But many horses don’t need such a complex and expensive test, because their blood insulin levels would already test positive without six hours of fasting and the glucose boost, says McGowan.

“The nice thing about insulin is if it’s highly abnormal, then you’re comfortable that it’s abnormal,” she says. “It’s a misconception that basal insulin is not good enough to be a diagnostic test.”

If the basal test comes back negative but the clinical signs suggest EMS, an OST is warranted, she explains. Vets might also perform an insulin tolerance test, in which they collect blood before and 30 minutes after injecting insulin, without the horse fasting.

Recently, researchers have suggested it’s not always necessary to fast a horse before performing an OST. However, EEG experts have decided against making recommendations to skip fasting at this time, McGowan says.

7. Reliable ACTH testing requires TRH stimulation.

False.

An important tool in diagnosing PPID is a blood test for concentrations of adrenocorticotropic hormone (ACTH), because the enlarged, dysfunctional pituitary gland produces too much of it, our sources say. Veterinarians usually diagnose PPID by drawing blood samples in the field at any time to run a basal ACTH test.

Similar to ID testing, though, veterinarians can diagnose PPID by using a test that measures hormone levels in response to a stimulant. For PPID, the stimulant is thyrotropin-releasing hormone (TRH). Veterinarians inject TRH into the bloodstream and test ACTH concentrations exactly 10 or 30 minutes later.

Also like ID testing, this complex stimulation test isn’t always necessary, says McGowan. Basal tests usually provide the readings needed to confirm what veterinarians have already seen in a clinical exam, she says.

Even so, if the basal results are borderline or they don’t match clinical signs, or if veterinarians are trying to catch PPID in its earliest stages, a TRH stimulation test might be a good option, she says.

Timing is critical, however, McFarlane adds. Recent research shows that when collecting the sample 10 minutes after TRH administration, even a minute can make the difference between a positive or negative result following TRH stimulation (TheHorse.com/1113886).

8. Clinical signs of PPID are more important than ACTH readings.

True.

To assess the likelihood a horse has PPID, experts have developed diagnostic thresholds of ACTH concentrations.

Contrary to popular belief, however, no single threshold point says whether a horse has or doesn’t have PPID, says McGowan.

“One of the biggest myths about endocrine disorders is this idea of a single cutoff value for PPID,” she says. “People get hung up on it. But it’s just simply not true.”

An accurate PPID diagnosis therefore depends first and foremost on a thorough clinical exam. If the veterinarian suspects PPID based on that exam, then—and only then—should he or she perform an ACTH test, she says.

The clinical exam is so critical, in fact, it should guide the way a veterinarian interprets the test results, McGowan adds. A 2020 study on 75,892 horses showed the importance of recognizing the wide variations in normal versus abnormal ACTH concentrations; since then, the EEG has recommended viewing ACTH depending on the horse’s clinical signs.

“The study found that when confirming a case of PPID—in a horse with clear clinical signs—you had a 95% chance of confirming it with a lower threshold,” she explains. “And when ruling out PPID—in a horse with early or subtle signs—you had a 95% chance of correctly ruling it out with a higher threshold. And then there was the space in between—the equivocal zone—where veterinarians have to use their judgment and the clinical signs of the horse to decide if it is a rule-in or a rule-out.

“So, basically, if the horse has got clear clinical signs, use the lower value, but if the horse has got subtle signs, use the higher,” says McGowan.

That’s important because it keeps the risk of false positives very low—meaning horses are less likely to get overdiagnosed, she says. 

McFarlane notes she’s frequently seen horses misdiagnosed with PPID and treated for years, without having the disease, just because of a test result. Fortunately, the treatment for PPID—pergolide—seems harmless, even at high doses. “But it’s less harmless for the owner’s pocketbook,” she adds, in these incorrectly diagnosed cases. 

Nevertheless, tests can be particularly helpful when clinical signs are unclear, McFarlane says. Indeed, the long, shaggy coats and wasting muscles in late-stage PPID horses might be easy to spot, “all the way from the other side of the pasture,” she says. But it’s easy to confuse subtle signs with general signs of aging or other conditions that need treatment. “There are a lot of signs that aren’t really specific to PPID, so that can make the disease a bit difficult to diagnose,” she says.

If the horse does have another health condition causing the signs—and gets misdiagnosed with PPID—that means delayed treatment for the true condition, she says. So while testing plays an important role in diagnosis, it’s vital to consider results in the context of the veterinarian’s physical assessment. “The tests are very good to excellent, but are they more important than a clinical exam? Absolutely not,” McGowan says.

9. You can’t rely on ACTH tests in the fall.

False.

ACTH values naturally increase in the fall, our sources say, and that increase seems to be particularly exaggerated when performing TRH stimulation. So while seasons can affect test results, the important thing is to use laboratories that take season into consideration. “There are several well-reputed laboratories that do that,” McGowan says.

Still, it’s important to consider what “season” truly means, adds McFarlane, who first discovered season’s effect on ACTH in 2004 while doing research in Canada. In theory, ACTH might start rising just after the summer solstice in late June, when the days begin to shorten, she says. Assuredly, by August the pituitary gland is already gearing up for the upcoming winter with its rising ACTH concentrations.

Plus, researchers have shown that “normal” ACTH can vary across geographic regions, she says. To complicate matters more, the extent of those variations can depend on the breed. “I’m definitely a lot less enthusiastic about making a positive diagnosis on borderline animals in the fall,” she says. “There are a lot of subtleties, and that means there’s a real art and science to the diagnosis.”

Regardless, when well-informed laboratories perform the tests and veterinarians interpret the results according to the clinical exam, diagnoses can be accurate even in autumn, our sources say.

10.  Breed matters in both EMS and PPID diagnoses.

True.

Without a doubt, easy-keeper breeds are at greater risk of developing EMS, says McFarlane. The EEG lists these as all pony breeds and Miniatures, all Spanish breeds, all five-gaited breeds (including Morgans), and Warmbloods. Donkeys might also be an at-risk species, but research is pending.

As for PPID, breed doesn’t seem to be a risk factor, says the EEG.

That said, “thrifty” breeds are at greater risk of being misdiagnosed with PPID—especially in the fall. They naturally have heavier winter coats and also higher ACTH spikes in the fall after TRH stimulation. “The amount of increase that they can have in their seasonal response is really phenomenal,” McFarlane says. “That’s led to a lot of confusion on diagnosis for a long time. It would have been great to have understood those breed-specific differences earlier on.”

Take-Home Message

When it comes to understanding endocrine disorders in horses, it’s easy to get lost in not only the terms and acronyms but also the risk factors, testing, diagnoses, and latest scientific findings. If you scored at least 5 out of 10 correct on this quiz, though, you’re well on your way to comprehending these complex issues. And if you got 8 or more right, you deserve a helmet salute for your savvy equine endocrine knowledge. Regardless, we hope the expert-guided information will help you lead your horses toward healthier, more hormone-balanced lives.

From baseline images to diagnosing complex cases, here’s why X rays should be key components of your horse’s hoof care plan

Radiographs have revolutionized medicine, veterinary or otherwise. In a little over a century, we have gained the ability to look inside a patient’s body and evaluate not just bony structures but also organs and soft tissues.

Veterinarians use radiology in their day-to-day practice. As an equine practitioner, I take radiographs on a very regular basis, with X rays of the hoof being the most common. In this article I’ll describe why hoof radiographs are important, how to use them, and the role they play in helping your horse feel and move better.

What’s in a Radiograph?

The outer part of the hoof capsule is made up of dense keratin, the same material that forms your fingernails. Inside you’ll find primarily the third phalanx (also known as the coffin or pedal bone) and some soft tissue structures. The coffin bone is attached to the hoof capsule by a network of laminae, a scaffolding of soft tissue between the wall and bone.

Radiographs of the hoof also include the second and first phalanx (the short and long pastern bone, respectively). If the horse is on the smaller side, you might see the fetlock joint on the same image.

Betsy Lordan, DVM, CJF, TE, a veterinary podiatrist with SRH Veterinary Services, in Ipswich, Massachusetts, explains the usefulness of hoof radiographs for diagnosing issues and monitoring anatomy: “While we can determine a lot about horses looking at their gross conformation, things are not always what they seem. Using radiographs, we can improve upon those clinical exam findings and fine-tune details which are not as easy to manipulate on the outside of the hoof capsule. Some parameters we evaluate include bony column alignment, sole depth, palmar angle (the angle the bottom of the coffin bone makes with the ground), and evidence of diseases such as arthritis or navicular syndrome (podotrochlosis).”

Baseline Hoof Radiographs

More often than not, veterinarians recommend hoof radiographs because they have narrowed the cause of a clinical lameness to the foot, typically using diagnostic analgesia, or nerve blocks. They use radiographs to evaluate the bony column for pathology (disease or damage). Sometimes, however, clients ask for a baseline set of radiographs on a sound horse, often during a prepurchase exam or on a newly purchased mount.

“Baseline radiographs are very helpful because the hoof is not a static ­structure—it will morph and change over time and adapt to a variety of circumstances,” says Lordan. “If you’re lucky, you will buy a horse that never has a foot or lameness problem, but the odds are slim.”

Horses can have individual anatomic differences that might have varying clinical significance. Having a good set of baseline radiographs when the horse is sound can help your veterinarian distinguish whether those variations are relevant to a clinical condition, she says. They can also help your veterinarian track the progression of a condition and provide prognostic information.

“I’ve worked on many a white line disease case where the horse was completely sound, and severe hoof separation and capsular rotation were detected incidentally on radiographs,” Lordan says. “Those are the types of cases where the average person would never know there was a problem until the horse was in serious trouble.”

Cases That Warrant Radiographs

Veterinarians use radiographs to adequately diagnose a wide range of clinical cases, including:

Podotrochlosis

Also known as caudal heel pain, podotrochlosis is a chronic condition, usually a bilateral (affecting both sides) lameness of the forelimbs. Kendra Fake, VMD, associate veterinarian at Willow Creek Equine Veterinary Services, in Reading, Pennsylvania, says evidence of podotrochlosis is one of the biggest causes of lameness she finds when assessing hoof radiographs.

Affected horses can have heel pain in response to hoof testers, a choppy gait with their forelimbs, and a noticeable head bob on a circle. “A lameness that blocks to the heel, combined with radiographs that show degenerative navicular (bone) lesions, allows the veterinarian to make recommendations,” says Fake, which can range from corrective shoeing, shock wave therapy, pain management drugs, and joint therapies to further diagnostics such as MRI.

Osteoarthritis

While it can happen in any joint, osteoarthritis is a common finding in horses’ distal (lower) limbs. “The development of osteoarthritis between the coffin bone and the short pastern (the coffin joint) is colloquially known as ‘low ringbone,’ ” says Fake. Then there’s high ringbone, which occurs at the union of the short and long pastern bones, known as the pastern joint. Veterinarians take hoof radiographs to look for arthritis, sclerosis, and other bony changes in the affected joints before recommending treatment protocols, including joint therapies and systemic medications such as phenylbutazone (Bute) and firocoxib (Equioxx).

Subsolar abscess

Most owners have probably managed these localized ­bacterial infections in the sole of the hoof at some point. The bacteria produce gas that builds pressure in the capsule. This causes the horse immense pain that can easily be confused with a fractured limb.

Usually, these cases do not require diagnostic imaging. However, if a significant amount of time passes with no respite for the horse, the veterinarian might recommend radiographs. While abscesses aren’t always visible on X ray, gas pockets and tracts—formed as the hoof tissues try to relieve the pressure—often are. Your veterinarian can then go in and try to follow these tracts to the abscess, providing drainage and giving the horse instant relief. Radiographs can help ­ensure ­nothing more sinister (such as septic pedal osteitis, or infection of the coffin bone) is going on in the hoof.

Keratoma

Uncommonly, horses can develop keratomas. “These are benign tumors coming from the keratin-­producing layer of the hoof wall that can cause frequent abscesses and lameness,” says Fake. Generally, horses with keratomas develop several subsolar abscesses in the same spot within a few months. Radiographs can reveal the presence of a keratoma in the body of the coffin bone.

“While sometimes bulging of the hoof wall or distortion of the white line may be seen on visual examination, radiographs that show resorption (breakdown) of the coffin bone where the tumor is invading can be critical in this diagnosis,” she adds. “Once the problem is identified, we can direct the horse toward surgical debridement of the tumor and resolution of the lameness.”

Laminitis

Laminitis is the inflammation of the laminae that attach the coffin bone to the hoof capsule. It can be an incredibly painful and debilitating condition for the affected equid, with chronic inflammation leading to rotation of the coffin bone within the dorsal hoof capsule—sometimes penetrating the sole—or even sinking of the entire bony column.

When laminitis causes coffin bone displacement and/or becomes chronic disease, it’s also known as founder. Determining why a horse has developed laminitis is a priority because several conditions can incite it, and a veterinarian should be involved at the first sign of foot pain. Farriery is very important in keeping laminitic horses comfortable, either with trimming or shoeing.

“The horse’s clinical level of pain is not always correlated to what is going on in the foot,” says Lordan. “Radiographs allow you to assess the degree of the problem and monitor for further deterioration or improved hoof growth in the healing stages. Horses that have been affected by laminitis may continue to show clinical discomfort during the hoof regrowth process, and radiographs help us distinguish that from disease progression.”

A veterinarian’s radiographs are invaluable to the farrier caring for the affected horse’s hooves. “A laminitic horse is a serious situation no matter the age of the horse or cause of the laminitis,” says Tyler Fortier, a farrier servicing New ­Hampshire and Southern Maine. “Radiographs are critical here. They are basically a road map for how to approach shoeing or not shoeing the horse. It shows a lot of information about what’s going on with the hoof, such as sole depth and the amount of rotation, that’s very valuable in treating a foundered horse.”

Radiograph-Assisted Podiatry

Farriers use hoof radiographs regularly to better care for their patients’ feet. Farriers are often the first line of defense against hoof issues and are frequently on the ground faster than most veterinarians.

“I think radiographs are extremely helpful for me as a farrier,” says Fortier. “My job is to line up the horse’s bones inside the hoof capsule and balance their hooves to support their conformation. What we see from the outside isn’t always correct on the inside. I might feel that my trim is really good, but the radiographs may say something different.”

While some vets and farriers work independently, briefing one another over phone or email, simultaneous visits can benefit case progress greatly. Besides allowing the opportunity to correlate the trim’s gross appearance with on-screen images, Lordan says taking radiographs during shoeing “provides an additional comfort level for the farrier who is being asked to remove a lot of hoof or do something outside their comfort zone. They can gauge their safety window of short vs. too short much more easily. Using radiographs while shoeing allows us to adjust things by degrees, check our work, and make further adjustments as necessary. Taking a set of radiographs gives your farrier the ability to do their best work.”

“Working with a vet as a farrier gives us greater knowledge of the horse we are working on,” adds Fortier. “A good relationship between farrier and vet is when they can work on a lameness together, come up with a common goal, and be confident and respectful to bounce ideas off one another, because not every shoeing script works for every horse.”

Take-Home Message

Hoof health is vital to the horse’s overall health. Hoof radiographs are incredibly useful tools that allow both veterinarians and farriers to do their jobs properly and best treat the horse.

Tackling osteoarthritis in its early stages can help keep your horse sound, comfortable, and happy in his job

Your 12-year-old sport horse has been coming out of the stall stiff, tracking up a bit short in the warmup, and just doesn’t feel like he’s giving his usual 100%. Before you simply shrug off these anomalies as age- or even weather-related, consider the real cause—they might be early indicators of osteoarthritis (OA). Detecting and managing osteoarthritis in its early stages can go a long way toward keeping your horse sound, comfortable, and happy in his job for years to come.

Suzan Oakley, DVM, Dipl. ACVSMR, ABVP, and Anne Moretta, VMD, MS, CVA, CVSMT, who work in private practice together at Wellington Equine Sports Medicine, in Florida, share their tips for keeping this ever-so-common wear and tear at bay.

What Is Osteoarthritis?

Arthritis is, simply, inflammation of the joint. “Osteoarthritis is a chronic, progressive disease,” says Oakley. “It can initially begin as synovitis, or inflammation of the synovial membrane which lines the joint surface. Eventually, synovitis results in changes to or degradation of the articular cartilage and can progress to include bony changes in the subchondral bone (the layer just below the cartilage surface) in chronic, long-term cases. Subtle pain is an important early clue that may indicate a joint-related problem.”

In sport horses osteoarthritis can develop in a variety of joints, says Moretta. “The majority of cases occur in limb joints that are used for propulsion or are subjected to more concussive weight-bearing,” she says. “The horse’s occupation (dressage, jumping, etc.) plays a role in the location and type of biomechanical loading and repeated stress the joints will have over time.” 

Recognizing Subtle Signs

To pick up on OA early, make sure you’re tuned in to any changes your horse might display in his overall movement and well-being. Prompt identification and intervention are critical to slowing the disease’s progression and keeping the horse agile.

“In private practice we have the opportunity to see and treat horses in the very early stages of the disease,” says Oakley. “Often, changes in movement patterns and (uneven) muscle development are evident before the horse is actually lame. It’s important to be aware of early signs of pain and to evaluate the whole horse.”

Other subtle indicators she says owners should be aware of include:

• Stiffness that might improve with work;
• Reduced range of motion of joints;
• Heat and swelling;
• Behavioral changes; and
• Changes in posture.

It is important to give the horse the benefit of the doubt if he’s having behavioral problems, says Moretta. Difficult or “naughty” behavior might be a sign of physical discomfort. Also, “often, limitations in the horse’s athletic ability are labeled as poor performance and may not be recognized as early lameness,” she says. “While not specific to osteoarthritis, these behavioral signs may indicate subtle pain issues.”

Examining the Whole Horse

When performing a comprehensive evaluation of a horse that’s not quite right, Moretta first collects a complete history, including what issues the client has noticed, and discusses the horse’s occupation and the owner’s goals. From there, her complete assessment involves the axial skeleton (vertebral column), tendons, ligaments, joints, and associated muscles.

“Our approach is very much integrative, so we look at the whole horse,” says Moretta. “First, I’ll notice how the horse is standing and then evaluate movement at the walk from multiple angles and on differing surfaces. We want to analyze the horse’s preferred or ‘compensatory’ movement patterns. These include stride length, straightness, head/neck/back/hip movement, adduction or abduction (movement toward or away from the midline) of the limbs, and overall symmetry. I utilize motion palpation (part of the spinal manipulation exam) to evaluate all the joints in the body, focusing on the limbs and complete spine.”

The whole-horse exam is also good for determining which problems are primary and which are secondary, she says. In addition, checking diagnostic acupuncture points can be very helpful.

Oakley believes owners and veterinarians often overlook muscles, posture, and movement patterns when evaluating these horses. “We want to identify areas of decreased (restricted) or increased (hypermobile) joint motion,” she says. “It is important to treat these affected joints early to reduce inflammation and minimize joint damage. We need an accurate diagnosis to be able to manage pain and to prevent further injury.

“Generally, I’ll start my exam on the opposite ‘corner’ from the lame leg, going over the entire horse,” she continues. “We look at where the clues lead us. Is the horse painful on flexion tests? Is the movement exam abnormal? We let the exam guide our imaging. X rays are the first step, providing information about the bone. A combination of X ray and ultrasound can be extremely helpful in many cases, especially in the stifles and neck.”

For instance, ultrasound provides information about the soft tissue and bone surface interface, Oakley says, and is much more sensitive than X ray for detecting osteophytes (bone spurs).

Also, don’t limit soundness exams solely to when problems are brewing, says Moretta. “When we do periodic performance exams, we look for subclinical (not observable) changes,” she says. “We can use motion palpation to screen for very subtle lameness problems when doing periodic evaluations.”

She says she uses the diagnostic subtle movement or muscle changes to dictate treatment and help prevent long-term and potentially career-ending lameness down the road.

A Multimodal Treatment Approach

Early osteoarthritis treatment and management should include evaluating lifestyle factors that affect your horse’s way of going, our sources say. Veterinarians then have various tools they can recommend to address the condition. Depending on their clients’ goals and budgets, they might suggest:

Shoeing changes A balanced, stable, and supported foot can help reduce joint trauma.

Weight management Preventing horses from becoming overweight also reduces the load-bearing on their joints.

Turnout and light, consistent exercise Keeping horses moving helps reduce inflammation, maintain a healthy weight, decrease stiffness, and encourage slow, steady muscle development for overall strength. “Finding the type of activity that helps maintain tone but does not exacerbate the OA is the key,” says Moretta.

Science-backed nutraceuticals (oral supplements) “Remember, there are no FDA regulations on the equine supplement industry,” says Moretta, who recommends owners purchase from respected companies using ingredients supported by research. Supplements designed to support joint health might contain glucosamine, chondroitin sulfate, and hyaluronic acid, among other ingredients.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone, firocoxib, and diclofenac sodium topical cream These can be very helpful for long-term management of osteoarthritis, Oakley says, noting that firocoxib produces fewer gastrointestinal side effects than ­phenylbutazone.

Intravenous and intramuscular treatments formulated to minimize joint degeneration “Polysulfated glycosaminoglycan and hyaluronate sodium can be very helpful,” says Oakley, who finds that some horses respond better to one than the other, because the treatments work in different ways and can complement one another. “The hope with these products is that we reduce the need for or frequency of joint injections.”

Intra-articular (in the joint) injections, such as corticosteroids, hyaluronic acid, and regenerative products “Short-term use of corticosteroids is highly effective as an anti-inflammatory treatment, but repeated use in high-motion joints can have some side effects,” says Oakley. “We have also had success with regenerative treatments such as IRAP (interleukin-1 receptor antagonist protein), PRP (platelet-rich plasma), and APS (autologous protein solution). In our clinical experience, regenerative treatments are promising, although they don’t work quite as quickly as corticosteroids. We feel that regenerative treatments may last longer for certain joint problems and may help to decrease the frequency of joint injections that a horse may need during his career.”

Moretta and Oakley stress that in their practice, they don’t inject “by the calendar” (such as every six months) but, rather, based on a complete performance exam and appropriate diagnosis.

Laser, therapeutic ultrasound, and shock wave therapy “These are all effective tools for local control of pain and inflammation in the equine athlete,” says Oakley.

Acupuncture Used as a complementary treatment, acupuncture might help reduce pain and inflammation; relieve muscle spasms; and improve nerve function and range of motion, says Moretta.

Spinal manipulation Moretta says she likes to use acupuncture and spinal manipulation in combination to try to lessen pain and restore normal biomechanics. “If I can reduce inflammation and muscle spasm with acupuncture, I can then use spinal manipulation to increase range of motion and reduce restriction in the joints,” she says. “We need to restore motion to early osteoarthritic joints. By reducing inflammation quickly, you restore more normal nerve function and circulation to the joint so it can heal faster.”

Functional electrical stimulation (FES, using electrotherapy devices to stimulate sensory nerves and muscles) Oakley says this therapy can help restore normal movement to the spine and decrease muscle spasms that may arise because of OA-caused abnormal movement patterns.

Ask your veterinarian which therapies he or she typically performs and which ones might be suitable for your horse.

It Takes a Team

Oakley and Moretta’s approach to managing early OA cases is to explore every avenue. “Our bottom line … is to consider the whole horse,” says Oakley. “Often, when there is primary joint pain, the horse changes his movement pattern, and you may end up with tendon or ligament injuries somewhere else due to a compensatory gait pattern. First you treat the primary cause, then address ancillary issues.”

For instance, in the case of a horse whose movement has changed, Moretta says she and Oakley “figure out why it occurred, treat the pain, and utilize rehabilitation protocols with both Western and integrative approaches.”

Rehabilitation (recovering from injuries) and ‘prehabilitation’ (preventing injuries) are essential parts of keeping horses sound and happy. Regular work with adequate warmup and cool-down—our sources suggest 15 to 20 minutes of walking pre- and post-work—is also key.

“In general, lots of walking is both good ‘prehab’ and ‘rehab’ to stay sound,” says Oakley. “It is important that the horse is not a weekend warrior. Also, older athletes don’t need drilling or repetitive work every day. They need to stay loose. They already know their jobs, so they may benefit from strength work (this varies by horse but can include ground poles, light lateral work, and walking over varied terrain) every other day.”

Our sources agree that keeping horses sound—at any performance level—­involves a “best practices” team effort, including correct shoeing, regular turnout, appropriate weight management, and periodic soundness exams to screen for brewing subclinical issues.

“It’s the team approach that is so important: the client/rider, the farrier, the vet, traditional and complementary medicine,” says Moretta.

Q. Can a horse go lame because of extreme hoof cracks and not being trimmed regularly? If so, is there anything you can do to reverse hoof cracks?

—Via e-mail

A. While most hoof cracks are superficial and do not cause much pain, horses can become lame due to deep hoof cracks that reach the sensitive inner structures of the foot. Routine regular hoof care (trimming and shoeing) is strongly recommended for every horse to prevent them from developing cracks and lameness.

Hoof cracks can be caused by long, untrimmed, and/or unbalanced feet creating hoof wall flares and separation of the hoof wall from the white line. Some other causes are environmental factors such as an environment that shifts from wet to dry. A wet environment allows moisture, mud, dirt, and debris to migrate through the hoof wall separations. When the hoof environment dries, the debris becomes trapped inside the hoof capsule, allowing anaerobic (not requiring oxygen) bacteria to take over.

Poor hoof wall quality due to nutritional deficiencies can also play a role in hoof cracks. Therefore, besides routine regular hoof care, a balanced diet and hoof supplements can help your horse’s hoof quality. In my experience, certain hoof dressings applied over the coronary band (I use Contender by Kinetic) will stimulate a healthy hoof growth.

A youngster’s hoof care lays the foundation for his future

Caring for a foal requires specialized knowledge, especially in one area: hoof care. Early care of the feet can greatly affect a foal’s monetary value, athletic prospects, and overall soundness, say our sources.

Some aspects of foot care can even impact a foal’s limb anatomy for life. “A lot of what you do (to the horse) as a foal is going to affect the animal as an adult,” says Stephen O’Grady, DVM, of Virginia Therapeutic Farriery, in Keswick.

What’s Normal in Newborns?

When a foal is born, he has all the hoof structures he’ll have for life, but they are immature, of course. Initially, in the uterus, the hoof is soft to reduce the risk of trauma to the mare’s reproductive tract. After birth it quickly hardens as the ­protective gelatinous perioplic membrane, or eponychium, retracts and dries out.

At birth, the hoof has a conical shape that tapers from the wider coronet to a narrow, pointed toe at the ground, says O’Grady. Much of the weight-bearing is at the toe until around one month of age. As the foal grows and the hoof develops, the hoof grows downward (distally) and its ground surface increases. O’Grady says exercise and trimming increase the foot’s ground surface area, and the trim moves that ground surface in a palmar/plantar (toe to heel) direction.

The First Exam

“I think all foals should have an examination performed by a veterinarian and a farrier within the first two weeks of life to assess limb conformation, examine their feet, and watch them walk,” says O’Grady.

Deviations can be normal for the foal initially; a veterinarian and farrier can determine whether any of these are ­problematic.

“When babies are born, they are generally a little bit toed-out, and that’s normal,” says John Sligh, CJF, a now-retired farrier in Alaska who worked with foals on Thoroughbred breeding farms in Ocala, Florida. “I don’t usually try to correct that because as the baby grows and his chest widens, those legs straighten right up.”

The hoof care team’s actions during an early exam are what can potentially affect the foal’s future limb and foot conformation. “As many limb abnormalities involve the joints, there is a small window of opportunity from birth to four months or so to correct many problems, after which it becomes more difficult,” says O’Grady. “You have a better chance to correct an animal if a limb deformity or foot problem is noticed early and addressed appropriately.”

For example, O’Grady says early diagnosis and conservative care can improve many angular limb deformities, such as carpal valgus (“knock knees”). Here, something as simple as controlling the foal’s exercise and later placing an acrylic extension on the hoof can be ­effective.

At the first trim, usually at a month of age, O’Grady says all that might be necessary is squaring the toe in the front with the rasp to remove the point so the foot can break over (the moment the heels leave the ground during movement) in the middle of the toe. On subsequent trims he recommends keeping the length of the foot’s ground surface trimmed to the base of the frog and not letting the heels grow forward. “You’re putting weight on a larger surface area; therefore, you’re stimulating the whole foot to grow stronger,” he says.

While Sligh says having the farrier out every 30 days after the first exam is adequate, checks every two weeks are even better, offering the farrier more chances to prevent problems from progressing.

In addition to detecting initial problems during that first exam, the farrier helps teach the foal to hold his feet up properly, says Sligh, who prefers to use two handlers with foals.

One person leads the foal up beside a wall and holds the foal’s head. While the farrier addresses the front feet, Sligh has the second person rest his or her hand on the foal’s rump to prevent it from moving away from the wall. When the farrier addresses the rear feet, the second handler simply holds the farrier’s tools.

“If you do this, you’ll make a far better horse out of him as far as cooperation goes,” says Sligh. “It makes for a lot easier foal to trim, and you can do a much better job on them, as well.”

The Vet-Farrier Partnership

O’Grady and Sligh both suggest foal owners find a veterinarian with an interest in farriery, especially foal hoof care, and an experienced farrier to coordinate foals’ care, even if it is only on a small farm that has a few foals born each year.

The veterinarian brings a knowledge of anatomy and physiology, along with the ability to diagnose and medically treat limb abnormalities. Meanwhile, the farrier’s focus is on the hoof’s functional and mechanical aspects and how trimming and farriery can affect the limb and foot.

Your farrier and veterinarian should strive to develop a collegial relationship in which they communicate well about your concerns and how to address them. “You’re helping the animal while helping the client,” says O’Grady.

He says many of today’s veterinary schools don’t teach extensive podiatry and farriery to students, so veterinarians often gain experience and expertise by attending continuing education courses and seeking hands-on training working with feet.

Sligh says another benefit to having the veterinarian present at the first exam is to take radiographs (X rays) of the limbs and joints as needed.

Mistakes to Avoid

O’Grady says many owners think their foals’ limbs and hooves look fine and turn them and their dams out in a big field right away. However, it’s vital to have foal limbs evaluated first.

“If you see something wrong with the limbs, you can limit that animal’s exercise, and this alone often makes a world of difference,” says O’Grady.

Never skip watching a foal’s movement before working on his feet. “How the foal walks and how the foot lands is giving you a prelude of what you’re going to do to the animal’s feet, if you’re going to do anything at all,” he says.

Overtrimming can also be an issue. “Foals don’t grow a lot of foot, and the foot they produce is immature horn and structures, so you don’t want to remove too much foot, especially off the ground surface,” says O’Grady. “I use nothing more than a wire brush and a rasp when trimming foals.”

He also advises against sedating a foal for foot care. “If you start sedating a foal, that foal does not receive the experience to understand that they are going to have farriery done every month and it should not be an unpleasant experience,” he says, adding that it can lead to having to sedate the foal every month and even into adulthood for hoof care, which should be discouraged. It is also unnecessary for a farrier to be rough with a foal or use a twitch, he says.

Sligh says the biggest mistakes he sees include:

• Not having farriers out frequently enough;
• Using one handler instead of two; and
• Farriers being too rough with

He says these mistakes can lead to much more difficult horses to handle in the future and into adulthood.

Common Foal Hoof & Limb Issues

Flexor Tendon Flaccidity

Excessive laxity (looseness) in the deep digital flexor tendon, which runs down the back of the leg, can cause flexor tendon flaccidity.

This results in the foal standing on his heel bulbs, with his toes raised off the ground. O’Grady says veterinarians and farriers most commonly see this in pre- mature foals (born before 320 days of gestation); dysmature foals (born 320 days or beyond), which are foals born exceptionally small; or sick foals. However, he says its cause is not completely understood.

“You want to treat these foals early and not wait until the animal is a month old (for the first exam), because then you’re going to have a deformed foot going forward,” says O’Grady.

However, Sligh says many foals’ weak deep digital flexor tendons will self-correct as their muscles develop and they gain strength. For those that don’t self-correct, he uses glue-on shoes to extend the heels for one or two trimming cycles.

O’Grady prefers to add heel extensions made of custom-cut plywood. Extensions provide the digit with stability and allow the muscle-tendon unit to shorten and be- come stronger. He says you should restrict these foals’ exercise to a small lot or pen with firm footing for one hour twice a day.

It usually takes seven to 10 days for this condition to correct if the farrier applies extensions when the foal is around 3 to 4 days old. At this point the toe should be in contact with the ground, and the muscle-tendon unit should continue to gain tension. O’Grady does not use any type of composite (e.g., acrylic glue-on) on a foal’s foot before 3 weeks of age.

Flexural Deformities

Flexural deformities have been traditionally referred to as ‘contracted tendons,’ ” says O’Grady. “The primary defect is a shortening of the deep digital flexor musculotendinous unit, rather than a shortening of just the tendon portion, making ‘flexural deformity’ the preferred term.”

Treatments for flexural deformities, which can be congenital (present at birth) or acquired (usually by 2 to 4 months), depend on the severity and structures involved. Therapy can range from restricted exercise, medication, and bandaging and splints to diet changes, physical therapy, trimming, and, in severe cases that won’t resolve with other treatments, surgery.

“This is definitely a problem for which you need to involve a veterinarian, because nobody can take a contracted tendon and stretch it,” says Sligh.

While the vet might treat with medication (such as tetracycline to relax the muscles and tendons) or by cutting the check ligaments (which attach to the deep digital flexor tendon just below the carpus, or knee, and prevent excessive lengthening of it), Sligh says he typically places an extension in the toe of the shoe to help the foal stay flat on his foot.

“Most of those babies I would put a tip shoe on if they were older, 6 or 7 months old, and they had a contraction, because they’re going to wear their toe off when they’re like that,” he says. “If you put a tip shoe on, it will at least prevent them from wearing their toe off.”

Angular Limb Deformities

An angular limb deformity is a deviation of the limb at a joint away from or toward the midline. The deformity is caused by one side of the growth plate above the joint growing faster than the other. A varus deformity generally involves the fetlock, with the digit moving inward (medially) toward the midline. A valgus deformity usually involves the carpus, with the limb deviating outward (laterally) away from the midline. A rotational deformity occurs when the limb is straight yet rotated laterally. This is more prevalent in foals with narrow chests. You and your foal care team must determine whether a toe-in or toe-out conformation originates from the limb or the foot.

O’Grady cautions against lowering one side of the hoof to correct a rotational deformity, despite published recommendations in veterinary literature.

“I believe in level feet,” he says. “I’ve never felt that you could lower one side relative to the other side where it was going to be helpful or make a difference. By lowering one side of the foot, all you’re doing is changing the plane of the foot from lateral to medial, which can be detrimental, as it may affect the limb above the foot.”

Sligh works to correct toeing out or toeing in a little at a time on each visit by balancing the hoof capsule, but he doesn’t stress too much because it’s impossible to get the leg completely straight.

“Sometimes people try to overcorrect them the first one to two months of their life, and you can just create a nightmare doing that,” he says. “You have very soft bones at that point, and you can actually create a crooked horse that wouldn’t normally be crooked.”

Take-Home Message

The bottom line of foal hoof care is to take it seriously and have it done often—preferably with a coordinated effort between a knowledgeable veterinarian and an experienced farrier. “It’s the most important time of a horse’s life as far as its feet go,” says Sligh.

5 health conditions you and your vet should watch for when you’re trying a horse to buy

In early spring 2022 Carly Ostrander signed an agreement to take a young Quarter Horse mare on trial before deciding whether to buy her. Ostrander paid half the mid-five-figure asking price for a 60-day test ride. She hoped the horse would become her next mount for national-level ranch and reined cow horse events and, later, a broodmare.

Ostrander rode the mare in a two-day clinic preceding her first show. The mare was working cattle well despite having had a few years off. Hours before their first class, the mare tied up.

Fortunately, a veterinarian and an ­ambulatory technician show on the same circuit. They ran intravenous fluids; the mare responded to treatment and was cleared to compete. However, the vet suggested following up with a polysaccharide storage myopathy (PSSM) test. In PSSM cases a mutation of the GYS1 gene causes muscle cramping due to abnormal glycogen (sugar) storage in the muscles.

“At that time, they told me that even if it was PSSM, it could be managed through diet and exercise,” Ostrander says.

After the show she ordered a barrage of bloodwork and sent a hair sample to the University of California, Davis, Genetics Laboratory. The results confirmed PSSM. Believing the situation was manageable, Ostrander and the seller, who had never noticed the mare tying up in the past, negotiated a reduced price. Ostrander kept the mare even though she didn’t have a future as a broodmare (PSSM is hereditary).

Following veterinarian recommendations, Ostrander continued competing and attended the American Ranch Horse Association (ARHA) World Show in Ocala, Florida. It was a 25-hour drive from her upstate New York barn, and she opted for layovers to make the trip easier on the mare. A few days into the show, however, the mare had a severe tying-up episode.

“Here we went with more fluid, more drugs, more bloodwork, and lots of bills,” she says. “I learned that sudden bursts of motion and standing in a stall for long periods of time can trigger an episode. Essentially, this horse is not well-suited to be a reiner or a cutter and is better suited to be a trail horse or a pleasure horse.”

Getting any horse, especially of this caliber, on lengthy trial is typically uncommon, says Beau Whitaker, DVM, CERP, co-owner at Brazos Valley Equine Hospital, in Salado, Texas. Allowing a horse to go home with a potential buyer can pose risks, so many sellers will not agree to a trial. However, if you are permitted to take a horse on trial—and even a weeklong trial can be advantageous—he recommends watching closely for signs of injury or illness.

A prepurchase exam and results from genetic testing (when available) reduces the guesswork when identifying a horse’s potential health issues. Trials offer an extended time to observe any medical conditions not previously visible and consult your veterinarian about them. The results could make or break the deal.

If you arrange for a trial, Whitaker suggests looking out for signs of these five health conditions.

1. Lameness

Soundness is the most common health characteristic buyers look for, Whitaker says. Lameness can be the result of an injury or wear and tear and can require ongoing maintenance, such as joint injections.

“Buyers need to consider how much maintenance they can live with, as it will increase ownership costs,” says Whitaker. “In addition, severe injuries could mean the horse is unusable for an extended period.”

He suggests observing the horse on a longe line and under saddle for:

• Head bobbing when trotting.
• Gait unevenness.
• A limb creating a “dropping out” appearance (or sensation, when riding) mid-stride.

Soundness issues are not limited to legs and joints. Problems in the axial skeleton, which includes the skull, vertebral column, sternum, and ribs, can also create lameness. Whitaker says neck pathology (disease or damage), kissing spines, or sacroiliac joint (SI) issues can also be performance-limiting.

“Stiffness in the neck or back and soreness in these areas after work suggests there may be an underlying issue,” he adds.

2. Hoof Problems

Hoof issues often get lumped under lameness, but it is essential to consider the foot on its own, says Whitaker. Corrective shoeing increases the expense of ownership and, depending on discipline and work intensity, the pathology at hand can limit performance.

Cornell University’s head of farrier service, Steve Kraus, CJF, has fielded many calls from clients who discovered unsoundness after buying a horse without a prepurchase exam, with laminitis, ringbone, navicular disease, and hock osteoarthritis being the most common discoveries.

If you have a horse on trial, Kraus suggests the veterinarian and farrier:

• Walk and trot the horse on hard ground to watch for head-nodding or hip-hiking.
• Watch to see if the front feet are landing toe first and, if so, search for the underlying problem.
• Examine the hooves. Farriers look for fever rings and abnormal growth patterns, which might indicate chronic laminitis.
• Evaluate hoof size. Farriers are good at evaluating hoof size relative to body size. “Inappropriately small feet usually lead to lameness,” he says.

Kraus describes a situation in which a regular client bought a competitive horse. When he arrived for the first shoeing, he immediately noticed mismatched front feet and asked if anyone evaluated the horse prior to purchasing. The client responded that the veterinarian conducting the PPE commented about the horse having a small foot and said, “I hope you have a good farrier.”

“I shod the horse to compensate for unevenness, and he moved well, but I predicted that the horse would not stay sound with increased work,” he says. “Eventually the horse became too lame to continue training.”

Whitaker adds that if you notice the horse is shod with anything other than normal shoes or has pads or a wedge, it is important to ask for details before buying.

Even when looking at feet, don’t forget to step back and consider faults in the horse’s overall conformation. “A high/low front end, a base-narrow hind end, a butt-high build in mature horses, and cannon bones misaligned to the radius (forearm) are all conformation faults that can interfere with performance,” says Kraus.

3. Gastrointestinal Issues

Gastric ulcers require intense medical management, involving long treatment periods of expensive medication and ongoing preventive strategies. The prevalence of gastric ulcers can be upward of 90% in certain disciplines such as racing. It is important to recognize the signs, so you can not only alert your vet and initiate early treatment but also decide whether you’re up for the potential ongoing expense and management if you purchase the horse.

“Symptoms are wide-ranging but can include irritability when the girth is tightened or reluctance to move forward at a trot or canter,” Whitaker explains.

A horse that colics during a trial can also be cause for concern. Depending on the severity, it might even necessitate surgery. The specific case and prognosis can determine the horse’s suitability for the rider’s goals.

4. Respiratory Issues

Equine asthma syndrome is the most common respiratory issue Whitaker treats in performance horses. It can be ­performance-limiting and requires environmental management and ongoing medications. Environmental dust and molds are typically the causative agents, though a summer pasture-associated condition can affect some horses as well.

Management involves minimizing environmental dust from hay, grain, and other sources in and around barns. Horses with summer pasture-associated symptoms must be kept off pasture for part of the year. Due to the seasonality of the condition, they might seem perfectly fine during parts of the year and severely affected during others.

“Symptoms to look for (with both asthma types) are coughing, increased breathing effort relative to the amount of work, and taking longer than expected to recover after exercise,” Whitaker says. Exercise-induced pulmonary hemorrhage “is common in speed event athletes and should be factored into the decision if the horse has a history.”

5. Eye/Vision Issues

Eye issues are quite common on sale exams or whenever horses change hands, but they often go undetected by owners and trainers unless the problem is very obvious. During trial, watch for spooking at noises, as well as cloudiness in or squinting/drainage from the eye, which might indicate corneal inflammation, equine recurrent uveitis, and other ocular diseases. However, recognize that observation on trial is no substitute for a veterinary exam.

What If You Notice an Issue?

For Ostrander, her mare’s medical issues meant she couldn’t compete or be bred.

“So, I will not take her to any big shows. I will not put her in that kind of a situation where she has to be in a stall for an extended time. At my house she lives outside just about all the time,” she says. “I had to promise to keep her or that if I sold her that it be to a home willing to keep up her care.”

Fortunately, not all medical issues that can emerge during a trial period are as substantial as the one Ostrander experienced. Whitaker says if a health condition arises during a trial, have a frank discussion with your veterinarian and ask yourself:

• Does the issue keep me from using the horse for my intended purpose?
• Do I have the budget to manage the issue?
• Does that leave room in my budget for unexpected events that can arise and cost more than expected?
• Do I have the time to deal with an issue that requires daily therapy or medications? “This may not be a problem if you are at a barn with full board, but there may be an extra expense to pay someone else to give the medication,” he says.

Hindsight Is 20/20

Looking back, Ostrander says she should have returned the mare after the first episode. She was attached to the horse, however, and made an emotional decision rather than an objective one.

Also, going into the deal, Ostrander knew she had time to make an educated decision and opted to bring the mare home without a prepurchase exam or genetic testing. Without that trial period, she would have done both first. She took two actions when the mare came to her barn that made a significant difference in the outcome. First, she purchased major medical and mortality insurance right away. Second, she stayed in immediate and constant communication with the seller.

“He knew exactly what we were going through, what we were treating her for, and the time, energy, and money we were putting into vets, testing, and treatments,” she says.

The silver lining for Ostrander was the seller was committed to ensuring the mare had a good home. He recently sold his breeding operation and had no place to keep the mare. In exchange for knowing the mare he had bred and raised had a place with proper care, he refunded Ostrander’s ­deposit—something not all sellers are in a position to do. Similarly, not all buyers are in a position to add another horse to their herd if the horse cannot perform its intended use. “I’ll be forever grateful to Morgan (O’Brien, DVM) and Karlene (Bushey, ambulatory assistant) for saving my mare’s life that day,” Ostrander says. “Just be cognizant that you’re not letting your desire for instant gratification of something to show or something to ride outweigh your senses.”

Laminitis in horses can strike any time of year, for a variety of reasons, but veterinarians and horse owners see endocrinopathic cases most commonly in spring and autumn. Understanding your horse’s risk level for this painful and potentially deadly hoof condition—and the physiological differences between spring and autumn laminitis—is critical to prevention.

Laminitis is a condition where inflammation in the laminar junction leads to the separation of the epidermal and dermal laminae in the hoof, which are basically what suspend the coffin bone within the hoof capsule. “For horses suffering from endocrinopathic laminitis, the trigger is an alteration to the metabolic state,” says Anna Garland, MS, a PhD candidate in equine physiology at the University of Guelph, in Ontario, Canada. “Over prolonged periods, if horses consume large concentrate meals or high-sugar forage, there will be an increase in the insulin response”.

The higher sugar levels in grass during the spring and autumn months are a key reason why laminitis is more prevalent during these times of year. “With the increase in insulin, an inflammatory response is triggered in the hoof; this increases the blood flow and delivers high volumes of insulin to the tissue,” says Garland.

How is Autumn Laminitis Different?

New growth of lush pasture triggers laminitis episodes in the spring, but different factors are at play in the fall. “There are two reasons why horses and ponies might experience endocrinopahtic laminitis in the autumn—nutrient changes in pasture and forage, and a metabolic shift,” says Erica Macon, MS, PhD, assistant professor of equine science at Texas A&M University, in College Station. These nutrient shifts often occur due to the start of colder nights and shorter days, she explains. And, “in the later autumn, hard frosts can make grasses retain their sugar content.”

Horses also experience a metabolic shift during autumn to prepare for winter, which can trigger a laminitis episode, she adds.

In her own research Macon found that horses with insulin dysregulation had the highest basal (resting) and post-oral sugar test insulin concentrations in the spring, but winter insulin concentrations in the metabolic horses were very similar to spring values. “Logically, it makes sense,” says Macon. “As we start approaching the colder months, horses start to pack on the fat to get them through the winter. … Insulin secretion goes up to promote the storing of fat. Thus, the body starts to shift to fat storage as the animal approaches winter, which increases insulin secretion, subsequently increasing the risk of laminitis.”

Autumn Equine Lifestyle Changes

During the summer months most horses are generally ridden more but, as winter approaches, show season winds down, and the months get colder, leading to a decrease in horses’ workloads. Reducing horses’ exercise in this way can negatively impact metabolic state. In a time when pasture sugar levels rise and horses begin to store fat for winter, “reducing exercise will only exacerbate fat storage,” says Macon. “I highly encourage exercise in the winter—even if you are just (working) your horse in the round pen for 15-20 minutes each day.”  

How Can I Detect and Prevent Autumn Laminitis?

Pillars of proper management of laminitic horses include recognizing their endocrine levels and managing housing, farrier care, exercise, and nutrition.

“First, horse owners need to know the endocrine status of their animal,” says Macon. “Have them tested for insulin dysregulation (or equine metabolic syndrome) and pituitary pars intermedia dysfunction (PPID, formerly known as equine Cushing’s disease).” If your horse is predisposed to endocrine disease (e.g., he’s overweight or obese), limiting nonstructural carbohydrates in his diet can help prevent the onset of laminitis, she adds.

When horses have comorbidities such as PPID, are obese, or are genetically predisposed to metabolic problems, their risk of developing autumn laminitis is higher, says Macon. “To be safe, my recommendation is to not allow horses and ponies that are at risk of endocrinopathic laminitis to graze on frosty autumn grasses/legumes,” she says.

Our sources recommend creating a unique management strategy for each horse because horses typically have individualized metabolic needs. If you know your horse is at risk for developing laminitis, and you are in a geographical region where autumn and winter have frosty nights, be sure to devise a plan to reduce your horse’s risk and avoid severe episodes. “Working closely with your farrier, veterinarian, and equine nutritionist is vital to creating a proper individualized management plan for your horse,” says Garland.

Decreasing your horse’s access to nutrient-rich forage (e.g., autumn frosty pasture), as well as incorporating regular exercise into their management plan can help reduce his risk of developing autumn laminitis. “Ideally, these at-risk horses will be housed on a dry lot with access to low-carbohydrate hay, but that is not always possible for most horse owners,” says Macon. “Therefore, giving horses shorter turnout times with a grazing muzzle is recommended.”

Ideally, turn horses out when pasture sugar content is at its lowest in the very early morning (generally 4AM until sunrise). Also keep in mind overall dietary balance. “In order to meet your horse’s nutritional requirements (i.e., protein, vitamins, and minerals)—which will not be met by your horse’s low-carbohydrate hay—you will need to feed a ration balancer,” notes Macon.

Take-Home Message

Understanding why autumn pasture poses a danger to at-risk horses and recognizing the seasonal metabolic shift that occurs can prompt horse owners to reduce their horses’ risk of developing endocrinopathic laminitis. Ultimately, the horses’ turnout schedules and balanced diets might need to fluctuate with the season. Evaluating your horse’s body condition in every season will help you determine what changes are necessary to maintain it optimally year-round.

Practical proactive considerations for keeping any horse sound

Proactive strategies can go a long way toward helping your equine partner stay sound, whether he’s a favorite trail buddy or a top competition horse. So in this article, three equine veterinarians and members of the academic community have weighed in with practical tips for maintaining a comfortable and happy horse.

1. Maintain a Team

While it might seem obvious, our sources can’t stress it enough: Be deliberate about maintaining a consistent relationship with your farrier and veterinary teams. “One of the biggest things for keeping horses sound and healthy is to establish a good working relationship with your veterinarian and farrier for regular maintenance and health care,” says Carolyn Hammer, DVM, PhD, professor of animal sciences at North Dakota State University, in Fargo. Ideally, your farrier and veterinarian should be able to communicate with one another when concerns arise. 

2. One Size Doesn’t Fit All

When it comes to shoeing options, different lameness or hoof conditions require different hoof care strategies. Key to keep in mind, says Tena Ursini, DVM, PhD, CERP, Dipl. ACVSMR, clinical assistant professor of equine sports medicine and rehabilitation at the University of Tennessee, Knoxville, is the applied shoeing setup provides the mechanics the horse needs to maintain soundness.

“I think a lot of discrepancy between farriers and vets is based on veterinarians trying to prescribe an exact shoeing package: If the veterinarian’s recommendation is one that the farrier is familiar with and can be successfully applied to that individual horse, everything is great,” she explains. “If it’s a shoe type that the farrier is either not comfortable with or cannot actually be applied to that particular horse for whatever reason, things go poorly, and the horse never gets sound. At that point the owner is unhappy, the farrier is unhappy, the veterinarian is unhappy, and the horse is definitely unhappy.”

3.  No Two Horses Are the Exact Same

Conformation is also unique to each horse. “The most important thing to realize is that not every horse is built the same; there is no single number for ideal hoof angle,” Ursini says. “It depends on how that horse moves and its conformation. Some horses are more upright, some have more angulation—so they will have a different foot angle in order to maintain an ideal hoof-pastern axis. Many people get fixated on a certain angle and try to fit every horse into the same box.”

In other words, horses are all individuals and must be treated that way.

4. Spinoff Effects

Don’t underestimate the importance of proper hoof balance, says Ursini. “The saying ‘no hoof, no horse’ is not an exaggeration,” she says. “Literally every mechanical aspect of how a horse moves can be altered by the shape and condition of their hooves. It is well proven in both the literature and clinical experience that horses with certain attributes—specifically, negative plantar or palmar angles of P3 (the angle the coffin bone makes with the ground; a negative angle means the back of the coffin bone is lower than the front of the bone, rather than both ends being level)—are associated with lameness and pain originating from the proximal suspensory, hock, stifle, sacroiliac (SI joint), and lumbar region.”

Ursini says in her experience, trying to treat all those sources of pain without addressing foot angles is impossible. “Corrective shoeing to improve the angles oftentimes removes the strain to certain structures, and after a short period of time I don’t even have to address those other issues, as the pain is secondary to the feet.”

5.  Look Deeper

What you can see does not tell the whole story. “The outside of the foot can definitely lie to you,” says Ursini. “While some horses have obvious signs of imbalance just by looking at them, I’ve been surprised several times by the degree of imbalance a horse has on radiographs.

“For horses being asked to perform at a high level, I would strongly encourage people to have all four feet radiographed on a routine basis—every six months to a year—in order to try and find imbalances early, before they cause other problems,” she adds.

Hoof radiographs play a key role in long-term soundness for any horse, says Ursini: “I’d like to reinforce the importance of radiographs to truly evaluate the balance and angles of the feet.” She lists specific factors your veterinarian and farrier should look for, including:

• The angle the wings of the coffin bone make with the ground (palmar/plantar angle).
• Sole depth.
• Dorsopalmar/plantar (toward the front/back) hoof balance (relative to the coffin joint and vertical forces of the limb).
• Signs of arthritis, laminitis, navicular disease (aka podotrochlosis), or other hoof conditions.

6.  Walk On

Don’t skimp on time spent walking, says Bruce Mandeville, JD, associate professor in Otterbein University’s Department of Equine Science, in Westerville, Ohio: “I don’t think we walk our horses enough. Horses are meant to be walking the majority of the day, yet many horses are stabled, ridden for 40 minutes, and stabled again.”

Mandeville, who represented Canada in three-day eventing at the 2000 and 2004 Olympic Games, as well as at the World Championships and Pan-American Games, notes that while actively competing, he would regularly walk his horses for up to an hour prior to gallops and again after galloping. “By walking long and low, the nuchal ligament that runs from the poll down the neck is engaged; this brings the spinal processes of the withers forward, putting positive tension on the nuchal ligament and, in turn, on (the) supraspinous ligament along the spine. This causes the back to raise and supports the weight of the horse’s torso.” 

To that end Mandeville urges owners to gain as much biomechanical understanding of the horse’s anatomy as possible. “Be cognizant of the horse’s shape and postures for optimal use of structures like muscles, ligaments, and tendons,” he says. “It would help our industry if we had more exposure to biomechanics—we could help our horses use their bodies more efficiently.”

7.  Leg Protection and Heat

Boots and wraps have long been mainstays for exercising horses. More recently they’ve become, literally, a hot topic. “Many owners are familiar with the recent study from Middle Tennessee State University concerning heat under boots and bandages,” notes Hammer. “There is obviously concern, but also in some events the need for protection. I think we’ll see more research looking at tendon temperature versus surface temperature.”

“I think we have overbooted in the past,” adds Mandeville. “Unless you have a specific need to boot, such as a horse that brushes (one foot or limb against the other during movement), the current approach is steering away from boots and wraps. This may be a case when we think we are doing something beneficial for the horse, but we’re not.”

Both Hammer and Mandeville note we might see more research surrounding cryotherapy techniques—icing, ice boots, and cold hosing—in the future to investigate the consistency of temperatures and the efficacy of various modalities and applications. They urge, as always, to consult your veterinarian if you have questions about leg protection and cryotherapy applications.

8. Therapeutic Products

Many barns employ popular modalities designed to keep horses as comfortable as possible, such as pulsed electromagnetic field therapy (PEMF), vibration plates, and gel boots. These modalities are worth considering, says Mandeville, based on his experiences leading classes on equine noninvasive therapies in which students tested various products on the university’s horses, measuring facial expressions and cortisol (stress hormone) levels in saliva.

“We see different effects on different horses. It’s worth exploring what brings comfort to your horse (after consulting your veterinarian, of course),” he says. “I would suggest horse owners try various therapies and see what the horse responds to the best before making an investment; each horse is different. You may also want to consider learning acupressure, which you can take as an online course.”

9. Arena Surfaces

Arena footing is a hot topic among riders and big business, as well, with a spectrum of surface options at various price points serving the needs of different sports and scenarios. Without doubt, arena surface construction and maintenance play roles in both performance and safety.

“Footing has evolved over the years and is very discipline specific,” says Mandeville. More recently “the main considerations are the condition and uniformity of the footing, drainage, dragging, and watering. The right conditions are a blend of art and science.”

Inconsistent footing can also be problematic. Mandeville cites the eventing cross-country course at the 2004 Athens Olympics, where surfaces changed from grass to dirt to arena footing, and many horses struggled to adjust to those changes, which can contribute to injuries.

For the average horse owner, however, “problems arise when the footing has degraded,” he explains. “Plan to replace your footing as needed. As much as possible, match your training footing to the type of footing you’ll be competing on.”

10. Do Your Research

From nutritional supplements to therapeutic boots and blankets, you’ll find many manufacturers (and horse owners and trainers) claiming their products support equine soundness. But don’t take what you hear at face value.

“I think it’s really important for owners to do their due diligence to find information,” says Hammer. She offers two points to consider:

1. Work with an equine nutritionist or veterinarian to establish a dietary program, including forage, concentrates, and supplements, to ensure both ingredients and levels are efficacious for your horse.
2. Alternative therapies of various types have grown in popularity, and some have better science behind them than others. “Chiropractic and massage can be great options for keeping horses comfortable,” says Hammer. “This is where a good relationship with your veterinarian comes into play; these therapies can’t fix every problem. Also, licensing requirements vary by state. When alternative therapies are appropriate, reach out to your veterinarian for recommendations.”

11. Last But Not Least: Lifestyle

Remember, overall lifestyle can also contribute to soundness. Being too heavy—as commonly seen in many horses and other pets these days—puts a burden of stress on joints, ligaments, and tendons, says Hammer. In addition, says Mandeville, owners should consider exploring ways to allow horses to live more naturally, including as much turnout as is feasible for the individual situation.

Take-Home Message

Start by establishing a supportive equine care team and determining your horse’s individual needs. Then, these simple steps can go a long way toward keeping your horse sound and can save you time and money in the long run.

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How farriers trim and shoe horses for their unique biomechanics, discipline, and riding surface

I spent some time the other day cleaning my Quarter Horse’s paddock. I watched him walk from the water trough to his hay pile, paying close attention to where and how each hoof landed on the soft ground and how he raised each heel from the muddy surface. He was diagnosed with podotrochlosis (aka navicular disease, a degenerative condition of the navicular bone and soft tissues in the back of the horse’s foot) via MRI long before I became a veterinarian, so I credit his pathologies for my eye for lameness. A rolled toe and heel elevation help ease his breakover to allow for a more comfortable existence.

How do veterinarians and farriers get and keep horses with and without conformational deformities like this happy and sound? With a simple, yet thorough, understanding of equine biomechanics.

Biomechanics Overview

The word “biomechanics” sounds scary, doesn’t it? As a veterinary school student, I thought so too. Thankfully, Thilo Pfau, PhD, a faculty member of veterinary medicine at the University of Calgary who’s spent much of his career researching performance horse biomechanics, has broken the basic concepts down for us.

Gaits, whether walk, trot, or canter, can be split into stride cycles that get repeated over and over. “For each limb, a stride cycle can be subdivided into the stance phase—the time period when that limb is in contact with the ground—and a swing phase—the time period when that limb is swinging through the air without ground contact,” explains Pfau. “The stance phase is often further subdivided into impact, support phase, and breakover.”

The impact phase is when the hoof makes contact with the ground. The support phase follows, when that hoof supports the horse’s weight while the opposite hoof is in its swing phase. “Finally, breakover is initiated by the heels leaving the ground when the toe starts to rotate further into the surface,” he says. “On a hard surface, breakover ends when the toe leaves the ground. On a soft, deformable surface, it ends when the whole solar surface is losing contact with the (ground) surface. Delineating these distinct phases is less straightforward on soft ground.

“Biomechanically, the stance phase is characterized as the period of time where forces are being exerted onto the ground by the horse and following Newton’s laws of motion: Equal and opposite forces are exerted back from the ground onto the horse,” he continues. “These are the ground reaction forces (GRFs). During the swing phase there is no ground contact and, hence, no ground reaction force.”

Hoof biomechanics are fluid, and farriers and veterinarians can manipulate them using podiatry. Take, for example, the point beneath the foot where the GRF originates—the point of interaction between the hoof and the surface. “The position under the hoof changes over the stance phase, typically being rather central over much of the stance phase and then migrating dorsally toward the toe during the breakover period,” says Pfau. “The position, however, can be altered—for example, when using heel wedges or graduated shoes to translate the point of force (toward the heel) and unload the deep digital flexor tendon (DDFT, which passes around the navicular and attaches to the coffin bone). However, since the overall amount of force, which is strongly associated with the body mass of the horse and the speed of locomotion, remains unchanged, other structures such as the superficial digital flexor tendon (SDFT, which lies over the DDFT) and/or the suspensory ligament will have to compensate for the drop in load of the DDFT to keep the horse limb stable.”

For this reason, trimming and shoeing are powerful tools for altering the biomechanics of movement by manipulating the point of force application under the hoof. “However, it is vitally important to always consider the complex interaction between the different structures within the horse limb in relation to the forces acting from beginning to end of stance,” he adds.

Biomechanics in Practice

So how do we apply biomechanics in practice? Rodney King is a certified journeyman farrier who operates North Canterbury Equine Podiatry, in Amberley, New Zealand. He focuses his practice on sport horses and therapeutic shoeing.

“I feel that very little can be achieved with the trim alone,” says King. “I trim fairly consistently on most of my horses regardless of the foot type or pathologies. I trim the heels down to the widest part of the frog and the toe down to the junction of live sole at the point I can start to feel the sole yield under firm thumb pressure. It’s a bit subjective, but I use my thumbs to feel and can get a good read on feet and sole depth with them. The dorsal wall (the front of the hoof) is dressed to remove flares and dishes. Once that’s done … it all comes down to the shoe.”

As Pfau explained, it’s the application of the shoe that adjusts the GRF and the point of force application. “The shoe will always be tailored to the pathology,” says King. “We can add elevation (at any point that requires it), increase mechanics (reduce breakover with a rocker or roll at any given area of the shoe), or we can alter ground reaction force (change the web width of the shoe so its interaction with the ground results in the desired effect on the foot). Often, the shoe will have more than one of these modifications added to fit the requirements of the pathology.”

He uses laminitis, which occurs when the laminar tissues that suspend the coffin bone within the hoof capsule become inflamed and fail, as an example. With these cases he’d try to reduce DDFT peak strain by elevating the heels of the shoe and reduce breakover by rockering the shoe.

“The shoe will usually have some kind of frog and palmar (rear-facing) support to not only support the (coffin) bone but to also help prevent the heels from sinking into the ground and increasing DDFT strain,” he explains.

Discipline Matters

It’s no surprise that farriers typically trim and shoe a Warmblood that performs high-level dressage differently than a Quarter Horse that runs barrels every weekend. Each discipline requires different movement and momentum from the horse and, to the farrier, that matters.

“In my day-to-day shoeing on straight and sound horses, I will always take into account the discipline of the horse when deciding how to shoe,” says King.

While a good trim can go a long way, King uses the shoe to support the specific discipline. “I will shoe the palmar hoof slightly differently for different disciplines,” he says. “As a rule, I would say as the speed of the discipline increases, the shorter and tighter I will fit (the shoe to) the palmar hoof.”

For example, he says dressage horses can be shod with a wider, flatter shoe and can tolerate a more supportive, fuller fitting shoe. Show jumpers might wear a similar style but without the fullness of a dressage horse’s shoes, as the chances of pulling a shoe increase due to the job.

“Endurance horses can be shod with a lighter shoe with a profile or section that suits the environment they are training in,” he says. “They can be shod with enough cover to support them through a shoeing cycle and are shod at around four-week intervals, as the shoes are generally worn out by this point.”

Not all Surfaces Are Created Equal

Arena and sport surfaces have come a long way, even in my lifetime as an aging millennial. I recall barrel racing growing up, when every arena we frequented was filled with deep, deep sand. Today, arenas can be any mixture of sand, wood products, stone dust, rubber, and synthetics.

“These surfaces offer great support and traction to horses and are far superior to older sand type arenas,” says King.

Eventers and endurance riders don’t compete exclusively in arenas, of course. Many athletes take their competitions to the field or trail. “I find that customers often ask for more traction via stud holes when competing on sand or grass,” he says. “A lot of our endurance horses will use pads and silicone packing leading up to race days, more as a preventive measure against foreign body trauma, but will remove this on race days.”

The biggest variability in these surfaces is their depth and support. The farrier’s goal is to support the foot but also prevent the coffin bone from sinking and increasing the load on the limb.

“I try to use shoes that will allow the foot to maintain a relatively flat stance during loading,” says King. “For example, if the surface is deep and deformable, I might add something that will prevent the foot from sinking at the heels. This might be as simple as adding silicone to the back half of the foot or a bar to the shoe.”

Take-Home Message

Shoes, surfaces, and sport all affect a horse’s movement. Biomechanics is the foundation of therapeutic podiatry. A thorough understanding of how the horse moves is necessary to maximize and manipulate it effectively.