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Low Heels with Suspensory Branch Shoe

Horse Care
#21

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Above is the old fronts vs. the new front set-up (with side clips). The hinds have the white socks and have the small trailer behind. The goal is to support the frog and the heels and engage the boney column. Since we are in Florida during the wet season, change is going to be slow and small. Comments? The left fetlock is very swollen. The vet says this is normal for him. Actually, it is not normal for him, and I am pretty upset about it. Can you see the impressions the fly boots have left? He had lots of turn-out yesterday, so if it was stocking up, then it seems like it would have subsided.

New Front Side Comparison.JPG

New Left HInd.jpg

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New Front Soles.jpg

#22

Been lurking since you started this thread - what a saga. The toe-stepping giant fragile ego thing is probably more frustrating than having an injured horse, 99% of the time. It’s miserable!!

Looking at the pictures posted - the trim on the hinds is somewhat improved. I like the shorter toe, but I can’t understand the approach to the quarters and heels - the arched hairline is a clue that the trim is not balanced, and the long hoof capsule says that there is a likely a lot that could be taken off to relieve the pressure on the quarters and to help move the heels back (not suggesting this necessarily be done in one fell swoop). Both pictures show a heel in the wrong place to support the bony column of the leg. The new setup at least has tried to provide some support with the shoe, but I can’t quite understand the approach to the hoof itself. It would be interesting to see lateral rads to see whether there has been any distal descent. Do you have a sense of sole depth/thickness?

Is the solar view old vs new set up of the hinds?

Did the farrier talk through how the set up in the fronts would address the heel issue? It looks as though the shoe is set back to bring breakover back, but I don’t understand how the set up at the heel is going to encourage appropriate alignment of the heels. My experience is that shoeing this way essentially locks the tubules at the angle they are currently growing (which is almost horizontal in this case).

Do you have recent hoof rads?

a big GIANT disclaimer that I am NOT a pro, but I do hoof care for my own horses, have successfully rehabbed some challenging issues, and I am actively studying with pros to grow my knowledge and skill set. I’m not saying any of the above with authority or accreditation behind me - just critical thought and applying theory that has served me well in my own rehabs.

5 Likes
#23

Okay these pictures make me feel much better… a definite improvement… how does he feel in this set up so far? He really backed up the toe and you can already see the big improvement in the jamming at the quarters/heels. I would bet definitely flat or negative plantar angles behind. The heels are folded under and crushed and the bullnosed appearance really clues you in. Using the DIM to support the frog and the collateral grooves will help get some of the weight off the heels and help them to unfold. and keeping him in a stall is going to make things worse unless he absolutely has to be in for the suspensory.

How is his diet? I really think getting this guys feet straightened out is going to help him A LOT… so growing a stronger healthier foot is going to help him so that he doesn’t need to be in this set up forever… I can’t even imagine how much this costs. I wouldn’t let him go any longer than 5-6 weeks before the next reset… please keep updating us.

2 Likes
#24

The stocking up may subside with time… cold hosing while massaging will help with that. He needs movement movement movement.

2 Likes
#25

Yeah I agree with all of this… will be interesting to see how the next reset looks… The fronts are going to be easier to rehab than the hinds… those hinds need a lot of help. I’ll be curious to see if this set up helps him.

Personally I would pull the hind shoes and put him in boots with pads to allow for very frequent trims.

1 Like
#26

IPEsq, in order to get to the bottom of why low heels would be good in any situation, I could only come up with allowing the heels to sink is good because the heels HAVE to sink to cushion the impact from a hoof that has a floating toe. A floating toe is a toe that is not allowed to grab the ground, and this is somehow good for healing suspensory injuries.

So, maybe, allowing the heels to sink is not actually a feature for healing, but rather a feature that addresses how to dispense the energy upon impact - the hoof hitting the ground. What do you think? Extending that thought, maybe if the sinking heel feature does create some strain on other structures, the thought is that the amount of this strain is believed to be within an allowable tolerance when the shoe is used to facilitate suspensory healing? What does a negative palmar angle to to that tolerance? Is it still acceptable?

#27

Boyle Heights Kid,

I also was thinking about pulling the hind shoes. He had been successfully barefoot for three years on the hinds, and then within three months in suspensory shoes, his hoof balance is a wreck. The think that stopped me was, one, was the new farrier going to be caught off-guard, and two, those prolapsed frogs are going to be so tender for him to walk on. I have sole freeze and have also used Hawthorne’s Venice turpentine before for the soles, but I was not sure how to handle the frogs (like to pull the front shoes during the hottest months). Would hoof boots have enough cushion in your experience? Or is it just maybe going to be ouchy even with treatment and hoof boots?

#28

An update one week post new shoeing setup: The horse has his appetite back. He is finishing his grain, enjoying his hay, and drinking water. HIs face has lost that tightness, which he also carried in his neck. After a whole week of intermittently sitting on his stall wall, he finally stopped. He is active again. He relished trotting in for dinner. Apparently this is acceptable during his rehab program. When he trots, the flipping motion at the fetlocks is gone. Before, in the old shoeing set-up, it was like the hoof impacted the ground, the breakover happened, and then the fetlock joint would look like it had knuckled over somewhere during or after the breakover, but he held it that way until beginning the forward flight phase again. It looked very strange. He does need some bodywork. Excellent suggestion. He came out of his stall Sunday and had a nice big roll. It was really encouraging seeing him work to loosen his body up.

His diet is good. He gets 1.25% of his weight, 18 pounds, in good quality timothy hay, spends an average of four hours on good quality pensacola bahia grass. We watch the sugar content and turn him out when it is supposed to be the lowest while keeping it mowed down. He gets 6 pounds of Triple Crown Low Starch as he is an easy keeper. He is always on hoof supplement, Hoof Secret being the latest. He is a 17 hand Hanoverian built more like a basketball player. Poor horse, he gets no treats, and no apples, carrots or other goodies if he not working! Even if he is working, some of that stuff is really rich!

4 Likes
#29

Hoof Armor :slight_smile:
https://www.ridingwarehouse.com/Hoof…page-HASK.html
https://www.youtube.com/watch?v=CuYLMreKosw

#30

This is great! These are all signs he’s feeling better. With all this going on you might want to think about treating him for ulcers. OTC Nexium has helped a lot of horses. There is a thread about it here in Horse Care that should be on this page or the next.

#31

Bolding mine -

Thinking about the attachment points of the suspensory ligament, I can kind of see the logic of a low heel giving some kind of relief to the suspensory, though I can’t assess the soundness of that logic with any kind of authority. My gut, however, says that the strain put on the DDFT by a negative palmar or plantar angle - and the pretty much inevitable stress to other soft tissues and resulting pain/discomfort and alteration of gait and posture isn’t likely to be worth any potential benefit gained by maybe relieving strain on the suspensory. But obviously, not a vet! And maybe it’s a case of “best of bad options”?

NPA is a pretty big bad deal, so even if the idea is to keep the hind heels lower intentionally, I would truly want to understand the timeline and plan for getting both the hind and front heels properly aligned and improving the position of P3. Low or Negative PA tends to create pain in the caudal hoof which leads to a toe-first landing, so that the structures of the foot and leg are being used pretty well backward of their intended function: impact shifts to the rigid toe wall where it can’t be dissipated, the bony column of the leg is not aligned to manage the impact forces which creates trauma to the joints, and the strong, flexible tissue of the digital cushion and frog end up being completely underused and often atrophy (which then reinforces the pain in the caudal hoof, heel contraction, and toe first landing).

It’s excellent that he seems to be feeling better! This of course is the ultimate goal. I would want to make completely certain that the improvement in comfort is not at the expense of hoof health. I have found (through miserable personal experience) that the high of seeing your horse pain free and moving soundly immediately after “corrective” shoeing is so frequently followed by a low when the compensatory adjustments made with the shoeing are no longer enough to mask the issue - if you’re “lucky” there’s room to make additional compensation with the shoeing. If not, you find yourself making tough decisions (or, if you’re me, accidentally learning how to trim and discovering that your passion in life is actually hooves. who knew). This is NOT an exhortation to pull his shoes off and just go it barefoot. He almost certainly needs support - I would just want, in your position, to know exactly what the plan is for getting the feet back on track. Maybe that’s accomplished in boots and pads, maybe in a composite shoe set up with padding or formahoof. Maybe the current set up WILL do this - I would just want to understand the mechanisms that the vet and farrier see as being in place for rehabbing those feet. And if the answer is that they don’t see one - then I’d start looking for second opinions.

1 Like
#32

The Bowed Tendon book by Tom Ivers has a great illustration on how letting the heel sink a bit actually takes some of the stress off the tendon/s. But this is something that is only done temporarily for healing/rehab. The illustration also shows how applying a wedge adds stress to the tendon. So I guess a good compromise would be to just shoe in a way to move the heel back. I’ll try to get a picture of it when I get home.

1 Like
#33

I completely agree. So, now look at the bottom of the hind hooves three months into the shoeing with the suspensory shoes (just trimmed three days prior by old farrier). Not only has the balance been altered with the NPA, but it looks like the hoof capsule is trying to adjust and accomodate the impact medial to lateral. The outside hoof bulb looks enlarged, and what is happening with the bars?

In fact, everything you have said is true evidenced by the contracting of the frogs on the fronts, the rolling back action due to the legs being used essentially “backward” (excellent description) from toe first landings, the swelling, and the interference injuries. Each hoof and leg is telling the story. It is going to take at least six months, my guess, to really be back on track, and a whole new hoof capsule over twelve months to get back to point A.

Alas, sadly, the initial short-term relief does seem to be over, and the masking is now uncovered. The fetlocks continue to be swollen, but no heat. He doesn’t sit on his stall wall anymore, but he stands suspensory treated right hind leg toe pointed forward, or he rests on his left hind leg and on the tip of right hind leg toe (no pointing forward), and today, a new configuration, standing on the left hind leg with the right hind leg knuckled over at the fetlock and resting on the front wall of his hoof (but not pointing forward). I have never seen anything like it.

My stomach is in a knot, and I recently sent all of his stile and suspensory diagnostics to a veterinarian outside the state along with videos and pictures of his hooves.
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#34

BoyleHeightsKid,

Thank you for the hoof boots link, the OTC Nexium idea, and the Tom Iver’s book! I looked and looked and looked for one set of illustrations posted online, probably what you have seen in Tom Iver’s book, that show how changing the hoof palmar angle changes the mechanics. I could not find it. Husband and I then sketched the linkages all up and down the leg just to prove to ourselves how a change in angles affect the structures of the hoof and leg to make a case for totally agreeing with IPEsq’s comment! Both of us having an extensive background in new aircraft stability and control test engineering to include dynamic and static fatigue testing, we thought maybe we could gain some insight. I wanted to post the sketches, but husband is still learning how to draw a horse’s lower hind leg. :smiley: My drawings were only marginally better! Kashmere’s description is brief and clear, and that helps a lot.

#35

@SporthorseFun Oh, I’m sorry! It’s so hard to be in that position - but as they say, the first step to fixing a problem is admitting (or in your case, identifying!) the problem. You are doing the right thing in looking for alternate vet advice and not letting this lie.

My glasses are… slightly out of date, and the image gets blurry fairly quickly when I blow it up, but in terms of bar I am seeing potentially a significant flare in the medial bar (can’t 100% tell if it is bar or just some dirt :lol:). There is flare/separation through the quarter, especially medially - and definitely evidence of uneven load on the heels. I’m going to shoot you a PM.

1 Like
#36

Can you get us a picture of him from the side of how he is standing?

#37

The above picture was to show the new farrier the extent of the damage when the shoe came off. The only other picture I took for him was to show the side clip damage, and that doesn’t show how he is standing from the side : ( These pictures were taken a few days before the shoe came off right after he was shod on his hinds by the old farrier. May help?[ATTACH=JSON]{“data-align”:“none”,“data-size”:“medium”,“data-attachmentid”:10695912}[/ATTACH][ATTACH=JSON]{“data-align”:“none”,“data-size”:“medium”,“data-attachmentid”:10695911}[/ATTACH][ATTACH=JSON]{“data-align”:“none”,“data-size”:“medium”,“data-attachmentid”:10695909}[/ATTACH][ATTACH=JSON]{“data-align”:“none”,“data-size”:“medium”,“data-attachmentid”:10695910}[/ATTACH]We were wondering why he was standing with his hind legs so close together when that is not a conformational fault of his. Now you see the new splint bone that has popped on the right front.

Legs right side.jpg

Legs left side.jpg

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#38

Kashmere,

Yes, there was a significant medial flare, and the hoof was really pink after being trimmed. I don’t want to read too much into that, but you have to wonder if something was happening between the laminea and the hoof wall? A little stretching?

#39

It is really interesting seeing those really upright pasterns and how post-legged he is. I remember thinking a couple of months ago, gosh he has really long pasterns. He does naturally have a straighter leg, but that is too straight. I didn’t realize then that the pasterns looked taller because they were becoming more and more upright as the coffin bone sank and the angles went negative. Wow, it really does take years to learn this stuff.

#40

So any flare is basically a stretching of the laminar connection, you are bang on. You can have good connection and get a little bit of flare at/close to ground level if the wall gets too long. Generally this will chip off if the horse is able to move enough over harder/abrasive surfaces (essentially how a hoof trims itself). This is the kind of flare that is generally easily managed with a trim. MANY horses load their hooves slightly more medially, so you will often see a lateral flare in the quarter as the wall growth in that region isn’t being worn down as much. The medial wall is also often slightly steeper. You can also have more wholesale poor connection due to inflammation or diet imbalance (and likely other causes of which I am ignorant!)- which in both cases could be exacerbated by mechanical (lever) forces at ground level as the wall interacts with the ground. When you have a weak laminar connection, one way this is visible is a stretched white line, where instead of showing up simply as a line demarcating sole from wall (when looking at a solar view of the hoof), it shows up as a “ditch.” You can see this quite well in the solar view you posted above - both the lateral and medial quarters toward the heel show that separation (more significant laterally - I totally got myself backward when I initially said the wall flare was more significant medially when looking at that image!). When you get closer to the toe, while it looks like the connection is improved, what is more likely is that this area is filled in with a laminar wedge - essentially material that forms in the gap of the stretched laminae. I suspect if you really cleaned up the sole - like scrubbed with a brush to remove as much surface dirt as possible, you would be able to see an area directly behind the wall at the toe that has a different texture than the sole behind it.

Where did you see the pink colour? I think it’s pretty safe to say that’s bruising/inflammation, but would be interesting where it was located. Was it a localized area (or several localized areas?) or spread out more over a larger area?

Looking at the picture of the old shoeing job - I don’t get a sense that he is post-legged (though obviously you have seen the whole horse and I am seeing most of a leg :lol: so take that as you will!) I actually like the position of the near leg in that image. It is showing the cannon bone perpendicular to the ground, which is a good neutral stance. I think we are very used to seeing horses camped under to some degree, which changes our impression of hind-end angles. In reality, it’s just an extremely common compensatory posture, very often stemming from long toe/low heels. The steep angle of the hairline and the bullnose aspect of the dorsal wall make me think there is NPA even in this image (my eyeballs fail again when zooming in so I can’t 100% see the heel placement). But it looks like perhaps a shorter hoof capsule than currently, maybe indicating less or no distal descent - and there isn’t that wonky pushed up hairline at the quarter.

Usually with NPA/low heels/long toe you see pasterns looking longer and at a shallower angle than more upright: if you want to visualize this with your own body, imagine that your toe is the tip of P3 and your heel is the palmar aspect of P3. With your foot lifted slightly off the ground, point your toes downward to simulate a positive palmar angle (e.g. your heel is farther from the ground than your toe). Note the angle of your tibia (i.e. your “pastern”). Now, raise your toes and drop your heel toward the ground to simulate a negative palmar angle - see what happens to your tibia? You’ll have to extend your knee a little bit, and your tibia will end up at a shallower angle to the ground. That all being said, if you are seeing a steeper pastern angle, perhaps there is additional postural compensation going on?

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