This is a terribly interesting thread. I have personal interest here, as my mare is NPA behind. However, she also has a bit of a steep croup, and I’m starting to wonder if that doesn’t contribute. Hooves don’t exist “on their own”, in trying to fix her I am starting to wonder if her overall hind conformation doesn’t contribute to our struggles.
Keep updating us, OP.
Also following this as my horse has NPA to some extent in all four, along with medial-lateral issues in the fronts. Just got custom shoes installed in front: bar shoes with built-in wedges where the medial portion is more wedged that the lateral. Custom as in the farrier started with straight steel stock and made the shoes. The theory behind doing it with shoes and not pads for the front is that the plastic pad material will compress somewhat as he steps and change more over the shoeing cycle, as compared to metal, and the farrier felt that it was critical for this horse, who also has some soft tissue issues in the foot due at least in part to an unfortunate encounter with a rock at a show a year ago, to land dead flat.
I would be curious to see these feet with this set up.
Thank you. I’m curious, is there a reason the farrier can’t correct the medial/lateral imbalance with proper trimming instead of building up one side of the shoe?
IME a set up like this does not help with long underrun heels either, it only furthers the damage. 
Agreeing here, as usual. Also wondering about potential issues this horse might have further up - these feet are pretty significant hi/lo and would indicate a lot of time spent with the LF forward and the RF back under the body (typical grazing with one foot back and one slightly out posture). The RF has a better DP balance and ML balance - I’m guessing the medial wedging on the RF is more to help compensate for the wedging on the LF than to correct an imbalance inherent in the RF - so would imagine that if there are issues showing up elsewhere we might see those perhaps in a tendency to be tight through the right shoulder, maybe some soreness or tightness through the right hind/over the right LS? Just guesses there, but have a little mare who had some wild hi/lo issues, so speaking from a bit of experience at least
@Peggy when you say this set up is to ensure the horse is landing flat - do you mean flat medial/laterally - i.e. loading the M/L sides at the same time during landing and with as equal weight distro as possible? I suspect a heel-first landing will be quite challenging - especially for that LF, so maybe there is also the goal of getting at least a flat landing (on the DP plane) as well? Also extremely curious about what injury this horse sustained with the rock - The caudal foot seems pretty wonky. How does it look from a solar view? Was there any collateral ligament damage diagnosed?
Like @BoyleHeightsKid I struggle when I see a very underrun heel shod this way. My experience is not broad - I am certain the farrier involved here has heaps more under their belt - but it does bear out that locking very distorted heel tubules into a rigid set up doesn’t provide them any way to realign themselves. With this foot being so pulled forward, generally, I suspect that the heel tubules are not TOO far off the angle of the growth toward the toe, so sometimes that can kind of trick the eye/brain into not seeing the distortion, when really it’s a case of wholesale distortion rather than a localization to the heel. All to say we see an “underrun heel” and end up lasering in our focus there, when the issue is really a forward foot, full stop. Do you have lateral rads and/or solar views (unshod ideally) of the LF? Would be really interesting to really look at the balance relative to the DIP joint.
We have shoeing rads, an assortment of other rads, two MRIs. The farrier had access to all this. The vet saw the horse yesterday and agreed with the shoeing. The balance looks better than it did before this shoeing. Nothing against all of you, and I do appreciate the feedback, but for now I’m going to trust the professionals that have been working with the horse.
No I am not going to post this other information. I hesitated about posting the photos as is bc I’ve seen where these shoeing threads can go and I’m not willing to deal with a lot now. Plus I didn’t want to derail the thread away from the OP. Maybe I’m being defensive but, aside from a lame horse, my mom died last week and a close friend died in May.
The original injury is that he stepped on a rock (*) on RF. All damage observed on MRI aligned with the divot on the bottom of his foot from said rock. He came to the party with medial-lateral imbalance issues that are readily seen on radiographs on both front feet, but more so the LF.
I edited my post to remove the photos, but it’s now in unapproved purgatory thereby making it look as though I deleted it.
(*) Going with Occam’s razor here as he certainly stepped on something and there were a ton of rocks at the facility (Galway Downs).
Eep. So sorry! Totally understand and did not mean to come across like a weird loon telling you what to do - when you have a plan and a team you trust it is often the opposite of helpful to have a bunch of random opinions tossed at you. And so sorry about your losses - that is terribly difficult to go through all at once. Crossing fingers your horse makes a full recovery!
Good luck to you… in the meantime, maybe start researching how hoof balance/imbalance can affect soundness and the whole horse. The ELPO has a lot of good articles:
https://www.lamenessprevention.org/s…_webpage=13310
Pete Ramey’s site, while he’s a barefoot advocate has a lot of valuable information on his site about balance and hoof health:
https://www.hoofrehab.com/Articles.html
and Page Poss while she is also a barefoot advocate has extensively studied hoof anatomy and also teaches:
http://www.ironfreehoof.com/#:~:text…%20the%20body.
Lots of good information on all these sites about hoof balance and how what you have going on in your horse can affect him. We are here to help and not rip anyone apart. Your experience contributes to the thread as your issues are similar to the OP. Again good luck to you and you horse.
It’s OK. I’ll take a look at the articles. The vet and both farriers have the advantage of a lot more data, including watching the horse move. But I also realize that it’s valid to consider opinions from those who haven’t been embroiled in the battle.
My farrier referred me to the second one bc his feet had gotten way out of balance at four weeks, though the radiographs didn’t look as bad as the feet. If either of you are on any of the farrier groups, pretty sure the information has been posted there.
Horse is still slightly off in RF and it blocks to the heel. You could go to any show in America (or maybe not since they’re not allowing spectators) and see horses that are more off than mine. For now he gets another two months of walking. Vet says we’ve done everything there is to be done. And now we wait.
Okay so here’s a great thread from a while back. I can’t believe I found it. Said horse was being shod by a farrier at Texas A&M
https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/310818-update-115-rocker-shoes-or-barefoot-for-a-low-heeled-negative-palmar-angle-horse
This is fascinating . . . So the ditch is a an area of weaker white line. I follow that pretty well. The flare was medial, and it was pinky-red over the whole medial wall, so a large area. Remember the asymmetrical suspensory shoes create loading laterally for healing a medial suspensory injury. From what I understand flares show up opposite the loaded side of the hoof. It is also interesting your observation on whether he is “post-legged” in the picture. I can see why you say he looks fine and is not really post-legged. The cannon bone is perpendicular to the ground, and I completely get the indicator of wonky pushed up hairline at the quarter, which we are not seeing yet.
The NPA creating a pastern looking longer and at a shallower angle was a surprise! Your description makes perfect sense. I will have to think about postural compensation, or it could be the horse grew some more leg, and I am only now fixated on that area of his body! Usually, he brings his back and SI into play to compensate for right leg pain. I did have someone look at his stifle radiographs and ultrasound from February, and his stifle was showing inflammation then. I got some bad news yesterday after the same vet looked at his radiographs and ultrasound from April for the suspensory. He has an avulsion fracture at the suspensory proximally, and he does have a 20-30% tear. I feel a little lost with the change in diagnosis, the treatment (surgery), and the path forward at this point (the outcome is not hopeful for complete healing). However, in staying focused on the original question, research has shown that long toes and low heels seriously aggravate this condition, avulsion fractures, at the suspensory proximal point.
It would be interesting to see conformation shots of him and to see his stance after he’s been standing for about 5-10 minutes to let him find a stance he finds more comfortable.
My senior boy had a similar injury that ended his racing career, but in his left front. There was no damage to the suspensory, but some sclerosis of the bone at the proximal attachment (when I took him to Cleveland, Dr Genovese diagnosed it as an avulsion fracture) and it would bother him every now and then. When it bothered him he was 1/5. We are very lucky here, we have a vet, Dr Keith Brown, who did his residency at Rood and Riddle only 15 minutes away. He is an excellent lameness vet who also understands how hoof balance affects them. He said 95% of the racehorses they saw with this injury went back to race. He injected the site with adequan and a steroid to help with healing. I never had a second ultrasound and he’s been 100% on it since. Because of this, and other track jewelry he came with, I make sure not to let his feet get out in front of him.
Daisy Bicking has a great Patreon page https://www.patreon.com/DaisyBicking/posts it’s $10 a month and she’s got many great video’s and case studies on special horses and videos on hoof balance and she also studies postural compensation. Just more food for thought
Figuring them out can be like peeling an onion. You get one thing figured out and another thing pops up. Thanks for sticking around and keeping us updated.
It would be interesting to see conformation shots of him and to see his stance after he’s been standing for about 5-10 minutes to let him find a stance he finds more comfortable.
My senior boy had a similar injury that ended his racing career, but in his left front. There was no damage to the suspensory, but some sclerosis of the bone at the proximal attachment (when I took him to Cleveland, Dr Genovese diagnosed it as an avulsion fracture) and it would bother him every now and then. When it bothered him he was 1/5. We are very lucky here, we have a vet, Dr Keith Brown, who did his residency at Rood and Riddle only 15 minutes away. He is an excellent lameness vet who also understands how hoof balance affects them. He said 95% of the racehorses they saw with this injury went back to race. He injected the site with adequan and a steroid to help with healing. I never had a second ultrasound and he’s been 100% on it since. Because of this, and other track jewelry he came with, I make sure not to let his feet get out in front of him.
Daisy Bicking has a great Patreon page https://www.patreon.com/DaisyBicking/posts it’s $10 a month and she’s got many great video’s and case studies on special horses and videos on hoof balance and she also studies postural compensation. Just more food for thought
Figuring them out can be like peeling an onion. You get one thing figured out and another thing pops up. Thanks for sticking around and keeping us updated.
It would be interesting to see conformation shots of him and to see his stance after he’s been standing for about 5-10 minutes to let him find a stance he finds more comfortable.
My senior boy had a similar injury that ended his racing career, but in his left front. There was no damage to the suspensory, but some sclerosis of the bone at the proximal attachment (when I took him to Cleveland, Dr Genovese diagnosed it as an avulsion fracture) and it would bother him every now and then. When it bothered him he was 1/5. We are very lucky here, we have a vet, Dr Keith Brown, who did his residency at Rood and Riddle only 15 minutes away. He is an excellent lameness vet who also understands how hoof balance affects them. He said 95% of the racehorses they saw with this injury went back to race. He injected the site with adequan and a steroid to help with healing. I never had a second ultrasound and he’s been 100% on it since. Because of this, and other track jewelry he came with, I make sure not to let his feet get out in front of him.
Daisy Bicking has a great Patreon page https://www.patreon.com/DaisyBicking/posts it’s a paid subscription and she has a couple of different tiers. She’s got many great video’s and case studies on special horses and videos on hoof balance and she also studies postural compensation. She also specializes in rehabilitation. Just more food for thought
Figuring them out can be like peeling an onion. You get one thing figured out and another thing pops up. Thanks for sticking around and keeping us updated.
Ugh, I’m so sorry about the further bad news. With any soft tissue injury, I think that unless there is a specific reason/need not to do so, keeping the ratio of toe/heel support to 50:50 around the DIP joint is even more critical than usual to avoid compensation by the soft tissue. So I would for sure think that managing the low heel and long toe is extremely important especially with this latest info.
The post-legged v not post-legged: again I would definitely give more weight to your observations since you look at the whole horse regularly! But I do think it’s interesting to look at and think about his (or any) conformation in light of how common a camped-under compensatory posture is. It costs a horse a lot more energy to stand with their legs angled under them than it does to have their cannon bones parallel to the ground so when you see it, it’s a really good indicator that there is something going on somewhere - and I think the first place to look is often toe length because camping under is a very consistent response to toes that have been allowed to grow too long.
A post legged horse can have a perpendicular cannon bone (sometimes the fetlock might appear behind the horse), but the difference between it and a normal leg is the angle of the hock and fetlock joints usually. A post legged horse with dropped fetlocks for example might have an upright cannon bone but the hock will be hyperextended looking and the fetlock is dropped and although the cannon bone is perpendicular, it doesn’t line up under the butt. If the fetlock hasn’t dropped, then the cannon bone would look like it’s leaning forward with the fetlock out behind the horse and the hock still too straight. If the horse is post legged as a conformational defect, then that would predispose them to PSD injuries. But NPA could cause the horse to appear post legged when it’s really not that way conformationally because it makes the pastern appear too upright.
When I look at some of the pictures I have posted, I understand the hooves by virtue of where the base of the heel support falls relative to the center of the cannon bone. I understand the cannon bone needs to be plumb. The open or closed angles of the hock, pastern, and stifle are unclear to me. I know he trots like he is on back stilts with NPA. However, when I try to compare his pictures with pictures of “normal” horses, they all look like their joints are too open, which would make him normal.
On the hinds:
If the hock joint is too open, or straight, and the pasterns have not dropped, the fetlock would look taller, but the horse would compensate by standing out behind. The confusion is one picture shows him standing under with an angled cannon bone, and another picture shows him standing with the cannon bone straight but maybe slightly out behind? Is standing under an attempt to unload the hind hooves or legs due to pain? Is standing slightly out behind a way to compensate for loss of heel support? Does the horse have the awful job of choosing one or the other when he has both?
With the new shoeing set-up - when the hope is that the heels are going to start moving back and growing down, what would you expect to see in his stance if pain were not an issue? I know no one is a vet here, but what are the mechanics, basic mechanics? I will post new pictures with his whole body next time. Shoeing cycle 2 in the new set-up is next week. Thanks for hanging in there with me.
I will also have a meaningful conversation with my new farrier about all of this. He seems to like to teach, so he can fill in the gaps for us.
If we had some good conformation shots of him to look at we might be more able to help you with this.
https://horseandrider.com/horse-heal…n-clinic-photo
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