Possibly NPA?

[maddyiy]

Could this feet be considered at risk of having a NPA?
I started to notice the heel lower in the RH than the LH, and to me it looks like the angle could be 0 or maybe negative.
My vet came less than two months ago and didn’t want to x-ray the foot since she said it’s okay in her opinion. Now I think I should have put my foot down and got it anyways.

I know it’s just a picture but I’m debating if it’s right to talk to her again about it, and involve the farrier, or if it actually looks okay and I’m just being paranoid.

(This is less than 4 weeks in the shoe cycle btw )

[Fiesta01]

I’m not a hoof expert so take with a large chunk of salt.

I would want x-rays on both. The RH hoof-pastern axis looks broken back, and from what I can see of the LH, it looks wonky, like a broken forward hoof-pastern axis.

Looking forward to being educated by some of our hoof specialists.

[maddyiy]

Thank you so much for answering!

Honestly I’ve spent so much money on him in the last months, that if it’s not strictly necessary I would wait for now. Plus the vet who follows me was not big at all on getting these x-rays and it worries me.

My plan was to tell her what I see and what concerns me and wait for her response. He should be shod again in two weeks so it’s a good time to plan some (maybe slight ) changes. I’m just really worried she’s gonna brush it off, I wouldn’t know what to do.

The left hind always looked a bit better angled to me, I’ll post a better picture of it, but it also tends to rotate so the farrier was addressing it. It certainly looks to me like there’s more heel on the LH.

Correct me if I’m wrong but I thought that trying to raise the heels a bit ( maybe just with the trim at first, without changing the type of shoes ) could be a good starting point, since they’re low and the angles look wrong anyways ( to me ), and maybe thinking of getting x-rays later on.

If someone has advice before I contact the vet I’d be really grateful!!!

[Obsidian_Fire]

You need films. Don’t let the vet tell you no, nobody has xray vision.
I’ve been dealing with NPA myself for several years now, taking films is a must. Your farrier should accompany you and see the films for their own self also.

[maddyiy]

Oh my god it makes me so mad that I didnt insist… Now I feel put in a tight spot and I don’t get why professional are not more meticulous sometimes

[JB]

Unfortunately, sooooo many vets just don’t know what they don’t know about feet. There have been SO MANY threads just here on COTH over the years of horses who are just going through the wringer, with hock and stifle injections, body work, all the things, and finally pictures of the feet get posted and the feet scream NPA, but the vet said “they look fine”

Yes, I’d be concerned. The good thing is that if there IS NPA, or even just getting too close to 0*, it hasn’t been long enough to start bullnosing the toe profile. The alignment needs to be fixed, but “fixed” might mean something different than simply aligning the hoof and pastern angles, which is why at least a lateral view of each foot would be a good idea. And since add-on images generally cost much less than the initial ones (because the whole setup has already been done), a frontal view is good too

[maddyiy]

What makes me mad is that this vet is so well known and renowned, she has a reputation of fixing terrible lameness and she’s been following my horse for 6+ months.
We’ve improved but he’s still not as sound as I’d like, we can get a step further in my opinion, and I don’t understand looking only at the fronts for lameness and wrong angles.

She thinks the fronts ( under run and low heels ) are the only problem and it doesn’t matter how much I disagree.

Anyways thank you so much for your take, in my opinion the hinds look better than they did in the past, but unfortunately I’m learning while I go and I’ve been discovering more about hind feet issues recently so maybe I just never looked at it with a critic eye.

Unfortunately at the moment I’m not in the position so spend other extra money, and since he’s due in a couple of weeks anyways I thought of getting a consultation with a new farrier and see what his opinion is, how open he is to my view and all ( without touching the feet at first ).
Then I’ll talk to her again and ask for her opinion and see where to go from there.

Unfortunately the farrier I work with at the moment has been advised by her and I cannot seem to have an useful conversation with him so I’m seriously thinking of changing. I’m just so scared of trusting new people and all that, I’m such a paranoid ahah.

I’m always open to new advice and takes btw, I really struggle trying to make the best decisions for him at the moment.

[Obsidian_Fire]

Many professionals don’t pay attention to the hinds. It’s always the fronts. I suppose because the fronts are where most problems usually are, laminitis, NPA, etc. I guess it’s easy to ‘assume’ the hinds are fine.

Don’t beat yourself up, we’ve all had to “learn as we go”. My mare’s feet were severely bullnosed and my (former) farrier was telling me there was nothing wrong.

Now that you’ve learned a little more, insist on the rads. Find out how things actually are in there. Develop a plan. Be courteous, but be firm. “I want to know for my own peace of mind” is a perfectly good reason.

[Warmblood1]

Is this a horse that can go without shoes? And are you currently trying to figure out a soundness issue?

[maddyiy]

Actually I’m thinking of pulling his hind shoes in the next month or two. I honestly would love for him to live out with other horses and I think he’ll benefit from it.
I’m hoping that even without hind shoes on he will move well. We’ve been dealing with a subtle lameness for more than a year and it’s finally starting to go away, this will be my last chance to change something and see if it works.

In the last few days other professionals have seen him and everyone says he’s shod well ( he’s due in a week so his feet are pretty long ) and that the new farrier I have is really good.

I was honestly pretty anxious because I don’t know him and I wasn’t sure if he was working well, but seeing how other professionals also think the same reassures me.
What can I say is that the horse is sound since he’s been shoeing him, and that certainly says something.
And I also think that to see positive changes I have to give him a bit more time to work thank just a couple of cycles.

I’ll try and mention it to him, with the idea of leaving him barefoot behind and see what he thinks. I just wish it wasn’t so difficult to communicate with professionals sometimes…

[Warmblood1]

The reason I ask is because shoeing can often exacerbate problems, one problem being the friction the shoe creates with the heels, which can often cause the heels to wear unevenly or perpetuate underrun heels. The shoeing I think is good. The shoeing is compensating for the lack of idea angles with the hoof. Apologies if I’m repeating things you already know.

The angle of the hoof wall and the angle of the heel should be roughly perpendicular. When you have a heel angle that is significantly less than the angle of the hoof wall, you have underrun heels. Above shows the angles of the hoof versus where they should actually be.

The cannon bone really needs to be vertical to get a correct assessment of angles but for the sake of conversation I’ve drawn them in. The red lines indicate the angles of the shoe - the farrier has backed up the shoe which brings the break over of the toe back and the heel back slightly. The yellow angles indicate the angles of the actual hoof. While the shoeing is working in the horse’s favor, it doesn’t magically erase all problems. I agree with you that the LH is much better than the RH. The heel of the shoe is falling where it should, a vertical line can be drawn to assess where that should fall:

When trimming the heel, the heel should be brought back to the widest point of the frog which would be the green line:

You can take a look at the bottom of the horse’s feet and see where the shoe has been placed and the heel has been trimmed to get a better idea.

A good way to assess palmar angle in the hind feet is to draw a line matching the angle of the coronary band and seeing where it points in relation to the knee. An angle that falls above the knee is a good indicator of NPA. The angle should point directly to the knee:

The really crappy thing about horses and shoeing is that some horses do better barefoot than they ever could shod, others will never perform as well as they would without some type of shoe. You could potentially remove shoes and get improvement all around. Shoes are not without problems and underrun heels and contraction are common with them. Shoes can help correct angles but often the effects of the underrun heel (etc) are still there. You may have an excellent farrier but the way the foot wears with the shoe may constantly work against you.

[maddyiy]

Thank you for explaining it like that! It’s much more clear now!

I have a question but I don’t know if it’s possible to answer without good pictures…
If the horse is barefoot and it looks like there’s almost no heels visually speaking, is that necessarily a problem or it could actually just be his conformation?

My question stems from the fact that he was barefoot behind for almost a year, and I think the overall look of the feet was good. The feet were really hard even when it rained for weeks, the sole and the frog had a much better consistency.
But, for what I can remember, it seemed like he did not grow much heel vertically wise.

Also, the hinds appeared even more different between them in the last months.
I’ll try and put some pictures that show what I mean.

I wanted to add two other pictures but it seems like I’m not able to, this one is not the same angle as the others I already posted but it’s all I have.

[Warmblood1]

Conformation should dictate how the horse is trimmed, although there are still some universal principals applied. Also, the quality of the hoof and how the hoof grows will also influence how a horse is shod or trimmed. For example, genetic predispositions that cause the hooves to grow a certain way (limb length disparity aka high/low heel, underrun heels and long toes often seen with laminitis or metabolic issues, etc). A horse with long, sloping pasterns is going to have a slight difference in angles than a horse with short, upright pasterns. Both front end and hind end conformation influence angles.

The difficult part about shoeing and trimming is fighting the genetic or conformational tendencies of a horse. Some horses are challenged in the area of growing an adequate heel for a variety of reasons. The heel must be backed up (although this seems counter intuitive at times) to the widest part of the frog with the toe adequately shortened to position the hoof in a way that is conducive to growing a heel that isn’t underrun. That is where more frequent trimmings come into play to manage hoof so that it doesn’t take shape in the wrong direction. Worth noting that wear can make growing heel difficult as well and that is why some horses do not hold up to being barefoot with the terrain and work that they do.

A difference in hoof shape between limbs often means that there is compensation in the body that is causing the horse to carry themselves differently throughout the body which alters the growth of the hoof. The severity and what that means varies - high and low heels are extremely common in horses and does indicate something else going but it doesn’t automatically mean the horse is unsound. Many upper level horses have high/low heels. Hooves should be generally thought of as managed versus perfected.

[JB]

@Warmblood1

When trimming the heel, the heel should be brought back to the widest point of the frog which would be the green line:

I just want to say that too many people take this very literally, and end up putting the heel bulbs on the ground and making the horse sore. Heels, like goes, go back where they belong, and while heels do migrate forward and need to be trimmed (or worn) back regularly, too many are trying to force them back too far, back to the widest part of the frog.

[Warmblood1]

My point was that in order to correct an under run heel and to build a healthy heel, the heel does need to be brought back while the toe adequately shortened. If someone is hacking the heel off to the point of placing the heels bulbs on the ground, then get your running shoes on and head for the hills. It looks like OP has a better farrier than that though.

[JB]

Yes, I agree, but my point is that too many, including those who learn to DIY, see “rasp heels back to the widest part of the foot” and don’t understand it’s not that black and white. Hoof and leg conformation play roles in there too.

[Obsidian_Fire]

@Warmblood1 & @JB … can one or both of you take the picture and show me what you would do in order to bring those heels back? Where/what would you trim? I understand taking toe off, I just don’t understand how to trim the heel.

[JB]

Heels like this typically get rasped. Generally, you find the live sole at the “seat of corn” (the sole in the corner where wall turns to bar), and heels get taken down to some level above that, depending on the horse’s comfort and the footing. Something like 1-2 credit cards’ thickness is in the range of what you’re looking at.

By default, rasping heels down moves them back.

Not all fixes can be done in one trim. If you’re down to 1 cc thickness and the heels are still too far forward, then you either come back in 3-4 weeks to work on the foot again, or you rasp MORE heel, which will likely make the foot sore if it stays bare, and you add a shoe to help protect things, and there may or may not need to be a bit of a wedge for a cycle or 2, or some other “trick”, to help out

[Ottbaxel]

Reviving this thread (and posting this in other threads too for visibility) because I just had hind rads taken of my older gelding. He’s always had back soreness issues (we won’t get into all of that now, but he does not have any kissing spine), and recently he started standing a bit camped under and resting his right hind foot, which is coincidentally the leg he kicks out with when he’s stiff. He also has wind puffs - he has always had these, they don’t seem to bother him, but I have always wondered what could be causing them. His SI palpates sore always, regardless of SI injections/mesotherapy,etc. Rads were taken at the very end of his cycle - he has an appointment on Monday with the farrier.

His left hind is 1 degree positive, right hind is neutral. Right hind has some med-lat imbalance, not crazy but I can see it with my untrained eye. Sole depth about 1.6cm on both feet.

To me, this doesn’t sound that bad. No negative angles, but the lateral imbalance and neutral angle on the right hind does seem to add up with his soreness presenting moreso on the right side. Honestly, I’m a wee bit bummed his hinds weren’t negative since that would help explain some of these constant issues he has.

My question is, (and I can post the rads as well if I need to), could just being neutral cause that much of an issue vs actually being negative? Could the imbalance on his right hind make a big difference in his movement and strain on his hind end? Would everyone recommend pads to fix, pulling the shoes to fix, or just trimming differently?

(I’ll be discussing with vet and farrier too of course, but want personal experiences please!!)

[maddyiy]

In my limited experience sometimes having neutral angles can be as challenging as having negative ones. There are certain horses that have chronic issues, that have moved with disfunction patterns for so long that even things that could be considered minor become a problem.

It’s not the same case but when my horse was intermittently lame for more than a year he didn’t have negative angles, he was still sore and he still had underrun heels that caused him to strain certain tendons and ligaments.

I started this topic five months ago and I can say that with a competent farrier his hinds are much better balanced now and he actually has nice “correct” heels for the first time since I own him, but this is what worked for me and I don’t know in your specific case.

Hopefully someone more knowledgeable on the matter will reply!!