SI pain or something else....

[kashmere]

Great news on the diagnosis! So much better to know what you’re working with and make a plan.

I am not a “barefoot uber alles” person, and I am also not a vet or a farrier. I am literally just a stranger on the internet so these thoughts are worth what you paid for 'em .

That being said, I’d really hesitate to go that shoeing route as the first step.

Thin soles are rarely improved by putting on a shoe - or in the case of an already shod horse, changing the type of shoe. They can almost always be improved by balancing diet and by allowing the sole to actually work - i.e. be stimulated by pressure via movement. Boots with pads for turnout, riding, or both - depending on level of comfort on various surfaces - are, in my experience, the best place to start.

A ditto with the hinds and the wedge pads. I’ll echo @BoyleHeightsKid’s recommendation to understand what is causing the NPA in the hinds. Underrun heels and a long toe are the culprit in almost every case I personally have seen. The underrun heel/long toe is in fact just super common full stop. Putting a wedges shoe on will very likely make her go soundly relatively quickly, which feels awesome when you’ve been struggling - but I’m not sure I’ve ever seen a horse who’s been put into wedges ever go back to regular flat shoeing. This is because it doesn’t actually address the structural issue in the foot; rather, it compensates for it mechanically while allowing the underlying issues to continue.

Again - it’s not to say that shoeing is bad. I lost a mare this summer at 20 who’d been shod on all four her whole like. Sound, happy, comfy. She absolutely could have been managed easily without them, but when I got her at age 19 I wasn’t about the mess with a good thing.

So I guess all that to say, I’d encourage you to take a beat before jumping into corrective shoeing and assess whether there are steps you can take to actually improve the hoof itself - via diet, trim, other kinds of support etc. Very few horses, in my experience, have hooves that inherently NEED to be shod, it’s more that the diet, lifestyle, and trim create issues in the hoof that mean managing the horse’s soundness seems easier with shoes. But in the long run, it’ll definitely save you a ton of $$$$ if you don’t lock yourself into the corrective shoeing route.

I managed a horse with caudal heel pain (e.g. “navicular”) in corrective shoeing for quite some time. She was working soundly, but the hooves essentially never changed. Since retiring her (for a multitude of issues), I’ve pulled her shoes and changed her hoof management, and I’ve seen drastic changes in the actual hooves themselves and she has zero heel pain symptoms.

YMMV, but just food for thought!

[GPjumper]

Regarding the front rim pads, he wants her in them because she is sore up front, which has caused her neck and shoulders to become sore. (Why we had to inject them) He recommended rim pads so we could still work to toughen up her soles using durasole/keratex and still giving her relief.
Her hind feet are actually shod well. Her toes are not long and her heels are not underrun. She is not actually at a negative angle. She’s at a zero angle. It’s her internal confirmation. My vet thought I was nuts when I wanted her x rayed behind. My friend who mentioned NPA wouldn’t have even thought of it by looking at her feet. She can’t go barefoot. We are not allowed to compete in hoof boots.

[BoyleHeightsKid]

Do the hind feet have a bullnose appearance when viewed from the side? This is my geldings left hind, right hind was a little worse. All I did here was back the toe up to maximize break over, float the quarters and get after the bars. He’s still got a ways to go, but he’s no longer NPA, but now more flat maybe a little positive after measuring the collateral grooves. He was sore behind with tight sore hamstrings. Would always come out of his stall taking a couple of short steps. Just correcting the NPA behind took care of the soreness. There is only 8 weeks between middle and bottom picture. The top is what I started with. NPA behind can cause all kinds of soreness, especially up high.

@kashmere makes a lot of good points. You need to address the underlying issues for the NPA and not just slap a shoe on it. That’s just treating the symptom, not the cause.

eta: I’m not anti shoe by any means, I just think there are some things that can’t be corrected with shoes and this is one of them. Hoof Armor also works awesome to help build sole. It gives them a protective layer. If needed you can do that under the front shoes.

[GPjumper]

@BoyleHeightsKid

Do the hind feet have a bullnose appearance when viewed from the side? This is my geldings left hind, right hind was a little worse. All I did here was back the toe up to maximize break over, float the quarters and get after the bars. He’s still got a ways to go, but he’s no longer NPA, but now more flat maybe a little positive after measuring the collateral grooves. He was sore behind with tight sore hamstrings. Would always come out of his stall taking a couple of short steps. Just correcting the NPA behind took care of the soreness. There is only 8 weeks between middle and bottom picture. The top is what I started with. NPA behind can cause all kinds of soreness, especially up high.

@kashmere makes a lot of good points. You need to address the underlying issues for the NPA and not just slap a shoe on it. That’s just treating the symptom, not the cause.

eta: I’m not anti shoe by any means, I just think there are some things that can’t be corrected with shoes and this is one of them. Hoof Armor also works awesome to help build sole. It gives them a protective layer. If needed you can do that under the front shoes.

Having dealt with NPA before in my old TB mare. (Wedge pads until we slowly fixed the issue) I was expecting to see the bull nose look. Her feet have looked great. Farrier met me at the vet’s yesterday. She’s in the 1 degree rim pads (x rays after shoeing confirmed this was the correct angle we wanted). Farrier is also going to pull to farther back and look to build up heel even more. She is to stay in the wedges for the next 2 cycles and will come out of them when her feet look better. When she comes out of them, he will back up the toe and make sure she has plenty of support behind her heel as well. Front rims will be probably be a life long thing, but we are still hoping to toughen up her feet enough to be out of them. Vet said some performance horses just like them.

[Obsidian_Fire]

@kashmere - in your post above, you mention the “structural issue IN the foot” as the cause of NPA. Having (and continuing) to fight this battle with my mare, I am curious about any and all stories and your comment made me go ‘hmmmm’. What exactly do you mean? What structural issue internally would cause NPA that would not be corrected by putting the hoof at the correct angle?
Example - hoof is NPA, add a wedge, voila structures line up. (Obviously that’s a very minimalist example). So growing heels in the correct way is natures version of a wedge. Is that all you mean? Or is there more to it?

Like I said, I battle this with my mare and my farrier has been a godsend. We did not do wedges, we did the “flip flops”. It took awhile, but by floating the heels we got them to grow down instead of under and by creating vertical depth we also increased our sole depth.

@GPjumper - your comment: Her toes are not long and her heels are not underrun. She is not actually at a negative angle. She’s at a zero angle. It’s her internal confirmation. My vet thought I was nuts when I wanted her x rayed behind.
Can you elaborate what you mean by her “internal conformation”?

[GPjumper]

@Obsidian Fire

@kashmere - in your post above, you mention the “structural issue IN the foot” as the cause of NPA. Having (and continuing) to fight this battle with my mare, I am curious about any and all stories and your comment made me go ‘hmmmm’. What exactly do you mean? What structural issue internally would cause NPA that would not be corrected by putting the hoof at the correct angle?
Example - hoof is NPA, add a wedge, voila structures line up. (Obviously that’s a very minimalist example). So growing heels in the correct way is natures version of a wedge. Is that all you mean? Or is there more to it?

Like I said, I battle this with my mare and my farrier has been a godsend. We did not do wedges, we did the “flip flops”. It took awhile, but by floating the heels we got them to grow down instead of under and by creating vertical depth we also increased our sole depth.

@GPjumper - your comment: Her toes are not long and her heels are not underrun. She is not actually at a negative angle. She’s at a zero angle. It’s her internal confirmation. My vet thought I was nuts when I wanted her x rayed behind.
Can you elaborate what you mean by her “internal conformation”?

He feet, from all outward appearances, look good. There are no signs of her having incorrect angles. Her heel isn’t low, nor is her toe long. It was only able to be determined by x rays. Farrier/vet both agreed this will be treatable without the wedges (eventually) but her hind feet wouldn’t look like normal hinds. She will have a short toe and a shoe pulled back to achieve what the wedge pads are doing.