Humor me please :). I’ve read a couple old threads but am interested in stories of NPA behind. What were the horses symptoms, were you able to resolve issues with a change in trim/shoeing, what shoe package did you use? All the things!
Getting rads of hind feet soon, last diagnostic in a long list…
Thanks!
Ohhh boy, where do I begin… this is a five-year saga, so buckle up, lol.
I bought my horse off the track when he was just shy of properly turning three. We didn’t do much to start with because a) he was a baby and b) he ripped off three of his four racing plates in his first two weeks with me. I decided to try keeping him barefoot behind just as an experiment. He also had some on-and-off stifle catching issues which I attributed to weakness and him growing because they would come and go. I don’t think I tried to canter him for multiple months after I started riding him, and when I did, he couldn’t hold his lead in the back. I chalked it up to weakness and gangly horse in a tiny indoor.
My trainer came out to give us a lesson that fall and, after watching him go, suggested that he should probably have hind shoes put back on because he didn’t seem to really want to step through from the back and was probably a bit sore. I was already thinking the same thing because he wasn’t growing enough foot to keep up with the wear (we genuinely had no heel left), so the shoes went back on. Over the next year, we continued the same cycle of questionable stifle, lead problems, etc., and every time I would assume he was growing again and back off until he seemed like he was “normal.”
When he was five I started asking him for more effort, and we mostly sorted out the right lead, but we were still having issues with the left. It seemed like it was probably still a weakness and balance thing because he would hold it when I cantered him out in the field, but the indoor was too much for him. He would also hold it if I rode him bareback so I assumed it was also just me being lopsided and accidentally cueing him to swap. He had a bit of a habit of bucking on the back side of fences too, but it wasn’t consistent at all and seemed like it was entirely attributable to him being excited.
The summer after he turned six (two years ago) I hauled over to my trainer’s for a jump lesson prior to a show and, after having to throw in a short stride to a tiny cross-rail, he proceed to put his head between his legs and buck for all he was worth. I came off and my trainer got on him for a few minutes so I could catch my breath. After she got off she asked me if she could try something and I said yes. When she palpated his SI area, he dropped his entire back.
(My trainer had seen him four times in three years so she was not to blame for any of the issues, I’m sure she would have spotted it much sooner had I been based at her barn at the time.)
I had the vet out the following week, they did a lameness exam, concluded it was SI because he wasn’t showing any stifle issues, and we ended up injecting him. It seemed to help a bit but it didn’t entirely resolve things with his lead swapping.
I moved him to my trainer’s barn a few months later and her vet (performance vet who comes from out of state) took a look at him. We all agreed he was too weak to really judge anything, so we decided to give it a few months of lessons to see what would happen to him with proper work. Fast forward a few months, the canter had gotten way better and then suddenly worse, and on a gut feeling, the vet blocked him for his suspensories. Sure enough, he was suddenly sound, and when we ultrasounded he had edema in both legs (worse in the right, compensatory in the left) and signs in the fiber pattern that it had been a chronic issue.
We rehabbed his suspensories that (last) summer and, on another gut feeling, I asked for hind feet rads at our appointment last fall that cleared him to go back to work. The rads came back with this:
Four(ish) degrees negative on the hind right, a degree or so negative on the left. This is what the RH looked like on the outside (yes, he did a number on that foot ripping a shoe off, excuse the acrylic):
We were sent off with instructions to bring his toe back, put him in McLane wedge pads, and recheck him again in about six months. We also did an internal blister on his stifles at the same appointment because they were genuinely loose and all the hill work and pole work in the world hadn’t done enough to strengthen and stabilize the area. He had no issues with that procedure and I’m happy to give further details on it if desired.
Once he got the pads on (late October last year) he had to adapt to the fact that he could suddenly push from behind and he felt NQR to start most of our rides for about two weeks. It always resolved so I rode him through it—it was literally just him adapting to new (and more comfortable) biomechanics. As soon as he figured out that he could lift his back and push, the NQR would go away and eventually stopped appearing at all. His canter has been a work in progress because we had five years of bad muscle memory to untrain regarding the lead swapping but over the last month or so it’s pretty much resolved. Our issues now are purely strength-related because we never could reliably canter for more than a circle before. We pulled the pads for the summer because I was not running even baby cross-country with them and this is what his foot looked like this past week (and yes, he is missing his left hind shoe here):
We’ll be reinjecting his SI and mesoing his back because he seems to have some residual discomfort there and our vet thinks it’ll help quiet that down and truly bring him back to baseline, but it likely won’t need to be an annual thing. He’s not at all reactive when you palpate him now, he just seems to need a bit of assistance to truly feel comfortable unlocking that area under saddle. We took images of his back and neck last year and there is absolutely no kissing spine or C6/C7 malformation causing any of this (bit of a shock in a Thoroughbred to have neither, honestly). His saddles are also fitted at least annually so that’s not an issue and our vet gets hands on him every six weeks to do chiro. We’ll likely re-wedge him over the winter with tiny wedges rather than the four degree he was in before, just to help encourage a bit more heel growth, but we finally seem to be on the other side of this.
tl;dr: no shoes in the back led to no heel in the back (I have photographic evidence that he had heel when I bought him, he really did not have typical OTTB feet then), stifle issues which probably existed separately but were exacerbated by the NPA, proximal suspensory desmitis, SI and back pain caused by the NPA and suspensory issues which led to a bucking problem, lead swapping in the back at the canter as a result of all of this, particularly on the left lead where the hind right had to push. No kissing spine or C6/C7 issues. Wedged the hind feet and internally blistered his stifles, planning to inject the SI and meso his back. The actual issues appear to have resolved but the work to retrain the muscle memory to correct it once the pain is gone can take months if not a year+.
Thanks for sharing! I just googled the McLane pad, did the one you used have frog support? That’s what I’m seeing on a quick search.
Yes it did. Frog support is critical if you want to grow heel! It needs to be able to make contact with the “ground” in order to help bear weight, etc., and if you wedge without frog support you essentially pick that structure up off the ground and put all the weight on the heels, which is the exact opposite of what you want for heel growth.
I have just started my journey in trying to correct NPA behind in my OTTB mare, so may not be much help. She has pretty typical TB feet, she does not grow heel or grow foot up, but grows a long toe and flares out a the quarters. She spent a lot of time barefoot in 2022 and 2023 because she had a foal, and with trims every 4 weeks we were able to help stop the constant cracking and splitting that was happening on all 4, but she was still very low in the heels. Now that she is back in work full time, we put front shoes on but left the hinds barefoot.
However, she has always been a tricky horse health wise and I have been slowly trying to work through her various issues. She constantly has gut/ulcer struggles, so it is sometimes hard to tell if she is going poorly under saddle due to stomach pain or something else. She was weak behind when being brought back into work last fall, worse on the left hind. My vet/chiro said she felt stiff in her SI, but vertebrae along the back were free/mobile. In the spring I had left blocks done and she blocked sound to both hocks, so had the hocks and SI injected. Her soundness behind improved after injections, but I still felt like she was just NQR. She struggles to go forward into a consistent contact and work over her back while pushing from behind.
I finally acted on my gut feeling that the hind feet especially may be causing issues, and had x rays of all 4 hooves done this July. As I suspected, she is NPA by 2* in both hinds and negative 1* in front. Her next farrier appointment is at the end of August, so I am working with him to come up with a plan for wedges/pads to help correct the angle in the hinds especially and see if there is anything we can do to encourage heel growth. I am hoping to see an improvement in her movement and acceptance of contact, and maybe even an improvement in her gut health if some pain from her incorrect angles may be contributing to the constant ulcer cycle she deals with. I started a thread a couple weeks ago with her x rays and solar views Hoof Rads - Correcting NPA
Somehow your thread didn’t come up in the search! Super interested to see what you decide on to work on the correction.
I will be sure to update after her next farrier visit!
Mid last cycle X-rays show a 0 behind so I managed to catch them pre NPA but we need to make change asap. Based off of rads and vet recommendation we are going to take the toe down to give her more heel relative to toe and bring the toe back. I’m hoping we can avoid wedges but tbd.
What caused you to check angles originally?
In general if I can worry I do about anything and everything. More specifically, I noticed she was a little ear twitchy when I groomed her loin. She’s super polite but I could tell there was some tightness despite a completely reflcoked saddle, chiro, body work, and a very reasonable work schedule. In general, I try to do X rays all around annually but with this horse I’d done two rounds of front only. My vet was very eh on needing to do the hinds but did them in my request and was a little surprised. Externally she’s got gorgeous feet but they are structurally small so when they look proportionate, the toe is often running a bit and the heel is going.
This could describe my TB gelding to a T. I often say his feet are deceptive because visually they look well balanced and an appropriate length, and then you get an xray and the toe length is excessive and the angles trend negative. @trakehners experience is similar to mine too. Thought we had the NPA managed, injected the SI. Big improvement in comfort and performance. Some NQR-ness returned behind so injected his hocks about a year later. Continued improvement up until about 4 weeks ago. Tightness in the low back, noticeably sore hamstrings, difficulty pushing off in transitions. We’ve done all the bodywork, saddle fitting, you name it.
It’s been about 18 months since his last set of balance rads and we have an appointment scheduled for next week to repeat and evaluate. I’ve been saying for about the last three cycles that I feel like his toes are getting too long and the heels are underrun. Maybe I’m a Smurf and need to trust my farrier. Maybe he’s due for hock maintenance. Maybe it’s something else entirely. Maybe it’s some combination of all of the above. I’ve learned the hard way to check the hoof angle box before committing to any other treatment, though, because that will just continue inflaming everything else from the hoof up until it’s addressed.
All sorts of different symptoms from hind end to front end lameness, back soreness, etc etc. NPA really effects posture and different horses will react differently to bad posture. They can also compensate on the front end causing lameness/injury there.
At the end of the day, you need a farrier that knows how to properly trim/balance a foot. So many farriers and vets say “put a wedge on it” but that’s only a short term band aid. Wedges/pads should be used only as immediate relief while a competent farrier adjusts angles (which may take a year or more depending on hoof growth). If your vet or farrier are saying that a wedge is the permanent solution then you a new vet or farrier. So many farriers just trim a little foot off then slap a shoe on (with or without a wedge/pad) and call it good, and that causes so many problems. /rant 
Will second this! My farrier was luckily in the barn shoeing other horses both times I’ve had rads taken in the last year, so he was able to come over and discuss what needed to be done with our vet in real time. Neither of them nor my trainer wanted my horse in wedges for any longer than absolutely necessary because (as mentioned) they aren’t meant to be a permanent solution and can cause other issues if they’re on for too long. OP, if your horse does have NPA, enough toe to really bring it back, and it’s not incredibly severe, you may be able to get away with not wedging. It really depends on the horse. Mine obviously needed the relief given the degree and his other issues (my biggest concern was honestly him straining the suspensories again and repeating our saga if we brought him back to work without giving him the support). Our entire barn also runs on a six-week trim cycle from November to April and a four-week cycle from May through October so it’s much easier to keep up with small changes in hoof balance in a way that you can’t with many horses on an eight- to ten-week cycle.
Our current farrier has been in the business for decades and none of us (including him) know how much longer he’ll be working, but his former apprentice will be taking over our barn when it’s time and he shares the same attitude towards continuing education/working with our vet. I remain convinced that half our problems are due to the fact that the last two farriers I used just weren’t… good 
I didn’t know enough about feet at the time to be able to see any of it either.
This also! Mine are all on a 4 week schedule, because that’s when my farrier is in town. It’s so cool to watch him work because I have 5 very different horses that he works on, and he’s been doing one of my personal horses for 7 years, and has helped with a number of other rehab cases. Depending on the time of year, some horses get a lot of foot taken off, just some shaping, or just a tiny rasping and that’s it. It all depends on how the horse is growing and what they need. A shorter schedule, while a little tougher on the pocketbook, is your friend.
I just listened to this podcast today and he talked about NPA too. It’s a good listen.
And then there’s this from Pete Ramey’s website:
Negative Plantar Angles
In hind feet, we often see the opposite problem. The plantar angle may present as ground-parallel or even a negative angle (P3 higher in front than in the back). Unless this was just a blatant trimming error (excess sole thickness left at the toe or excess sole thinning at the heels), this hoof form is generally caused by an incomplete or too-forward hind stride - the hind limbs reach too far forward and/or do not extend far enough behind the horse during locomotion. The list of potential causes for this type of movement is long: compensation for front foot pain, too much stall time with associated general muscle stiffness, inadequate warm-up prior to work, saddle fit issues, rider balance issues, dental issues, unnatural training practices (think big lick training of walking horses or false collection that does not include a rounded back), plus a host of potential injuries to the back, hips, limbs, etc.
Therefore, when faced with a zero or negative plantar angle case, you need to use lateral radiographs and the collateral groove depths (discussed below) to determine if there is excess sole thickness at the toe that needs to be removed, but you also need to get to work trying to find and treat the true underlying cause(s) of the movement pattern that actually caused the problem. I typically request a veterinary exam, plus an evaluation by a sports massage therapist. If there is no injury that makes it contraindicated, daily stretching by the owner, plus cavaletti work and light hill work helps these horses more consistently than any other treatment I have seen.
Heel wedging is often recommended for these horses. If a heel wedge immediately corrects the short or forward hind stride, it is a good thing - this correct movement will ultimately correct the plantar angles and the growth pattern of the foot over time. If, however, the horse continues the same movement pattern after the heels are wedged up, the wedges become dangerous and are not recommended, as they are only serving to increase the stress to the extensor tendons, joints, ligaments, etc.
https://www.hoofrehab.com/HeelHeight.html
Read thru the kissing spine threads also. NPA & KS seem to go hand in hand. There is so much more to it than “a proper trim”. Some horses just never really come out of it, no matter what you try.
My mare has it, and it’s been an expensive nightmare of every possible shoeing, barefoot, repeated xrays (with farrier present), everything you can think of.
I think there are certain conformation traits that predispose a horse to having NPA also.
My mare’s “symptoms” at first were a dragging LH and bullnosing. At the time, I had no idea what it was. I googled until I found a picture of a hoof like hers and then started reading. I went to my vet and got films. My (at the time) farrier blew me off. I fired him and found one who has been with me every step of the way. We’ve used flip flops, wedges, full pads, rim pads, no pads, you name it. Now, she’s just barefoot behind. We don’t ride that hard, it’s not a huge strain on her, and it hasn’t changed anything for better or worse. She basically maintains at 0. She’s shod up front with glue-ons and 3D pads, I wish I could afford to put the same package on back to see how she does, but I can’t. She’s an OTTB with thin walls that just don’t take nails well, is why we went to glue on. They are expensive. It’s about $140 just for materials alone, not counting packing material, the pad, or the labor cost. If I had to double what I currently pay, all in… ouch.
Read the KS threads. Really. Many of us talk about NPA there.
Thanks. I’ll check it out. Back pain, specifically lumbar. But no KS in this case, so one thing going for us at least…
You should check out the thread on applying glue ons yourself. A lot of people do it and if it might help your horse, it’s worth a shot to be able to afford it (obviously still have to pay for materials but don’t have to pay your farrier to do it).
I priced it to about $200 in supplies for a set of 4, with plugs and packing. That’s for 4 new shoes, so a savings of ~$120 every time I can reset.
It really isn’t hard, and I’m on a learning curve with no one having already done it on my horses in my situation. It would be much easier if I had someone already glueing shoes on that could show me the fiddly details!
That said, it isn’t for everyone and I get that.
Commenting to follow along with this.
My gelding just got rads done in the hind and we discovered -4 and -5 degrees in each. He’s been really sore all over behind, swapping leads behind constantly, takes a short step at the trot, super reactive in the canter, very very heavy on one rein, hard to bend left, and overall very loud/chewy/stressy in the mouth. We had looked into stifles, back, stomach, dental, front feet, SI, hocks, blood tests, etc. and still nothing showed up.
He just got his feet “fixed” on Thursday, so it’s too soon to really notice how much it has helped him (if this one shoeing was even enough to get him started down that path). I am unsure the actual name of the shoe my farrier used, but he found wedged shoes that are thicker at the heel. Added a pad underneath to keep the frog from falling through & the heel getting crushed. He has good sole depth, so we are trimming a bunch of toe each cycle to fix the angles, but hopefully this shoeing setup will help in the meantime.
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