Equine Orthopaedics and Rheumatology Q&A 02

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A four-year-old Thoroughbred presented with mild chronic bilateral forelimb lameness which responded to palmar digital perineural analgesia.

Question	Answer		Article
Comment on the foot balance and why this may be significant.	The radiograph shows a severely broken back foot–pastern axis, associated with long toe–low heel conformation. The orientation of the solar border of the third phalanx slopes palmarodistally, and the horse has divergent heel and dorsal hoof walls. A perpendicular line from the centre of a circle drawn around the distal interphalangeal (DIP) joint intersects the weight-bearing surface of the foot close to the heels. The ideal foot conformation is shown in the diagram. This defective foot conformation is thought to exert abnormal pressure on the palmar soft tissue structures of the foot, leading to pain and possibly eventually navicular disease.		[[|Link to Article]]
Discuss how this can be improved, and suggest what shoes should be applied.	The foot conformation can be improved by trimming the toe. ‘Dubbing’ the toe will shorten it in a dorsopalmar direction and reduce leverage. If it is possible to shorten the toe in a proximodistal direction, this will improve the angulation of the third phalanx. However, in this case there is too little sole to achieve much at this stage. The heels should be preserved, and shoeing should employ a shoe that extends as far caudally as possible to help support the heels and to shift the centre of weight distribution in a dorsal direction. A suitable shoe would be a wide-webbed, seated-out shoe with the branches extending caudally to the level of the bulbs of the heel. An alternative is the egg-bar shoe, which will often achieve greater caudal support. The shoes should not be nailed on past the lateral and medial limits of the foot, and the shoe should extend at least 3–4 mm outside the limits of the wall to allow heel expansion. Careful attention should also be paid to the medio-lateral balance of the foot. This will depend on the presence of limb valgus or varus but, in a straight limb, the medial and lateral walls should be of the same height with the medial wall slightly more vertical than the lateral.		[[|Link to Article]]