Rehabbing Equine Athletes' Hooves

The steps veterinarians and farriers take to identify, evaluate, and treat riding horses’ hoof problems. 

Hoof problems can be time-­consuming and tedious—not to mention frustrating—to treat, especially when they’re plaguing an equine athlete who’s a few weeks from the regional show, preparing to canter down centerline at a year-end competition, or needing the performance of his life to make the national team.

This is where veterinarians and farriers come in to identify, evaluate, and treat hoof and shoeing problems. But even with today’s modern technologies and continuously evolving techniques, managing horses’ feet is no cakewalk.

Craig Lesser, DVM, CF, a podiatrist at Rood & Riddle Equine Hospital in Lexington, Kentucky, and Pat Reilly, Grad.Dip.ELR, chief of farrier services at the University of Pennsylvania’s New Bolton Center School of Veterinary Medicine, in Kennett Square, explain their hoof rehab approaches.

Don’t Downplay Routine Hoof Care

First, let’s reemphasize the importance of preventive care, which is important to all facets of your horse’s health and soundness—including his feet.

“Proper farriery care from a skilled farrier is essential to keeping your horse working at its top potential for as long as possible,” says Lesser.

Researchers have confirmed that in healthy working horses, the long-used four- to six-week interval between trims and shoeings is effective for preventing unbalanced loading and reducing injury risk due to excess loading (Lesniak et al., 2017). Still, it’s important to work with your farrier to determine the ideal interval for your horse, as slightly shorter or longer cycles can be beneficial in some cases.

Routine farrier visits can also help your hoof care team identify problems early. One study on the prevalence of hoof issues in a group of nearly 950 horses in the Netherlands revealed that an “unexpectedly high prevalence of hoof disorders was observed during regular hoof trimming.” While most of the issues—including thrush, hoof wall and quarter cracks, sole bruises, white line disease and widening, and chronic laminitis—were in their mild stages when first noted, left untreated they could develop into more serious problems that could ultimately sideline an equine athlete during treatment.

When Things Go Wrong

Despite regular hoof care from a skilled and experienced farrier, things can go wrong with your horse’s feet. 

“When things don’t go well, the easy thing to do is look at the foot and start pointing out the imperfections,” Reilly says. “And sometimes, that’s warranted.”

But remember: There’s no such thing as a normal or ideal hoof.

“I tend to go back to humans—nobody has perfect conformation,” Reilly says, noting the same holds true for horses. “So what are we going to do when things go wrong? And this is where everything falls apart because the real short version is nobody has enough facts (about the equine foot), nobody has enough understanding.”

For example, he says, a farrier might recognize he or she needs to “wedge up” a hoof (i.e., apply a shoe with a wedged heel to relieve tension on certain structures), but to what degree? In many cases it comes down to opinion, past experiences, and, ultimately, a little trial and error.

“The problem with horses is nothing stays where you put it,” says Reilly. “Over the course of a shoeing cycle, everything is growing. It’s like you’re starting out in a size 10 shoe and, six weeks later, you need a size 12. The angle of the hoof changes by 3 ½ degrees, on average, over a six-week interval.”

Lesser says when things go wrong, it’s crucial for veterinarians and farriers to work together to find a solution.

“This is key to success,” he says. “Farriers have the skill set and knowledge to treat many issues within the hoof but, without diagnostics that veterinarians can provide, they are working with a handicap.”

Reilly concurs. For instance, he says, take navicular bone problems and heel bruises, which both cause lameness and often respond similarly to nerve blocks, or diagnostic analgesia. “They’re going to block out the same way,” he says. “But, if the cause of lameness is a bruise, now all those trimming and shoeing changes indicated for navicular bone problems—bar shoes, backing up the toe, wedging up the foot—are not only not going to help, they’re going to hurt. They’re actually going to make the condition worse because we’ve just concentrated force in the area of the heel that’s bruised.”

A thorough clinical exam can reveal important information about the issue, and diagnostic analgesia can help identify areas of pain. But veterinarians typically need diagnostic imaging to get as much information about the problem as possible. Radiographs can help them diagnose issues such as thin soles and negative palmar angles (horses should normally have a slightly positive angle between the bottom of the coffin bone and the ground surface), but they simply can’t see every structure within the rigid hoof capsule. Other modalities such as MRI and computed tomography (CT) offer more detailed insight, but not all veterinarians have easy access to these technologies, and not all owners choose to pursue these more expensive options.

“And a lot of times, if an owner can’t afford an MRI, now it’s back to an educated guess,” Reilly says.

This is where veterinarian and farrier communication really comes into play.

“Because I’ve worked at the same place with the same vets for 15 years, we’ve all had a very common set of experiences,” Reilly says. “So when I say, ‘Remember when we did this and it worked and when it didn’t work?’ We’re all drawing off the same experiences.”

In field settings certain veterinarians and farriers might not have collaborated on cases before being presented with a challenging lameness. And, Reilly says, it can be tough to get the entire health care team on the same page when they don’t share those common experiences. That’s why he teaches his vet students the importance of reaching out to their patients’ farriers to discuss treatment plans.

For instance, “it might sound great to say put a bar shoe on to treat a problem, but if this horse is already shod with a shorter shoe because nobody can keep a shoe on because it’s turned out in a swamp, that’s something we need to discuss,” he says.

“I work for the owner,” he continues. “The vet also works for the owner. Sometimes that direct communication can seem like an unnecessary, time-consuming step or one that could result in confrontation because the vet’s going to want to do one thing and the farrier’s going to want to do something else.”

That communication, however, could ultimately reduce a horse’s rehab time and improve his chances of full recovery by simply eliminating steps one party knows won’t work but the other might not.

Implementing Therapy

Once the hoof care team reaches a therapeutic plan, it’s time to execute it. Of course, this isn’t always as straightforward as it one would hope. Even when veterinarians know exactly what they’re treating, the logical approach might not work for a particular horse.

“If something works, you keep doing it,” Reilly says. “And if something isn’t working, you identify where the pain is coming from and then protect that.”

He says owners can be particularly helpful in guiding hoof rehabilitation decisions: “If we can train our clients and riders to pay attention to how the horses are going throughout a shoeing and rehab cycle, we can learn what the horse likes,” he says. “If I have a horse who the owner reports is constantly moving better at the beginning of the shoeing interval, I learn something. Or if the horse does better at the end of the shoeing interval, I’ve learned something different. (Or maybe) this rider’s ring is harder than somebody else’s ring, so you’re going to get different characteristics.

“Those are the questions farriers need to ask,” he continues. “‘How is your horse in the beginning and end of the shoeing cycle, and how is your horse on different surfaces?’ Once you train people to pay attention to variables that are outside of our control, we end up with a better dialogue and better ideas of how horses are going and how to shoe them.”

Hooves aren’t quick rehabs. It can take a year for a horse to grow a completely new hoof, so be patient as your veterinarian and farrier work to help your horse perform at his best or, in some instances, just be comfortable in the meantime. And remember that some issues can’t be cured.

Still, Lesser says, “Many horses can be managed to the point to live productive and athletic lives. Once there are bone changes this cannot be reversed, but they can be managed.”

Common Issues and Treatments

Keeping in mind that not all treatment approaches work for all horses, some of the common issues and therapeutic options veterinarians and farriers see and use in riding horses include:

Thin soles “Many of these horses need additional protection to the bottom of the foot,” Lesser says. “This could be as simple as applying a shoe or a shoe with a pad to elevate the foot off the ground or added mechanics (i.e., shoeing) to help grow more sole.” (The proper movement shoeing enables translates to better blood circulation to the extremities and stimulation of sole and wall growth.) With correct maintenance, most of these horses do very well, he says.

Poor-quality hoof walls “These are a problem with horses that like to pull shoes,” Lesser says. “Farriers are often reaching for modern material such as glue-on shoes to help these horses with compromised walls continue to be ­athletic.”

Laminitis Lesser says he uses aggressive mechanical and medical support to treat these cases. Depending on the severity and the speed of intervention, horses can return to function, although sometimes at a lower level (TheHorse.com/184663).

Podotrochlosis (aka navicular disease) “We’re able to do a lot more now than we used to with more targeted therapies thanks to advances in imaging,” he says. “I often shoe these horses in a fashion that the concussion is redistributed away from the navicular region and, depending on the issue, wedging or rockering may be considered. Navicular syndrome is a degenerative disease but, if treated aggressive medically and mechanically, this diagnosis is much more manageable than in the past.” (See TheHorse.com/navicular.)

Lower-limb soft-tissue issues “This relies heavily on the location of the injury, chronicity of disease, and severity of the lesion,” Lesser says. “A general rule is that the closer to the hoof the injury is, the more helpful therapeutic shoeing can be in the rehabilitation process.”

Results vary and, again, not all horses respond to treatment approaches the same. We say it regularly, but in hoof rehab cases it’s particularly important to design and implement a therapeutic plan for each individual horse.

Take-Home Message

A hoof or shoeing issue can, quite literally, stop a horse in his tracks. “If things go wrong,” says Lesser, “a veterinarian and farrier team approach to determine the exact cause of lameness and proper medical and mechanical application to rehab your horse’s hooves is essential.

“The saying ‘no hoof, no horse’ is true,” he adds. “Without a good farrier and consistent care, your horse will not be able to compete to your desired level.”