SPORTS MEDICINE, LAMENESS, AND REHABILITATION


Fig. 1. A club foot shod flat. It is evident how the distance between the apex of the third phalanx and the shoe is less than the distance between the posterior area of the third phalanx and the shoe creating a positive capsular palmar angle which in this case promotes uneven load distribution over the sole.


upright or club feet has been directed at trimming the heels to shift the load caudally and at reducing break- over, but the amount of heel to remove can be difficult to determine.3,10 Often, the addition of heel elevation following the trim is necessary to compensate for the shortening of the musculotendinous unit. It has been described that the degree of wedge that is applied often mimics the amount of heel removed, which can be a subjective approach, and clear information as to its effectiveness unloading the toe and promoting even hoof growth is not readily available.10 When dealing with upright or low-grade club feet, the author has found that the mechanical advantages provided by the rocker or banana shoe are very valuable to counteract the abnormal forces acting upon these feet.8,11 Themar- ket has several options of shoes that provide built-in mechanics (rocker or banana shape) on the ground sur- face, while the foot surface remains flat. This approach will provide a certain amount of relief of the tension of the DDFT by providing a reduced breakover, but it is still a flat shoe.Working as a veterinarian with an em- phasis in equine podiatry, the author has the opportu- nity to radiograph the feet of patients on a regular basis, and it has been repeatedly observed that either with a flat shoe (even if it hasmechanics on the ground surface) or with the traditionalmethods of dealing with upright/club feet, it is common to find that the distance between the apex of the coffin boneandtheshoeis less than the distance between the wings of the coffinbone (posterior area) and the shoe, thus creating uneven load


distribution over the sole (Fig. 1). Also it is common to find longer breakover distances (toe ahead of the apex


Fig. 2. Guideline of the trim(white line of radiopaque paste), bring- ing the heels back from the widest part of the foot to the widest part of thefrog attempting tomatch thepalmar rim of thethird phalanx (red line), but without compromising themass of the foot.


of third phalanx), especially if the shoeing is fitted to the toe and if the shoe does not provide sufficient mechanics on the ground surface. The leverage caused by the longer breakover is one of the principal causes of hoof distortions.7 As a consequence, and aided by the increased pull


of the DDFT that characterizes this condition, there will be a constant uneven blood perfusion to the solar corium, where less blood reaches the toe in compari- son to the heels, giving the heels the elements to have increased growth, thus promoting the clubby charac- teristics of these feet.7,8,10 As explained before, if the management approach


is based on lowering the heels, trying to make the foot look “normal” or to match the other foot as it has been suggested by some literature,12 it will cre- ate an increased tension on the DDFT, which will increase the pulling forces over the coffin bone obliterating the blood perfusion over the toe area, creating a negative vicious cycle where the horse has less toe growth and more heel growth.9,10 Many times, these horses will not put their heels down after trimming, because of the pain caused by the pull of the tendon (soft tissue strain, solar corium compression, lamellar stretching and pressure over the navicular bone). In order to remove the excess heels yet avoid the complications previously des- cribed, it is fundamental to compensate what was removed by using a wedge5,10 or, in this case, an “air wedge” provided by the rocker or banana shoe (Figs. 2 and 3).8,13


AAEP PROCEEDINGS / Vol. 68 / 2022 311


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