Hock and stifle injuries in the equine athlete can hamper the animal’s ability to perform. These issues don’t appear as frequently as those related to the front end, which can lead to unfamiliarity on how to treat the problems. Three farriers we spoke with credit recognition of these issues early on and sound applications of hoof care as the proper means for battling hock and stifle injuries. Diagnosing The Problem Clinton Corners, N.Y., farrier Taylor Keenan works with a variety of horses, but typically sees these injuries in jumpers. “Especially with the hock,” he says. “That area takes a lot of abuse, especially when the animals are asked to do what humans are asking them to do.” Keenan says he is lucky when it comes to hock and stifle problems. Typically clients who call him on these issues, describe the hind end of the horse as not being right and dragging a bit. They are usually aware of a lack of forward momentum. “So I’ll look at the feet, and if I see that something’s kind of dubbed or is wearing off on the dorsal toe, that’s an indication that the hoof is dragging through the material — indoor, outdoor, or wherever they are riding,” says Keenan. “At that point, I’ll suggest that it probably is higher up in the limb, such as a stifle or a hock.” He will monitor how the horse goes, and ultimately will rely on the veterinarian. Following radiographs, he finds that the problem with his jumpers is more likely related to the hock rather than the stifle. “The hock has so much lateral movement in it when it lands low and continues to move on through the stride, and that lateral movement over time has a tendency to strain collateral ligaments a lot,” he reasons. “Depending on the horse’s conformation, it can certainly challenge the whole area. For example, the tibial tarsal joint seems to be the one that gets the most wear and tear. That particular joint is usually where the veterinarians I work with say the problems occur.” Hall Of Fame shoer Doyle Blagg also finds that there are more injuries and wear and tear found in the hocks. Despite the stifle being a less frequent issue, it can be a more difficult case when trying to get the athlete to work. The stifle injury won’t deliver the same visual localized trauma as will the hock. “Usually if it’s a lameness or swelling, that goes along with the hock,” says the Collinsville, Texas, farrier. “The stifle usually is going to be a lameness directly associated with it. If the horse is hurt in his stifle, it can’t back up. “If you want to check for yourself to find out if it’s in the stifle or the hip, have the horse back up. If the horse can back up, pick its foot up and back up, it’s not in his stifle. “If it is in the stifle, his leg will lock up and he’ll just drag it. There will also be a hopping effect, he’ll hop forward sometimes with a stifle problem. Without a stifle problem, he won’t hop.” Delaware, Ohio, shoer Dean Moshier labels his typical cases as varied degrees of hock and stifle soreness, rather than injury. For him, this stage of stiffness is the point at which early intervention is key. Moshier knows his horses well and will be quick to red flag any concerns he has in regards to issues related to the hock or stifle. When he or the client raises a concern about the hind end, Moshier says early intervention with handling the horse is key. “One of the reasons I have a good reputation for working on horses that are difficult for other farriers is by holding the hind legs lower,” he reasons. “Sore hind limbs that are held too high for the horse to be comfortable can result in a battle. I find that I am usually the first line of defense when it comes to diagnosis of hock and stifle problems due to lack of range of motion.” Treatment Keenan advises other shoers to keep the treatment approach as simple as possible. He is fond of saying he wants to maintain soundness through long periods by being “aggressively simplistic” or “simplistically aggressive.” “It will go a long way,” reminds Keenan. “Like with breakover, you set a shoe back on a foot 3/8 of an inch, which makes all of the difference in the world to the horse. It can even be enough to keep it from tripping in the future.” Base-narrow and toed-out horses usually make for good jumping horses because they have a good base of support underneath them and launch up and forward. Because of their conformation, Keenan finds adding lateral extension will deliver greater support to the foot and bring the base of support out wider than it would be if it were shod only to the wall or perimeter foot. “With all the soft tissue in and around the hock joints, the increasing of the ground reaction forces seems to help stabilize it,” says Keenan. “It definitely helps with reducing the lateral movement of the hock through the stride. He prefers a Kerckhaert DF and makes the modification himself by hammering out the ground surface of the shoe, usually from the fourth nail hole back. “A lot of times I’ll reduce the ground reaction forces on the medial branch and also on the ground surface with a hand grinder, then the medial wall,” he adds. “But this also gives a lot of support to the lateral wall, and therefore up the limbs through the hock. The individual case dictates the length of the extension. Overall, he’s received positive feedback from his clients on the results. Keenan does warn about overdoing it with support. He is fond of quoting Chris Gregory, who spoke on leverage and support in a presentation at the 2011 International Hoof-Care Summit. “You’ve got to be careful with support not becoming leverage,” said Gregory. “Like I said, most of my horses are base-narrow and toed-out on the hind,” he says. “Therefore, if a plumb line is drawn straight down through the limb, they’re standing inside that plumb line. So I have to get them wider or give them more support laterally. That is why that shoe is so effective, if it’s used appropriately.” Moshier also encourages the owner to get the vet involved with diagnosing and treating hock and stifle problems. He does find that disagreements with the veterinarian concerning treatment can arise, so a knowledgeable farrier must be ready to explain and defend his or her approach for shoeing. This disagreement with vets and owners commonly occurs for him with squaring the toe on hind limbs. “It is not uncommon for a horse to square his own toes from not wanting to elevate the hind leg,” he finds. “Those toes need to be re-established, not accentuated. I do like an ‘efficient’ hind foot. “In some circumstances, barefoot may be best. The feet can remain shorter throughout the shoeing cycle, rather than be lengthened with a shoe. Most of the time my shoeing modality is not altered, assuming that it took into account the conformation of the horse initially.” Blagg warns that farriers need to be mindful of the length of the foot and what’s going on with the foot. Too much toe is something to avoid with in a hock problem. A horse with a stifle problem can find it harder to handle its legs. As far as shoeing goes, Blagg argues that you could be more valuable to your client by knowing how to address a hock problem rather than a stifle problem, primarily due to the frequency of the hock injuries related to the stifle. But when dealing with horses that may be in poor condition due to inactivity, then you should be prepared to come across a stifle problem on occasion. “They stay in the stall 23 and a half hours a day and come out of the stall for 30 minutes and then you put them back in there, or something like that,” he says. When shoeing a horse with a stifle problem, he will employ a basket or uneven shoe. The rounded bottom allows the foot to rock. “A basket shoe is a way to strengthen the muscles once they get weak,” says Blagg. “A horse that has a stifle problem is going to have the stifle jump in and out of the joint. It’s tough and it hurts like the devil. You can’t make him stay in there any other way than like with a basket shoe. You make one for that horse and put it on him and make sure that it wears the shoes all the time. It’s always working to make those muscles manipulate.” “You need to stand it up straighter sometimes because you want to get him to breakover easier,” he says. “And, try to get the problems out of there instead of creating more problems to make things easier for the horse to work and move. Same with a stifle problem, get it to move around a little easier. It may not cure the problem but it will help the labor in moving his legs. With the hock, there are several variables. He says you can set your shoe to the outside, to the inside, try to make a shoe that’s thicker on one side or not as thick on the other side. Properly done, there are several things you can do to value the shoe one-way but not the other. It’s usually slow to manifest as a problem as far as the hock goes, he says. “It starts out and then slowly gets worse. Usually it’s not something that goes right quick. It could, I’m sure, depending on if you have had an injury or if you’re dealing with some sort of conformation, usually in this area. In the hock, you’re usually going to have a conformation problem that goes along with it.” Communication And Teamwork Keenan says to keep the team effort in mind. His focus is the hairline and below in terms of shoeing, although what the team is doing is approach the issue from the whole horse. Primarily with hock problems, he will defer to the vet regarding how much rest the horse will need. Overall there needs to be a balance when bringing a horse back from any lameness injury. “I think the common trend here is pushing the animal too hard too quickly,” he says. “There’s a cause and even a potential for reinjuring. It could be a contra-lateral lameness. You damage one side and the other side is favored, and if that continues to go on for a period of time, then you can see lameness develop in the other limb as well. That usually comes from the client that doesn’t listen to the vet; or the farrier.” To avoid situations like this remind the client to “buy in” early on and realize that this may not be an overnight recovery. Keenan says it is easy for him to follow-up on hind end and other cases because he visits all of his stops at least once a week. He also advises other farriers to maintain these relationships by utilizing all communication tools at hand, from phones to email to Facebook. “I want the horse to perform — I want it to be the best that it can be, because then it’s easier for that person to do their job — whatever it is that they’re doing.