THE REAL KEY. Scott Kimbel says it is critical to fully understand the relationship between form and function when working with foals.

Believe it or not, there are some people in this world who think that a horse’s foot health doesn’t need attention until it needs shoes. Whatever your philosophy on the subject, these three footcare professionals would beg to differ. 

In a collaborative presentation at the first annual International Hoof-Care Summit, farrier Scott Kimbel and equine veterinarians Stephen O’Grady and Bob Hunt delivered valuable advice, tips and guidance when it comes to caring for foals at what they believe is the most influential and critical age of the horse.

Scott Kimbel, Frankfort, Ky. 

  • Balance, Balance, Balance. “The three most important points to remember about trimming foals are balance, balance, balance,” Kimbel begins. “That’s because we balance in three different planes. The X balance is the medial lateral balance, the Y balance is the flare-in, flare-out of the foot along the ground surface, and the Z balance being anterior posterior or the pitch of the foot.” 
  • What Is Balance? Kimbel explains that balance is the correct form or proper hoof angle and alignment of the foot with the limb. “The reason we balance is to gain a uniformity of pressure forces on the bottom of the foot,” he says. “It lets the foot and limb function properly and lets the animal do what we’re asking it to do, not only in the short term, but in the long-term period of time.”

The key, Kimbel argues, is understanding the relationship between form and function. “If the foal isn’t in proper form, you’re not going to get the proper biomechanical function. It leads to in not only younger horses but older horses, myriads of problems with the foot itself, the wall and all the supporting structures, tendons and ligaments.” 

  • Approaching The Foal. To prepare for trimming the foal, Kimbel starts out by having someone walk the foal toward him, away from him and then stand the foal up next to him.

“There are two balances in this situation, dynamic balance and static balance,” he explains. “We want to see the limb in motion and at rest. We are also evaluating conformation and determining where there might be possible points of imbalance.” 

  • Philosophy Of Trimming. Another critical point to Kimbel’s approach is to make sure that you treat each foal as a unique being. “We’re not trying to make these foals into the ideal horse,” he continues. “We’re trying to make that particular horse what it can be. By balancing, we are constantly pushing these guys toward that point that lets the limb develop to its optimum achievement. It’s gradual and takes time and patience. You have to give the horse time to develop.” 
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CONGENITAL FLEXURAL DEFORMITIES. Stephen O’Grady (far left), says that a lot of times you should do nothing at all, since the foals will get better by themselves in a couple of days.

The Process

  1. Start Early. “I start looking at foals at 2 weeks of age,” he says. “Once that balancing starts, it continues throughout their lives.”
  2. Read The Foot. “I like to pick up the foot and read it,” he continues. “On a young horse, I like to know why the horse is wearing the foot the way he is. It can be very telling. But I always trim them back to balance. If I don’t know what’s causing them to be unbalanced, I give them time and eventually, it’ll reveal itself.”
  3. Individualize. “People talk about trimming to the widest part of the frog,” Kimbel maintains. “We can’t do that on every horse. The conformation of some feet simply will not allow us to do this without imbalancing the foot.”
  4. Anterior Posterior Balance. “For those of you familiar with Duckett’s Dot system, we measure 1/2 inch back from the trimmed point of the frog and draw a line across that,” he says. “It’s the widest part of the foot. From this point, we ideally would like to have one-third of the foot anterior and two-thirds posterior from this point. By maintaining this relationship, it allows for proper heel growth, toe length and development of mass of the entire foot.”
  5. Minimal Knife Work. “I don’t care about making the foot look pretty,” Kimbel states. “Or, at least on the bottom. I take out what is needed, but I don’t like too much knife work. I want the foal to get the hoof density and create hoof mass for strength.” Don’t expect dramatic visual results. Horses that have been properly maintained from an early age show little change in foot shape between trim periods. “We end up with a foot that basically looks the same as when we started,” he says. “That is, with a short toe, strong heel mass, and uniform balance of pressure at the walk and at rest. When you’re trimming these guys, remember form and function. You’re gently bringing them into balance. I look at them every 2 weeks. Once they’re balanced, it’s just a matter of maintenance.”
  6. Maintain A Good Relationship With Managers. “I look at the horses on occasion with managers,” Kimbel continues. “It reduces the surprises and keeps everyone abreast of what is going on. Most managers will look at the foals on their own and come to me with problems — and then we’ll look at them together.”
  7. Don’t Underestimate A Relationship With A Vet. “It’s always helpful to be able to call on their expertise and to be respected by them by what we can do as farriers. They know what our job is and what we can and can’t do.”
  8. Take A Team Approach. “Everyone in the barn who handles the horse should have a clue as to what is going on,” he says. “Get everyone in the loop.
  9. Other Tips. Besides these valuable points of advice, Kimbel says there are other considerations that don’t necessarily directly relate to the foal or its feet that can make a big difference in your success. 

Establish and understand with management and owners the fact that foals need to be taught to tolerate farriers. “You can’t do this type of work when they’re dancing or jumping around,” he says. “It’s critical that owners and managers know what their job is to let you do your work.”

Stephen O’Grady, DVM, Marshall, Va. 

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SIZING UP CONCERNS. Like most good farriers and vets, Robert Hunt prefers to see his foals in motion and at rest to evaluate conformation.

Just because they’re babies doesn’t make them free of problems. In fact, it’s often quite the contrary. Steve O’Grady, DVM, MRCVS, not only was a professional farrier before going to vet school, but was elected into the International Equine Veterinarians Hall of Fame in 2003. An expert in hoof abnormalities and disease, he offers sage advice for dealing with flexural deformities. 

A. What Is It? Flexural deformities, O’Grady says, are a shortening of the musculotendonitis unit that results in hyperflexion of a given anatomic region of the limb. “The term, contracted tendons‚ is a bit of a misnomer,” he continues, “as the tendons lack the ability to contract. The primary defect is a shortening of a muscular tendonous unit.”

B. Affected Joints. O’Grady explains that the affected joints are the distal interphalangeal joint (the coffin joint), the metacarpophalangeal joint (the fetlock) the carpus or any combination of the above. 

C. How Deformities Occur. When it comes to flexural deformities, they can either be congenital (present at birth) or acquired. Congenital deformities usually involve a combination of joints of the lower limb and have abnormal flexion with the inability to extend joints.

“They’re all pulled tight,” O’Grady explains. “The animal is essentially walking on its toe.” 

The key to preventing congenital deformities is to keep a close eye on the mare, as many mares will consistently produce foals with flexural deformities. Other congenital causes can rest on the management team’s shoulders: nutritional management of the mare while she is in foal and exposure to the influenza virus. 

D. Treatment Of Congenital Flexural Deformities. “A lot of times, you do nothing at all,” O’Grady admits. “They’ll get better in a couple of days. Sometimes, you want to restrict their exercise to a small paddock or use physical therapy. For this, put your foot behind the fetlock or pastern and use the heel of your hand on those muscles and tendons. Bandages are also good and you can use full limb bandages to get those muscles to relax and they can really drop down nicely.” 

If no improvement is noticed within 3 days after foaling, O’Grady says that aluminum or wood toe extensions taped to the foot, coupled with oxytetracycline can do wonders. 

E. Acquired Flexural Deformities. Acquired deformities usually develop 2 to 4 months after birth. In these cases, farriers are often the first ones to see the foal’s foot axis becoming more upright, making the farriers’ role critical. 

Another thing to keep in mind concerning acquired flexural deformities is the fact that the conformation in the foot does have the tendency to change according to stresses and pain. According to O’Grady, these changes usually involve the distal interphalangeal joint (coffin joint) initially. 

F. Science Says? “Etiology,”?O’Grady explains, “it’s all speculative. There’s nothing really proven. The foal has to have the propensity to acquire this deformity. In other words, you can overfeed them or trim their feet aggressively and they wouldn’t acquire this deformity. For the foal that has a propensity, you can make mild changes to their diet or feet and he’s up on his toe.” The factors, however, that contribute to acquired flexural deformities are heredity, nutrition and pain. 

G. Nutrition. When thinking about nutrition, the key is to pay close attention to overfeeding, excessive carbohydrates and unbalanced minerals. All can play a critical role in the conformation of foals.

H. Pain. “You can get pain from developmental or orthopedic disease,” O’Grady continues. “You can get trauma from hard ground. Overtrimming (such as too much taken off the bottom of feet) can certainly set this in motion. On some of these guys, after the trim, they’ll go up on their toe. 

“Put a hoof tester on them and the foal will show marked discomfort. You can take your thumb and press on the sole and it will be soft. Remember, this is an immature structure. One of the best lessons I ever learned is to put the knife away until they’re 6 months old. Until then, use a wire brush when dealing with the sole.”

I. How To Diagnose. As far as diagnosis is concerned, O’Grady says the following can be signs of acquired flexural deformities: 

  • Abnormal or uneven wear at toe (early sign). 
  • Increased dorsal hoof wall angle (everything else is in alignment).
  • Broken forward hoof-pastern axis.
  • Unequal hoof wall growth that is higher at the heels.
  • Heels that do not contact the ground.

“These signs can be very subtle in young foals,”?he warns. “Keep an eye on them.”

J. Treatment. As far as treatment is concerned, O’Grady strongly recommends first taking a conservative management approach before trying anything too radical. 

K. Eliminate The Cause If Possible. “It’s pretty hard to do,” he admits. “We usually don’t know what the cause is.”

L. Restrict Exercise. This is important to reduce trauma. 

M. Make Judicious Use Of Non-Steroidal Anti-Inflammatory Drugs. These include ibuprofen or aspirin. “Use just enough to take that pain away,” he says. “Combine these medications with restricted exercise and you can see the hoof angle go down in a day or two.” 

N. Administration Of Oxytetracycline. “I’ll use oxytetracycline on the ones that are acquired, but where it’s effective is if you see a foal go up off his heel and the bones of the digit (P1, P2, P3) are in alignment,” he explains. “Tetracycline and toe extensions will provide some help. If you have a flexural deformity involving the coffin joint, forget the tetracycline. It’s not going to give you the benefit.”

O. Toe Extensions. “We see a lot of toe extensions put on when the heel of the foot is off the ground,”?O’Grady comments. “I’ve done it and it has the potential to pull the coffin bone out of the hoof capsule. If the heels are off the ground, don’t put on a toe extension. Give them some tetracycline. The next day, if the heels are on the ground, go ahead and put your toe extensions on. Next, cover the sole with Equilox to take care of the bruising.”

P. Consequences Of Non-Treatment. Ignoring a flexural deformity is not a smart idea. It can result in a series of steps, leading to a club foot: 

Q. Increase In Length Of Heel Relative To The Toe. This includes:

  • Contracted heels.
  • Bulge at coronary band.
  • Broken forward hoof pastern-axis.
  • Concavity in dorsal hoof wall.
  • Flat thin soles. 

Club Foot 

“Think of all the mechanics that are going on in a club foot,” O’Grady says. “The formation of a cavity at the dorsal hoof wall has to go somewhere, so it flattens your sole and the heels grow higher relative to the toe, etc. There’s no mechanical way you can get out of this hoof capsule distortion without doing some kind of release procedure. The surgery of choice is a inferior check ligament desmotomy. Prevention is always your best weapon.”

Bob Hunt, DVM, Lexington, KY 

All farriers have horror stories about diseased feet, conformation or employing new techniques for the first time. It’s a stressful job anywhere in the country. But add the pressure that comes with administering corrective techniques to a Thoroughbred foal that is worth a million dollars.

An equine surgeon and farrier, Hunt has seen a lot of messed up feet — and his clients aren’t as forgiving with mistakes on these horses. Here’s what years of experience have taught him — and provided benefit to his equine clients. 

1. Deviation Of The Frontal Plane. “As with flexural deformities, they can be congenital or acquired; both genetics and environmental causes are important,” Hunt explains. “There’s more than one way to skin a cat. Not every case needs surgery and we probably operate on 80 percent more foals than we need to.

“Many of these foals are born with the ability to correct. People want things corrected right now. Ask yourself if it will straighten out without surgery.” 

2. Knock-Knees. “Most people call it knock-knees, but we call it carpal valgus,” Hunt explains. “Knock-kneed foals, or carpal valgus deviation, is a normal finding in foals. We have the tendency to get excited and are probably too aggressive. Everyone wants to do something — and right away.

“There is debate over rest vs. exercise or conservative versus surgical treatment. The most common surgical procedures include periosteal stripping and transfisial bridging. In general, we address many of these problems too aggressively as horsemen.”

3. Pigeon-Toed. “For several years, we paid tremendous attention to these little pigeon-toed foals,”?he admits. “My biggest nemesis in this situation are big-muscled, fine-boned fillies that are offset in the knees. They come out a little upright and don’t settle down and toe out right for you. You can do everything under the sun, but they’ll still be offset and want to track basewide.”

To correct this headache, Hunt prefers to watch the horse in motion. If there’s ample hoof, he avoids putting on acrylics. The ultimate goal is to reload the foot to encourage the foal to start using the inside portion of the foot.

“They’ll start toeing out to unload the lateral wing of the foot and at least get them tracking in the right direction,” he says. “Without ample amount of foot to work with, acrylics may be necessary.”

4. Don’t Be Crazy About Acrylic. “It’s not your best friend and isn’t without problems,” he says. Problems he’s seen include hematomas, thermal injuries, severe bruising, broken coffin bones and lateral wing fractures. 

5. Surgical Management. Hunt says the two big areas where he has had success over the years are in periosteal transections, or stripping, (PEs) and transphyseal bridging. PEs, he says is an attempt to enhance growth on one side of the leg.

“Some people say PEs don’t work,”?he says. “I say that PEs without another management change have little effect. It’s the same as saying you can use your rasp and make every foal straight.”

PEs, Hunt says, are most effective when there is the most growth present, usually performed in the second or third week of the horse’s life. For severe deviations, which he defines as more than 10 degrees, he recommends an implant, as well. 

Transphyseal bridging is the practice of arresting growth on one side of the limb. “You don’t want to stable every crooked legged horse you see, because there are ramifications for that. Considerations should be given prior to implant placement, for they are not without complications.” 

6. Exercise Vs. Risk. “This is still a controversy,” he admits. “Do you turn them out or keep them up? With flexural deformities and angular deformities, you’ll do a lot more surgery and intervention if you’re observing the foals as they’re coming in at the end of the day.

“ They always look worse. Wait until morning. Each one is an individual with regard to exercise. If he’s got structural problems, laxity in the joint capsule, it is a dangerous practice to put that foal out with a maiden mare in a large field. Gradual is a good key.”

7. Sizing Up Your Problem. Like most good farriers and vets, Hunt prefers to see his foals in motion and at rest to evaluate conformation. “It’s much more important to me to see how the horse is walking toward and especially away from me,”?he says. “Even if he is extremely correct now, you can see where he’s going to end up. They have a characteristic way of hitting the ground.”

When the foal is walking away, Hunt watches how the contact point of the heel hits the ground. “You won’t appreciate that when they’re coming toward you,” he explains.

Hunt maintains a horse walking toward you will give you further insights to how crooked he is, the flight pattern and sweeping movement of the leg. “As far as contact,” he says, “how he’s wearing that foot, it’s very critical to watch these things walk away from you, and which heel is hitting the ground first.”

8. Be Absolutely Sure. If you know you have a lame horse on your hands, Hunt highly recommends taking radiographs. “You can have an underlying bone disease,” he argues. “They can have crushing and malformation of bones in the hock. If you see curbed or sickle hock and they’re cut in under the hock, you’d better radiograph, because they’ll be trouble down the road.” 

9. Be Wary Of Over Correction. “One thing, and this truly does happen, is that you can correct too much,” he says. “You can end up with a very correct looking angle that’s coming straight at you and an off-set knee. The ankle is extremely active. In effect, you’re working against yourself with two deviations and you’re sunk. You’ve just lost your ankle growth.”

10. Think About Ankles. “I worry about these ankles,”?Hunt continues. “Try to get a straight line. If I have a straight axis to work with from the knee to the foot, we can handle the knee later on. One key thing for farriers to do is protect the foot and keep it balanced. This is a critical thing to keep that in alignment because otherwise, you’ll get into trouble.”

11. Focus On Balance, Not Correction. “I don’t like to get over aggressive,” he admits. “With chronic use of overcorrection of these feet, you’ll deform them. You can see rings that develop from over extension if you don’t give the foot a rest from time to time. It’ll become deformed and many times, won’t recover. You can pick them out at sales — or after the sale when the Equilox comes off where they ran through the sale ring.”

12. Take A Holistic Management Approach. “When looking at these problems, they’re not just surgical or feet problems, they’re total management problems,” Hunt maintains. “It starts with genetics and ends at the finish line at the track. Everything on the management scheme, from turn out schedules on is involved. Become a component and ambassador for farm management.”