High-Heel Low-Heel

This syndrome is now commonly recognised and a number of theories of why and how it develops have been put forward. It is not restricted to one breed or one type of event. Untreated horses with this type of hoof structure show consistently upper body muscle tension patterns and resulting performance deterioration. This is one of the important things that should be considered when buying a horse. When viewing a horse the tension in the subclavius, infraspinatous, pectorals and pain and trigger point patterns should be related to the positioning of the

Healthy Digital Cushion
Note the cauliflower look to the texture and the alignment of tissue

shoulders, scapulars, and the pelvic balance in the hind end and much more. High-heel Low-heel consistently causes mid thoracic back pain and can be a night mare for saddle fitters.

From a farrier’s point of view this can be one of the more persistent imbalances to overcome. High-Heel Low-Heel imbalance in the front limbs is when one hoof capsule is higher in the heels then the other hoof capsule on the opposing limb. This causes a horse to change its orthopaedic balance and the weight forces within the hooves; it also causes changes in the upper body of the horse.

Unhealthy Digital Cushion
Note the look of the tissue and the position within the hoof

The farrier has a lot to consider, which hoof is the correct height and which is not, what are the forces on the internal structures of the feet and the related forces on the orthopaedic stance of the horse. The stress I am referring to is the stress placed on the bones, distal cartilage, ligaments, laminae and vascular flow of the hoof that cause the equine to alter its stance or movement due to discomfort in its hooves. Any or any combination of the distal cartilage, impar and bilateral ligaments of the distal sesamoid bone, deep flexor tendon and bursar, digital cushion, bars of the foot, or the laminae can be affected.

Darrall Clifford, equine hoof-care and orthopaedic balance farrier who deals with these sorts of problems on a daily basis explained the problems he finds in the horse;

“The main problem I find as a farrier is the limb with the high heel transfers more weight onto the opposing limb, this overloads this limb and alters the vascular flow and causes the breaking down of the tissue in this hoof. The effect is that the tissue of the digital cushion (overload) changes its texture and alignment within the hoof and this affects the upper body (scapula-humerus angle) and the alignment of the distal phalanx with the hoof capsule and the bars of the foot in the horse. With the digital cushion deprived of blood flow it can not perform its roll of shock absorption and supporting of the upper body. Its shape is then significantly changed and protrudes out the back of the hoof affecting the shape of the bulbs of the heels and the growth of the horn tubule; it also sits more medial-laterally in the hoof and forces the bars of the foot out. This then places pressure on the wings of the distal phalanx and can significantly affect vascular flow to the sensitive laminae at the heels leading to detachment of the hoof capsule in this area. This will then affect the orthopaedic stance forcing the heels down and forward (under-run) and the dorsal wall (toe) becomes unloaded and begins to grow quicker (causing a lever affect on the heels) than the heels of the foot and completely changes the biomechanics of the hoof.”

Healthy bars of the foot

In the limb with the higher heels we have just the opposite with the heels becoming unloaded and the dorsal wall (toe) becoming overloaded, meaning the vascular flow to the heels is greater than the toe. This causes the heels to grow faster and without correct biomechanical forces expanding the hoof it becomes contracted placing stress on the distal phalanx and digital cushion, that in turn places strain on the distal sesamoid bone and impar ligament.

This is where it is hard to determine which hoof is correct or not as the high heel looks healthier then the lower heel and the lower heel presents with under-run heels and can also have a concaved dorsal wall due to misalignment of the hoof capsule and distal phalanx. It will also have less vascular flow and for this reason take longer to repair and presents with soreness in the hoof usually at the back half of the foot.

Unhealthy bars under pressure

What we must do is start to reduce the hoof with the higher heel as to unload the limb with the lower heel and allow the return of vascular flow and growth back to this hoof. This process will decrease the pressure on the loaded limb allowing growth at the heels and a better hoof phalanx alignment and loading on the other limb bringing about expansion to the contracted or upright hoof.

This then brings about a better orthopaedic balance; meaning structural and functional balance of the entire muscular-skeletal system of the equine, starting in the hoof and extending throughout the upper body – all bones, muscles, tendons, ligaments and hooves perfectly aligned and working together in harmony, as they are designed to do.