The Club Foot

What is a Club Foot?

lengthening tendon

Schematic of splicing and lengthening a tendon

The club foot is rarely a genetic deformity but rather pathological. Very few, if any, foals are actually born with a club foot and in the few rare cases, it is not the foot but the deep digital flexor tendo-muscular structures that are usually at fault. In a number of these cases, it may be necessary to operate to lengthen the tendon (it is spliced on the diagonal and the ends of the splices are reattached gaining a few millimetres of extra length); in other cases, a good trimming regime and appropriate physiotherapy started at an early age should suffice. Here we might be permitted to talk of a “true club foot” insofar as there is a disorder from (before) birth.

The other form that we see is what may be best termed the “false club foot” which is not a result of genetic but rather one of pathological causes, one of which would appear to be laziness! Well, at least in part. As we know, the foal is quite ridiculously proportioned and should either have shorter legs or the neck of a giraffe…as it is, it doesn’t. It is obliged to either spread its front legs sufficiently far apart sideways, or lengthways. It is this latter position that is oft the precursor of the false club foot; the laziness of the foal in always standing with the same foot forward every time it eats. One possibility is that the anterior arteries of the rear foot are restricted meaning that the rear of the hoof is being fed better and exhibits greater growth. Another theory – one based upon our own observations – is that the front foot, through increased pressure  on the caudal (rear) structures, consequently shows greatly increased growth in this region. Add, to either of these theories, insufficient wear and we have the makings of a deformed hoof. Whatever the actual physiological process, the rear of the hoof rises causing the coffin bone (P3) to show apparent “rotation” within the structures.
Laziness is of course not the sole factor. The incidence of a false club foot among horses truly at liberty is in all probability, zero. Confinement and constraint are really the primary cause, with “laziness” being a secondary factor. Being confined, the young foal will have very little possibility to move – certainly not sufficiently – and thus has no chance to negate the detrimental effects of favouring one leg when eating. If the foal is in a position to move at liberty and traverse kilometres during the day, as would have the wild horses, then the effects of favouring will be cancelled out.

  • Club Foot at T0

 

Treating the Club Foot

It would be going a little too far to say that to treat a club foot is simple – it is far from easy, but the process itself really is basic. Obviously we are not discussing cases where an operative procedure is necessary, although, surgically, that too is at least in theory, basic.

In all cases, the earlier the problem is tackled, the less severe the changes to be enacted and the less traumatic it will be for the horse. Furthermore, for the horse with the true club foot, the shortened tendo-muscular structure will need to be helped by appropriate physiotherapy in order to stretch the muscular structures sufficiently to alleviate its effects, where these are not so severe that they require surgery. The older horse will be less capable of responding favourably to this procedure. The false club foot, not being a result of shortened tendo-muscular structures, will not need to be treated as such. However, the necessary lowering of the caudal structures of the hoof will put pressure – or rather, tension – on the deep digital flexor muscle (DDFM) which will almost invariably cause a certain amount of discomfort and muscular pain which will require intervention by the owner/keeper of the horse.

The (non-surgical) treatment of the club foot entails little more than the progressive lowering of the caudal hoof structures. Particularly in the older horse, and even more so in the shod older horse, the club foot deformation can result in castellation, or contraction, of the caudal structures; this will almost certainly be permanent damage. There might be a mild degree of decontraction during the treatment but it is rare that the hoof gains a completely normal configuration.
A progressive lowering is actually an intense process. Stretching the DDFM is always going to be a little uncomfortable, but if the horse is to be encouraged to move, this must remain a discomfort and not become a disability therefore frequent small trims are preferable to less frequent major interventions. It is also less likely that the hoof will respond to the trim in the way desired if the hoof is left for long periods between trims. One of the main problems with any excessive nail growth (remember, the hoof is nothing more than a nail), is that vascularisation will follow the growth of the nail. The claws of dogs, rabbits, cavies etc. are excellent examples of this problem; when the claws grow too long, it becomes more and more difficult to trim them short because the blood supply starts to reach steadily further down the nail. If the hoof is only trimmed every six to eight weeks – a normal routine – growth will outstrip the attempts to push vascularisation back deeper into the hoof. Experience shows that an interval of no more than 18 days is essential in the first months of the treatment.

Pushing back vascularisation can sometimes be quite dramatic; the only reliable way of determining if enough has been trimmed/rasped is to go to the point that the rosy, blood engorged, layer under the hoof wall is just starting to show through. It must be noted here that it is not the intention to draw blood, nevertheless, the difference between “enough” and “a bit too much” can be a little as one throw of the rasp. Do not panic!!! The horse is not going to bleed to death (a 450kg horse has about 34 litres of blood) . The wound will close up within minutes and in all likelihood, the horse will not even realise it has bled. The risk of infection is also extremely low provided the horse is not kept in confinement.

The time needed to treat a club foot is almost entirely dependent upon the initial severity of the problem. The easiest of cases may just take a couple of months; the most difficult may never be corrected completely. The latter is particularly true of older horses. As a horse, or any animal for that matter, grows older, the bones, joints, tendons and muscles all take on a steadily more “fixed” form appropriate to that animal and its habitual posture. Ossification and de-ossification will start to play a role in the process. For this reason, particularly with older horses, it is strongly advised to start with an X-ray of the foot in question. If the joints are unaffected, then there is little reason not to proceed – indeed, when hoof capsule rotation is so severe that the point of the P3 is the principle point of support for the horse, then action is an absolute necessity. Left in this state, the possibility of a perforated sole is vastly enhanced. As anyone who has experienced that with a laminitic horse will testify, that is one situation to be avoided at all costs.

 

  • Dorsal

There is nothing to stop anyone from attempting to correct a club foot on their own horse but it would be sensible to glean some advice from a professional (do beware of approaching farriers – there is a general tendency within the profession to consider club feet untreatable other than by – inappropriate – shoeing) and certainly do talk to a vet. Again, not all vets are open to the possibilities; the veterinary world still considers the feet to be the domain of the farrier and as such, vets will refer almost every foot problem to a farrier “because he […supposedly…] knows what he is doing”. Sadly, the presence of (false) club feet shows us that the latter is not always the case.

Finally, it is essential that the owner/keeper exercises the horse sufficiently every day, particularly horses that have restricted or fairly solitary turnout; neither of these situations is advisable and the prime advice here is to move the horse to an appropriate location where it can be part of a group. If the horse is within a group, the group-dynamics will most likely suffice to keep the horse mobile but whatever the situation, in order to avoid stiff muscles and even the possibility of “Monday morning sickness”, the horse must have regular daily exercise.