6.2.1. Club foot, desmotomy of the inferior check ligament
1.Title of the article (Diagnosis): Club foot
Authors: Hana Hofmannová, CE-F, Ing. Jindřich Vinčálek, CE-F
Place of work: Třeština - Háj - Mohelnice
Podkovářství, 38.4. Úprava a podkování špalkových kopyt, ISBN: 978-80-7490-052-5, Tisk Pálka 2015
Breed: Czech warmblood
Age: 3 y/o, farriery treatment at 18 months of age
Working discipline: Breeding and recreation
2. Data of the patient
Reason why the owner complain: Permanent lameness and discomfortable movement of the mare
Duration of the problems: Since 6 months old
From birth to 18 months deep bedding
After 18 months of age recommended box stabling on the harder surface
Bedding: Since 18 month of age on firm surface with minimum of wood shavings
Surface, on which the horse moves most often: Sand manege, grassy paddock
Frequency of the hoof care: Till the age of 18 months 8 weeks, now 4 – 5 weeks
Type of shoeing: Barefoot, trimming started after 18 moths of age
Characterisation of the problems:
4th grade club foot on the left front limb caused by unbalance of the ratio of the lenghts of the tendons and bones.
both limbs with outward rotation, more significant on left front limb
slightly toed in
the movement mechanics is more affected by outward rotation of the whole limbs
impact and loading diagonally on outer half of the hoof with breaking over the inner toe
stance slightly camped under with axis broken in coffin joint (due to club foot) on left forelimb
left forelimb combination of slight outward metacarpal deviation woth off-set carpus
right forelimb sligth outwrad deviation of the matacarpus
Shape of the hoof and pathologic changes:
triangular shape of the sole, typical for the club foot
dorsal wall tends to concave bend
Evaluation of the hoof care and of the type of shoeing:
In previous hoof care, the heels were not trimmed sufficiently and dorsal wall was not leveled. This caused prolongation of the sole part and worsening of the dorso-palmar balance of the hoof. In movement the hoof could not properly break over and this increased the strain of the deep digital flexor tendon. This load caused faster growth of the heels. The mare was barefoot.
Long intervals between trims, improper stable management (deep bedding) and dietary faults (feed with hight protein content) caused uneven development of the tendons and bones and resulted in club foot, which could not be corrected by a trim anymore. Treatment strated at 18 months of age.
Fig. 1., 2.: From left - Left front hoof before first trim at 18 months of age
4. Problem description
5. Choisen solutions
Trimming at the age of 18 months:
18 months - maximall shortening of the heels, leveling of the bent dorsal wall
Fig. 3. and 4.: Left front hoof after first trim at 18 months of age.
Shoe preparation and shoening at the age of 18 months:
For first shoeing was chosen shoe with dorsal extension (teh idea was to increase tension fo DDFT to prolongate it).
Fig. 5. and 6.:Left front hoof after 1. shoeing at 18 months of age
Veterinary treatment at the age of 18 months:
Dietary measures - significant reduction of feed ration
change of stable management and bedding, he foal was stabled in box with firm surface and small amount of wood shawings
Fig. 7 - 9.: Left front hoof before second shoeing
Fig. 10 - 11.: Left front hoof after secod shoeing after six weeks
Fig. 12 - 13.: Left front hoof before third shoeing after six weeks.
Trimming at the age of 21 months:
Based on the evaluation of results was recommneded to change type of shoeing and perform desmotomy of the inferior check ligament of DDFT
Fig.14.: X-ray images at 21 months
X-ray image still shows forward broken axis in coffin joint, i.e. 3rd-4th degree club foot
Fig. 15. - 17.: Left front hoof before shoeing at 21 months age
Shoe preparation and shoening at the age of 21 months:
Based on X-ray images (see Fig. 14.) and current, not very effective farriery measures, was chosen two clip shoe with rocker.
Fig. 18. - 20.: Left front hoof after shoeing at 21 months of age
Trimming at the age of 30 months:
After evaluation of unsatisfactory results (see Fig. 15. and 16.) the owner decided for suggested desmotomy. Before the desmotomy, the heels were shortened as much as possible, dorsal wall leveled and sole flattened without rocker.
Fig. 21. and 22.: Left front hoof after removing the shoe before trim, shoeing and desmotomy at the age of 30 months
Shoe preparation and shoening at the age of 30 months:
Before desmotomy was used two clip shoe, without rocker, which was not set back.
Fig. 23. - 25.: ZLeft front hoof after shoeing before desmotomy at the age of 30 months
Fig. 26. - 27.: Left front hoof 3 weeks after desmotomy before trim and shoeing from side view.
Fig. 28.: Left front hoof 3 weeks after desmotomy
Rules of the further care:
Short interval between shoeing.
Keep the hoof without bent walls and with heels as short as possible.
Fig. 29.: Left front hoof 7 weeks after desmotomy from side view
6. Follow up – Development of changes
trimming the heels as much as possible led to improvement of the broken back axis of the digit (see Fig. 1. - 4.)
Changes in shoe choice and shoeing:
18 months of age: shoe with dorsal extension (Fig. 5. and 6.)
21 months of age: two clip shoe with rocker (see Fig. 18. and 19.)
30 months of age: before desmotomy: two clip shoe without rocker, not set back for easier breakover (see Fig. 23. - 25.)
Farriery treatment effect:
18 months of age - by lowering the heels as much as possible and leveling the dorsal wall improved the angles of the limb and shift the point of gravity in palmar direction (see Fig. 1. - 4.)
shoe with dorsa extension (see Fig. 5. and 6.) increased pull on the DDFT
30 months old - before desmotomy were llowered the heels as much as possible and used shoe without rocker. Desmotomy released the inferior check ligament of DDFT. This caused improvement of the angles and broken axis of the limb.
Result of the care:
Left: Fig. 1: left front hoof after start of treatment at the age 18 months.
Right: Fig. 29: Left front hoof after 12. weeks of treatment and desmotomy of the inferior check ligament of the DDFT.
DUring the 21 months treatment was achieved overall improvement of the mare’s health. Desmotomy significantly improved angle of the affected hoof, and also axis broken forward in coffin joint is less prominent. The mare is currently sound, pregnant and with very light work.
Conclusion (take home message):
Club foot is caused by uneven ratio between tendons and bones. It could be caused genetically or acquired. It could develop as a result of injury and insufficient load of the limb. Foals quite often developm the so called "grassy foot", especially on rich pastures. Not only for this reason should be paid close attention to the hoof care of foals. Frequent check-ups and regular trims in shorter intervals could prevent possible problems.
Complete resolution fo club foot is very relative and depends on many conditions: age, grade of affection, management codnitions etc. In adults, the correction is quite uncertain, because many anatomical structures adapt to shortening of the DDFT and are strongly interconnected. In this cases it is necessary to rather respect this conformation and try to improve the biomechanics with proper trim and shoeing.