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Title (Diagnosis): 4.2.1. Contracture of the DDFT and development of club foot – coffin joint contractures in the foal

1. Author of texts and photograph: Ing. Jindrich Vincalek, CE-F

Place of work: Stud farm Měník

2. Literature review: Podkovářství, ISBN: 978-80-7490-052-5, Tisk Pálka 2015

3. Patient Data No.4.2.1.

Breed: Czech Warmblood

Gender: Stallion

Age: Born 28.5.2015

Color: Albino

Working use: Rearing and training in stallion test station

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4. Anamnéza:

Potíže, na které si majitel stěžuje: Hříbátko stojí pravou přední končetinou na hrotu kopyta a má pohybové problémy.
Doba trvání potíží: cca 8 týdnů
Ustájení: V boxe s matkou
Stelivo: Sláma
Frekvence úpravy kopyt: Žádná
Typ kování: Žádné
Kulhání, případná diagnóza: Vzhledem k otlačenému hrotu kopýtka projevovalo hříbě kulhání 3.- 4. stupně a jevilo značnou nepravidelnost pohybu

Reason why the owner complains: The foal stands on the tip of the right hoof and has movement problems.
Duration of problems: approx. 8 weeks
Stable conditions: In box with mother
Feed: The foal is 6 months old sucking, fed together with mother hay, haylage and grazing
Bedding: Straw
Frequency of hoof care: So far none, only the owner himself lowered the heels
Type of shoeing: None
Lameness, possible diagnosis: Due to the bruised tip of the hoof, the foal showed 3rd to 4th degree lameness and considerably irregular movement.

4. History:

Characteristics of changes: Due to the shortening of the DDFT and its check ligament, the hoof joint had flexural deformity. The side and heel parts of the hoof narrowed due to the non-loading of the heels.
Hoof shape and pathological changes: Compared to the left hoof, the right one is narrower with high heels and takes a triangular shape. The joints on the distal limb showed inflammatory processes of growth zones (epiphysitis).
Limb posture: Due to the pull of the shortened DDFT, the limb axis was broken backwards in the carpus and the hoof developed the fourth degree of the club foot. The dorsal wall pointed to the ground at an angle of more than 90 °.
Evaluation of trim: The hoof was neglected.

5. Case description:

6. Chosen measures:

Chosen trim : 1st treatment took place at 5.5 months of age of the foal. Maximum trim of the heels and leveling of the dorsal wall was performed.
Shoe preparation : A sufficiently long concave hind shoe with two clips was chosen for the shoeing. It was narrowed between the clips so that the dorsal arch of the horseshoe, when the clips were correctly positioned on the hoof, exceeded the dorsal supporting edge of the hoof by two cm. This created a dorsal extension acting to extend the deep flexor. The overhanging branches have been forged at the level of the heel edges into calkins which initially provide support for the lowered heels so as to facilitate the loading of the hoof on the heels and their support.
Shoeing: shaped horseshoe was nailed to the side to heel parts of the hoof. The horseshoe attached in this way partially reduces the pull of the deep digital flexor tendon on the hoof wall laminae in the dorsal part of the hoof and reduces the risk of mechanical laminitis.
Veterinary measures: After consultation with a veterinarian, desmotomy of the check ligament of the deep flexor has been postponed for the time being and farrier care has been recommended.
Principles of further care (it is important to cooperate with the breeder:
Immediate weaning of the foal from the mother
stabling on hard surfaces,
organized movement (leading),
limited feed ration,
thermal bandages and administration of analgesics to reduce pain.

7. Development of changes

The effect of the 1st selected hoof treatment was manifested after 6 months of farriers and breeders care. During 6 trims and shoeings, the heels were lowered and the calkins were gradually removed. The angle of dorsal wall decreased significantly.

Changes in the choice of horseshoes and type of shoeing:

April 2016 - Stallion was shod Dr. Hans Castelijns. An aluminum sheet horseshoe with removable heel support and a Luwex Premium packing material was used to support the sole and lower surface of the coffin bone.
Effect of the 2nd farrier's measure: An aluminum horseshoe with a more pronounced dorsal extension had a positive effect on the elongation of the deep flexor tnedon. After 14 days, the support of the heels was removed and in this way the hoof was shod twice at intervals of 5 weeks.

The long extension in the dorsal part of the hoof extends the breakover and helps to stretch the deep digital flexor tendon. Loading of the maximally lowered heels is enabled by a removable heel support. It is necessary to follow an organized movement.

Further shoeing was again performed on a concave shoe with dorsal extension. During the second year of the foal's age, with gradual elongation of the deep digital flexor tendon, the dorsal extension of the horseshoe was gradually reduced to an overlap of 2-5 mm.

Result of the care

The shod hoof had a narrower shape, but a favorable angulation of the dorsal wall. Attempting to leave it unsupported, there was quickly a partial return to the club foot and damage to the hoof wall.

Short check ligament of the DDFT causes the carpus to bend backwards and the attachment of the DDFT increases the palmar angle of the coffin bone. The dorsal wall andle is more than 90 °, the hoof stands on the tip and the heels have no contact with the ground.

Even the maximum load on the limb is not able to bend the coffin joint. The heels remain more than 4 cm above the level of the ground. When viewed from the side, hoof-pastern axis is significantly broken forward. Right picture shows very well the worn area on the tip of the hoof. Palpation reaction reveals a thin sole and bruised sole corium.

Fetlock and carpus growth zones show inflammatory processes (epiphysitis), caused by excessive growth of long bones. This problem can be caused not only by the dietary mistakes of the breeder, but also by excessive movement of the foal.

The effect of the 1st method of the chosen treatment and shoeing of the affected hoof was manifested already after 6 months of farriers and breeders care. During 6 adjustments and shoeing, the heels were lowered and the calkins were gradually removed.

The angle of dorsal wall decreased significantly.

Bottom, side and top view of the hoof after the 2nd change of shoeing to aluminum horseshoe with removable heel support

The stallion could be included in the herd at two years of age.

8. Current state

At the current age of almost three years, the young horse is shod on both front limbs with a light concave shoe. For the first time, the shoeing interval was extended to 8 weeks.

Looking at the right hoof from the side before trimming (1st picture from the left), it is evident that the shoeing interval has been extended to 8 weeks and the hoof has the shape of a 3rd degree club foot. Typical features are hoof-pastern axis broken forward, a curved dorsal wall and high heel.
When viewed from the side (picture in the middle), the left hoof has a slopeing shape with slightly raised heels and the HPA axis is slightly broken backwards.
In the picture of both front limbs from the front before trimming (picture on the right) you can very well see the different length of the toes of both limbs

Right hoof when viewed from below before trim (left): The manifestation of the short DDFT are less loaded heels and the entire palmar part of the hoof. The hoof mechanism is not fully functional and therefore the hoof develops as narrow. The anteroposterior balance is shifted to the front so that the longer tip of the hoof constantly creates an extension to the deep flexor.
Left hoof when viewed from below before trim (right): The two clip shoe on the left sloping hoof is shifted behind the front edge of the hoof and even after 8 weeks still supports the correct anteroposterior balance.

Right hoof when viewed from the side after shoeing (picture on the left): By maximally lowering the heels and aligning the dorsal wall, the shape of the hoof and broken forward HPA axis were significantly corrected. The shoe was placed with the front edge on the dorsal edge of the bearing surface of the hoof. Since the horse is almost three years old, it is no longer appropriate to create a horseshoe with too large dorsal extension, on the contrary, in the next shoeing it will be necessary to gradually facilitate easier breakover to avoid damage to the adolescent limb. The horseshoe is a bit shorter in the heels, because there is a risk of pulling it when the heels grow.
Left hoof when viewed from the side after shoeing (picture in the middle): The bearing edge of the hoof was lowered in the dorsal part a little more than in the heels, which aligned the hoof-paster axis. The two-clip horseshoe was set with its front edge behind the dorsal edge of the bearing surface and the longer branches of the shoe were lifted at the neds to prevent pulling.
Both front hooves when viewed from the front after shoeing (picture on the right): The described adjustment of the hooves achieved a partial alignment of the length of the toes of both limbs, but the ratio of the length of the fetlock and the hoof of both limbs cannot be aligned in any way

Right hoof when viewed from below after shoeing (left): By lowering the heels and aligning the dorsal wall, a significantly better anteroposterior balance was achieved, as well as a slightly better spaciousness of the hoof and shoe
Left hoof when viewed from below after shoeing (right): The backward-shifted horseshoe supported the correct anteroposterior balance. The branches of the horseshoe could be longer, but in soft paddocks and herd breeding it would be in danger of losing the shoe.

Correcting the club foot in foals is very difficult, especially if the limb is neglected and the shortening of the deep digital flexor tendon is long-lasting. It almost always ends with permanent changes in the limbs and restrictions on the use of the horse in adulthood. Conservative methods of treatment require extensive care of the owner and farrier, which is in practice very often neglected shortly after birth.