Long Toe – Low Heel Syndrome by Abi Pass

‘Long toe – low heel’ syndrome and/or ‘underrun heels’ are two common and often co-existing condition of the horses feet that if left unaddressed can be a detriment to a horses musculoskeletal health.

As the name suggests, horses with ‘long toe – low heel’ syndrome can be seen to have their heels dropped closer to the ground than the ‘healthy hoof’ with a much longer toe. ‘Underrun heels’, which often occur following or prior to ‘long toe – low heels’, is where the back wall of the hoof slips further  forward than the bulb of the heel. Both these conditions cause the horse to place its weight further back onto its heel, this:

1. Reduces the natural shock absorbing priorities of the hoof, causing more concussion to be transferred up the limb. Overtime this can lead to heel pain, lameness and osteoarthritic changes in joints, such as the coffin joint.

2. Puts extra strain on the flexor tendons that run down the back of the limb due to changes in joint angles. When more strain is created in these tendons, greater pressure is put on the navicular bone/bursa, increasing the risk of navicular disease. Over time microdamage to these tendons can also lead to tares and ruptures. 

How does this happen?

There is no one cause for these conditions, they may be genetic (seen from birth), as a result of poor farriery long term or as a secondary sign of pain somewhere else in the body.

Does this happen to all the feet?

Not necessarily… this can been seen in 1, 2 or all limbs. It is unlikely to be symmetrical. One heel may be lower than the other. In fact, some horses display one low and one high heel. This can have a big impact on the rest of the body. Always keep an eye out for the symmetry of your horses feet!

The bigger picture…

The saying ‘no foot no horse’ couldn’t be truer. These conditions don’t just effect the angles at the pastern and fetlock joints but also at the elbow, shoulder, scapula, hock, stifle and hip… which ultimately leads to a change in the posture and function of the back. Changes in joint angles can stress nearby muscles, for example, those around the shoulder, leading to overdevelopment. Horses with long toes or underrun heels may struggle to come through behind, engage their core and lift their back, resulting in a hollowed appearance with minimal top-line…

What else could this effect?

How about saddle fit? A change in scapular angle and overdeveloped shoulder muscles such as the trapezius and serratus ventralis may prove a nightmare for gullet and panel fit. Poor top-line may result in bridging. Whereas with asymmetrical heels the difference in muscle development between left and right shoulders may cause the saddle to slip or twist…

How do I address this?

It’s time to talk with your farrier! Something many of us are apprehensive to do. Correct or even  remedial farriery may be necessary to shorten the toe, bring the heel back underneath the horse and lift the heel. Natural balance shoes and similar products can be used to alter the point in which the horses hoof rolls over the ground (which is usually extended by long toes), helping to change the forces and angles through the limb and encourage lifting of the heel.

Remember, if your horse is lame always talk to the vet first and ask for their advice!

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