Case study with radiographs - Alfie - a 12 year old ex-trotter with NPLA and compensatory pathological posture
- Beccy Smith
- Nov 11
- 7 min read
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Alfie is regularly trimmed by a professional hoof care provider; however, the question of poor hoof balance was raised by a body worker, equine physio and trauma-informed therapist Yasmin Stuart. Yasmin was concerned that Alfie's posture was negatively impacted by suspected negative plantar angles (NPLA), meaning his hind hoof coffin bones were potentially sitting lower at the back than at the front, causing a compensated, pathological posture.
Alfie had recently been diagnosed with arthritis in the neck vertebrae following concerns raised about his level of comfort and behaviour. I was shown photos of Alfie's hooves, which were broken back, with long toes and short, under-run heels, and this confirmed my suspicions raised from his history that his hooves had been distorted for some time. This was reflected in his posture and development, which, along with his chronic hoof morphology, hadn't been recognised as connected to his hoof morphology; and placing him at greater risk of lameness and pathology, and therefore less than optimum welfare.
In the previous 3 years since he was purchased, Alfie's owner invested in her hoof care knowledge and sought advice and hoof care services from 3 different hoof care providers, but it appears the hoof imbalance and pathological posture were not resolved.
Alfie's owner had podiatry balance radiographs of Alfie's digits on the recommendation of Yasmin, and the vet confirmed NPLA bilaterally. Alfie's owner sought my assistance to recommend a hoof care plan for her team to consider, via our popular and comprehensive integrative equine podiatry initial consult.
The radiographic evidence revealed medial-lateral and dorso-palmar imbalances, and this was supported by the external photographic documentation as well as dynamic and static assessments taken during the consult.
Given Alfie's history and the impact of climate in the environment he lives in, it is critical to break the negative cycle between hoof and posture, and an additive intervention was identified for primary consideration by Alfie's professional team. This, along with an appropriate reductive trimming approach to help rehab and improve Alfie's hoof morphology and posture, aims to:
Help create equilibrium around the coffin (DIP) joint for neutral and global posture
Reduce leverage and torque on the joints
Help remove unhealthy tension and strain on soft and connective tissues
Improve breakover and load on the hoof and therefore limb and body of the horse
Allow for improved circulation and nutrition to the digit, limb and also in the body of the horse
Allow for elevation of the plane of the hoof while also allowing for optimum reduction of hoof material for improved phalangeal alignment (and coffin joint equilibrium)
Facilitate healing of the sole corium for sole, frog and caudal hoof development
Protect from unwanted wear, to help improve medial-lateral and dorso-palmar balance
Help provide comfort and support for efficient and effective rest and movement
It is critical that the trim, shoe material and shoe placement all support integrative rehab and optimise welfare parameters, and it is also critical to discuss a hoof care plan first with the horse's professional team, starting with the treating vet. This is actually a legal requirement in the UK when a horse is under veterinary care.
Radiographic and hoof morphology assessment and findings
Dorso-palmar and latero-medial radiographs were taken within a month of the consultation.
I have highlighted on the radiographs:
the angle of the phalanges, P2, P2 and P3
the palmar (front hoof) and plantar (hind hoof) angle
the approximate centre of rotation of the joints
the angle of the dorsal hoof wall
the wall and sole depth
the top of the hair line of the coronet band
the top of the extensor process of P3
The external hoof morphology photos also highlight a less-than-ideal hoof pastern axis, which is indicative of a lack of ideal phalangeal alignment and therefore lack of equilibrium around the coffin joint. The radiographic and hoof morphological evidence are associated with increased incidence and risk of pathology and lameness. It is critical to equine welfare that early recognition and ideally, prevention of this, to minimise the risk of injury, lameness and poor or suboptimal welfare states in equines.
Integrative equine podiatry assessment and findings
The photos below demonstrate improved welfare parameters (posture and physiology; namely hoof morphology) and therefore the positive impact of the implementation of the reductive trimming intervention imposed. They also highlight the need for improved hoof morphology on posture, as well as diagrams depicting potential additive intervention for both front and hind hooves.
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