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Does your horse need hoof rehab?

Updated: Apr 5, 2023

We feel the biggest crisis facing domestic horses in the UK today is lack of awareness of lameness and pain in horses. We believe this is mostly due to unrecognised hoof and body imbalances, and when pain and disease is being recognised, it is treated symptomatically and on the whole, ineffectively, as the root cause isn't typically being addressed. As a result, horses are suffering unnecessarily.

The good news is that one can easily learn to recognise unhealthy hoof balance and compensatory posture and for the majority of cases, integrative hoof and body rehab done right can be both highly effective and achievable.

In this article you will learn:

  • how to easily recognise a horse who needs hoof rehab

  • why to rehab the hooves

  • what to do if your horse needs hoof rehab

  • how long rehab takes and what it costs

  • when hoof rehab ends

What is healthy hoof and posture?
This is the most important question. If you don’t know what healthy looks like, how do you recognise your horse needs support?

There are many opinions on this. We have tried many trims and hoof care approaches and have documented the results. We lean on evidence based science in making sense of the data we have collected over the years, but also consider the horses behaviour, demeanour, attitude, response to assessment of the whole body, soundness, gait, posture and consider this with feedback from owners, trainer and other professionals involved.

We can say with confidence that the following guidelines can help you identify a healthy hoof (although the ideal hoof shape or morphology will change according to the individual horse and even the individual hoof):

  • Straight hoof pastern axis (HPA)

  • Healthy phalangeal alignment and appropriate palmar or plantar P3 angle (as assessed on quality radiographs

  • Appropriate vertical depth, dorsal-palmar and medial-lateral balance.

  • Minimum of 60:40 toe to heel ratio around the centre of rotation of the coffin joint (for the barefoot horse)

  • Maximum of 5 degrees difference between the dorsal wall hoof angle and heel angle

  • Healthy posture and gait with cannon bones perpendicular to the ground (on a level, firm surface)

  • A hoof free from disease, infection, flares, cracks or other signs of distortion and unhealthy growth

  • A hoof score appropriate to the use of the horse, age and health.

  • High/low syndrome, where the front or back pairs of hooves have different morphology

You can learn more about these and other articles we have published at the end of this article.

Here are some examples of hooves which meet minimum health/score for hoof and body health/posture as befitting the individual equine in their unique environment:

Healthy hoof on grass kept non-ridden pony in winter (hoof score 6/10)

Same ponies hoof, different angle - the winter conditions reduces the frog reduces the score to 6/10

Same hoof from a different angle

Healthy hooves in recovered laminitic living on grass 24/7 and in the winter - scoring 6/10

Same pony, different hoof and angle - note the unhealthy frog due to winter conditions - scoring 6/10

Same hoof - note the lower than ideal dorsal wall and heel angle from the influence of the winter environment - hoof score 6/10

Same hoof, sole view - note the unhealthy frog but due to good pre-winter development, the hoof successfully withstood the harsher winter environment - hoof score 6/10

Same hoof - different angle, note the natural curve to the functional sole and rolled toe - hoof score 6/10

Same hoof, different view - note the thick/concave sole and weak frog from winter conditions - hoof score 6/10

Young donkey hoof - hoof score 5/10 due to age/development

Young donkey hoof - hoof score 5/10 due to age/development

Hoof in rehab (hoof score 5/10) showing ideal hoof shape in 6 months (hoof score 7/10)

Healthy posture in young fell pony - scoring 4/10 due to age/development

Young donkey with normal posture (hoof score 5/10 due to age/development)

Young fell pony with normal posture on an incline - hoof score 4/10 (due to age/development)

Normal posture in non-ridden grass kept pony (hoof score 6/10)

It is incredibly useful to learn to document your horses hooves and body, and monitor progress on a regular basis. You can share the photos with your horses team of professionals.

What is unhealthy?

This is easy to answer, and basically, any hoof which doesn’t fit the above considerations, eg:

  • Broken back or broken forward HPA

  • Lack of alignment of the phalangeal bones and unhealthy palmar/plantar P3 angle

  • Lack of depth, and evidence of imbalance on all places of direction

  • Unhealthy toe:heel ratios around the centre of rotation of the coffin joint

  • Unhealthy posture or gait and evidence of lameness

  • Evidence of active or inactive disease processes, infection, inflammation, cracks, hoof distortions and unhealthy growth

  • A hoof score too low for the minimum required for the age, health status and use of the horse

Here are some examples of horses with unhealthy hooves and which require intervention and hoof rehab:

Hind hoof on a aged TB - hoof score 2.5/10 due to lack of phalangeal alignment, insufficient vertical depth and diseased horn

Same hoof, different view - hoof score 2.5/10 for the same reasons

Same horse, front hoof, scoring 2/10 due to lack of phangeal alignment, vertical depth and caudal collapse

Retired eventer with lack of phalangeal alignment and insufficient vertical depth - hoof score 3/10

Undiagnosed unresolved chronic laminitis - hoof score 2/10

Lack of phalangeal alignment and vertical depth in low level endurance horse ridden barefoot under trimmers guidance - hoof score 2/10 (this is a hind hoof)

Unresolved chronic laminitis 2 days after 'natural barefoot trim' - hoof score 1.5/10 due to severity of lameness

TB in ridden work - front hoof over trimmed and over worn leading to mechanical laminitis - hoof score 1.5/10

Same hoof, different view - walking on the heel bulb - hoof score 1.5/10re

Same hoof, different view - thin sole and insufficient depth all round - hoof score 1.5/10

Riding horse after 6 months inappropriate rehab with lack of phalangeal alignment and depth - hoof score 2/10

Leisure riding horse with lack of phalangeal alignment and inappropriate vertical depth with suggested healthy morphology post-rehab - hoof score weak 4/10

Compensatory posture in riding horse after 6 months inappropriate rehab with lack of phalangeal alignment and depth - hoof score 2/10

Compensatory posture common in low plantar P3 angles/lack of phalangeal alignment and depth

Compensatory posture in riding horse - this is common in horses with excessively worn/trimmed hooves with low palmar/plantar P3 angles and lack of phalangeal alignment and depth hoof score 2/10

These represent common hoof morphology and postures we have found throughout the UK. In our experience, the vast majority of horses we visit in the UK have INSUFFICIENT HOOF HEALTH and require comprehensive rehab of the hoof AND body.

Why should we rehab hooves (and therefore the whole horse?)

It is well documented that unhealthy ideals in terms of the hoof morphology and posture prevent correct biomechanics for optimum rest, movement and therefore the performance and health of the horse. For instance, low plantar P3 angles in the front hooves are associated with tissue breakdown, pain and pathology in the navicular region of the front hoof. In the hinds, low plantar P3 angles are associated with lameness and pathology in the hind limb suspensory ligaments, the hocks and stifles (An investigation into the association between plantar distal phalanx angle and hindlimb lameness in a UK population of horses. P. E. Clements, I. Handel, S. A. McKane, R. P. Coomer. First published: 30 September 2019

We would also argue that unhealthy hoof ideals are associated with the development of secondary concomitant lameness and disease including but not limited to:

  • laminitis

  • kissing spines

  • sacro-iliac issues

  • nerve impingement and associated organ dysfunction

  • shoulder, neck and cranial issues

  • dental problems

  • ulcers, colic and malnutrition

  • reproductive organ issues

This will negatively influence

  • behaviour

  • performance

  • saddle fit

  • soundness

  • trainability

  • loading and travelling

  • reproductivity

  • usability

  • longevity

  • quality of life

As such, a horse with less than optimum hoof and posture might be recognised by a vast array of symptoms and behaviours associated with the above which might not necessarily be associated with hoof related issues.

What to do if your horse needs hoof rehab?

First of all, please don’t panic and feel bad – you don’t know what you don’t know! Have courage and take heart from this and congratulate yourself for learning something really, very important for your horses wellbeing! The next step is ensuring you employ a suitably experienced team of professionals to properly assess your horse and support your horses rehab from an integrative perspective. This means working on both hoof and body, and in consideration of the emotional state of the horse, and as befitting the individual and his or her environment.

It can help to have photos of your horses hoof and body so you can share these with your team. These should ideally be marked up or annotated to show the ratios and illustrate the lack of health or balance. To help you, we have created an online course which is free, and even provides instructions for your vet on how to take quality radiographs for podiatry/balance purposes.

We use HoofmApp app to quickly mark up photos when out in the field and Metron-Hoof to assist with taking scaled radiographic images and to mark up radiographs and hoof images and provide reports. We offer this as a stand alone service or as part of our on-line and in-person comprehensive equine podiatry consultations.

Teamwork makes the dream work

All members of your horses team need to be working together to fully support your horses rehab. This is the biggest challenge horse owners and non-hoof care professionals face in the UK as there simply isn’t enough suitably knowledgeable professionals. The truth is that most farriers, barefoot trimmers and EP’s simply don’t recognise what we consider the low scoring hoof as unhealthy or compensatory posture and the compromising impact this has on horse welfare and therefore it simply isn’t properly addressed in most cases.

All horses deserve and need a basic level of health needed for comfort and well-being, yet from our experience, most horses lack even this. In addition, the impact on the owners well-being and comfort are compromised as a result of caring for a horse which is itself; compromised.

The misinformation and lack of knowledge widespread throughout the UK equine industry is represented at all levels, and in all areas of the industry, from hoof care, to saddle fitting, from farriers to barefoot trimmers, vets to therapists, leisure riding to professional training.

Shoes or barefoot?

From or experience, the majority of horses can be successfully rehabbed barefoot, with or without boots and pads. A small number will require an intervention beyond barefoot/boots/pads, either to facilitate a return to healthy ideals, when they can then continue their rehab barefoot, or where pre-existing pathology and un-resolved pain requires permanent intervention for welfare reasons.

Shoes should never be used to mask an unhealthy hoof to meet human desire and pleasure, at the expense of the horse as the presence of a shoe will inhibit optimum functionality of the hoof and horse and should only be used where absolutely indicated.

Keeping horses shoeless take an appreciative change in management style as the environment must accommodate the needs of a shoeless horse, however the benefits to horse and owners and exponentially greater in the long run.

Rehabbing hooves = weekly assessment and 1-2 week trim cycles

We approach hoof rehab holistically and will assess and support the horse by examining the environment and providing the very best stimulus needed for hoof and body health. In most cases, we will seek to preserve hoof structures we wish to develop (internally and externally), and remove the external hoof structures to relieve unhealthy pressure to internal structures. This often requires weekly assessment and a small trim to correct the hoof imbalance in the shortest amount of time, and to facilitate integration with the body. Typical trimming cycles of 5-8 weeks are usually insufficient to restore the hoof capsule fully.

The body keeps the (hoof) score

Hoof care should be centered around providing comfort and facilitate healing of the internal and external structures of the hoof. This organically assists posture and movement. However, most horses with chronic hoof imbalance and low scoring hooves have chronic compensatory patterns throughout their whole body. This can influence both growth and wear on the hoof, and to overcome this, both hoof and body should be supported to successfully integrate the changes which will occur in both.

Balanced ThroughMovement Method and nerve release therapeutic approach

As part of our integrative approach to equine podiatry and hoof rehab, we recommend regular, even daily therapy for the horse and after years of trying a wide variety of exercises and approaches, our favourite therapeutic approach is Balance Through Movement Method, or BTMM as it is known.

This works to help the horse achieve optimum balance and strength through the development of the body and mind, and aims to reverse and prevent nerve and spinal compression and even help resolve undiagnosed lameness.

I am currently training to become a nerve release practitioner (Lazaris nerve release technique – qualifying summer 2023). This is extremely effective in helping release nerves, blood vessels and lymph which have become compressed due to compensatory or developmental posture, with or without the involvement of hoof imbalance (they tend to be interrelated).

Owners and trainers can learn BTMM via a masterclass and get in-person support from the UK’s only qualified nerve release practitioner Yasmin Stuart. We also find fascial movement therapy, cranio-sacral, McTimoney, chiropractic, visceral manipulation and bioenergy healing therapy can be highly effective in relieving unhealthy pressure and assisting the body in finding and maintaining a neutral posture and correct hoof growth/balance. However, BTMM educates and empowers owner and trainers to facilitate healthy posture through connection and movement and it assists greatly with ongoing daily hoof and body rehab.

In addition to hoof and body care, nutrition, movement, exercise and other elements of management will require thorough examination to identify and relieve unhealthy pressure or stimulus impacting health, and in accordance to the hoof score. We also use Wave red light therapy pen and pads as well as Equipod microcurrent therapy for targeted pain relief and tissue repair and these are affordable, easy and safe to use and ideal as part of owner led rehab at home.

How long does hoof rehab take and what might it cost?

The answer to both questions is related to the current hoof score, the presence and degree of pathology and lameness, the level of soundness and the hoof score required of the horse. It will also depend on resources and the available environment. For instance, if a leisure riding horse has a hoof score of 4/10 (the most common hoof score we see in the UK) before rehab, and it is relatively sound and only required to hack on quality turf for 2 hours a week, it will only require a hoof score of 6, this might take 3-6 months, depending on the above factors. But for a grand prix show jumper, a hoof score of 8 or more will be required, to be able to withstand the rigors of the sport and this might take longer if the starting score was 4.

It might also be pertinent to rehab the hooves in pairs. Often, hind hooves are unshod and also might have greater influence on compensatory posture and can be rehabbed before the fronts, if these are shod and are in better health. Every horse, owner and environment is unique, and every rehab is therefore unique.

In terms of cost, I would ask anyone who has owned or cared for a horse with chronic lameness, what this means. Lame horses cost more than money. There is a less definable cost to the emotional, mental and even physical and spiritual well-being of both horse and human. Hoof rehab done right is arguably the best investment a horse owner could commit to in terms of long term value in all areas and is highly rewarding too.

The very best solution to rehab is prevention, and this requires education. We are committed to delivering highly efficacious solutions and information, to empower horse owners to make better decisions for the betterment of the horse and to enhance the human-equine relationship.

When does hoof rehab end?

When the horse has adequate hoof score for his health and well-being.

  • Hoof rehab requires teamwork between professionals involved with the horse, beyond the hoof care professional (eg, vet, therapist, trainer, behaviourist, animal communicator, dentist, nutritionist and saddle/bit fitter).

  • Teamwork really does make the dream work – so chose carefully as not all professionals are equally knowledgeable and appropriate for your situation

  • Learn to document your horses hoof and body to monitor progress and evaluate interventions applied

  • BTMM + hoof care which achieves truly healthy hooves offers an efficacious and integrative route to achieving and maintaining a healthy, happy horse (and owner!)

  • The time taken and costs to rehab are as variable as horses and people and are multi-factoral. Prevention is cheaper than the solution.

  • Always aim for the maximum hoof score achievable, as this provides the optimum chance for the horse to withstand a less than ideal environment or period of illness.

  • Rehab can take place at home, and therapy can be supported through a holistic approach to manage pain and boost tissue repair

  • The higher the hoof score, the healthier the horse, the happier the horse and the more resilient to disease it will become. And as we all know – no hoof, no horse!

Additional resources and assistance

We take an integrative and holistic approach to whole horse hoof and body health. We appreciate the relationship between body, limb and hoof and seek to address imbalances while positively influencing appropriate static and dynamic hoof balance and biomechanics.

If, like our clients, you want to learn a PRO-Active approach to hoof care and wish to prevent lameness in your horse, consider booking us for an Integrative Podiatry Consult, Educational Event, Mentorship, On-line Course or join our new Remote EP mentorship plan where you can learn top tips on how to help rehab your own horses hooves, and have weekly support, tailored to you and your horse!

We also recommend you learn how to document horses hooves and body, whether you trim your own, your clients horses, are an equine professional (in any capacity/field) or simply want to track and monitor progress of your horses hooves and the impact their hoof care has on their posture.

Related articles:

Further information, recommendations and links

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Beccy Smith BSc ADAEP EBW

Diploma in Advanced Applied Equine Podiatry and now an Independent Integrative Equine Podiatrist, Consultant and Therapist

CEO and Founder of 100% Non-Profit Community Interest Company Holistic Reflections CIC

Holistic Reflections CIC – a 100% non-profit organisation promoting wellbeing and resilience in people, horses and the environment - for the benefit of all.


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