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What does a truly healthy hoof look like and how might we achieve this?

As anyone who has observed a hoof change from a weak hoof to a robust, fully functioning hoof will tell you, it can go through an ugly duckling phase where the hoof simply doesn’t look like what we are used to seeing currently in the hoof care industry! I want to share with you some interesting hoof images, marked up using HoofMapp app and Metron-Hoof software which might make you question what a hoof should look like, and how it might be achieved.

In order to see the problem, you first have to look!

In this article I also discuss:

  • The changes in one hoof in less than 5 weeks, and it's potential morphology after 6 months hoof rehab. I also briefly discuss how the hoof adapts to its environment and the impact of changing hoof morphology on the horses health.

  • I also discuss what are healthy ideals and how these apply to this hoof and what it might inform us about this horses hoof score, or usability.

  • I discuss the problems with the industry currently and how popular trimming approaches, and potentially also the inappropriate use of ratios and trim cycles might interfere with the full restoration and maintenance of a truly healthy hoof.

  • How to choose an appropriate hoof care professional to help your horse achieve and maintain its full potential from the hoof, up

The hoof as a dynamic and adaptable organ?...

A bit of hoof science first - the hoof is comprised of an inner foot and outer hoof. The inner foot grows the outer hoof. The outer foot protects and stabilises the inner foot. The outer hoof can change shape, according to the influence of the outer environment. It can also change shape according to the inner environment; and these are considered metabolic in nature, and might involve changes in nutritional status of the horse or in hormone status for example (as in endocrinopathic laminitis).

The inner foot is comprised of 3 types of tissues which one could categorise as dynamic (cartilage – as in the lateral or ungular cartilage, digital cushion, tendons and ligaments); static (as in the 3 bones in the foot bone - the pedal bone - also called the coffin bone, P3 or the distal phalanx, the navicular bone and the distal end of the 2nd phalanx – also called the short pastern bone), and as well as soft and connective tissue which make up the sensitive laminae, blood, lymph and nerve tissue.

As a horse owner or equine professional faced with helping a lame horse with a hoof balance problem, what you need to understand is that the internal foot is constantly receiving information via pressure from the outer hoof and will change in shape on the inside as a direct result of the trim applied, the shoe applied or how it wears the hoof (if it is barefoot). It is THIS which creates the outer hoof shape. It is incredibly dynamic and responsive.

The hoof is an incredibly adaptable organ and will deform and reform (restore) according to the internal and external environmental forces applied to it. If we look to the domestic horses wild cousin, the deformation might naturally occur from season to season, for instance when wear exceeds growth and when food and water resources are scarce. This might typically occur during the winter months. In summer, the hoof will tend to wear less, and grow more, and the internal foot and outer hoof will change, hopefully restoring to a healthy morphology and function once more.

This is an essential survival mechanism but this is designed to be a short term affair. If one were to mimic (knowingly or unknowingly) the wild horses hoof after a long winter on frozen ground, and continued to trim or shoe the horse, the hoof might develop a lack of digital cushion, lower than ideal palmar P3 angles and a lack of healthy phalangeal alignment to the distal limb bones and joints, placing the horse at greater risk of pathology, pain and lameness, both in the foot and in the hind limbs in particular, further up the limb (see: 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

Furthermore, we have documented and shared images of horses with unhealthy compensatory posture and gait where the horse has what is considered ‘unhealthy ideals’ comprising low heels and long toes; essentially a horse with too low a palmar P3 angle and lack of phalangeal alignment. We believe this is responsible not only of the majority of lower limb lameness but also common pathology in the body leading to concomitant lameness, poor performance and poor health in general. I discuss this in more detail in this 1 hour webinar:

Helping horses develop and maintain healthy hoof ideals is essential to the well-being of the whole horse. If we are helping the horse grow a healthy hoof capsule, we need to appreciate there is a lot of change which needs to happen on the inside too. As the hoof is allowed to develop or restore, there will be times when it simply won’t fit what are considered ‘healthy ideals’. During the period in which the hoof is restoring, not all internal and external structures will restore at the same rate. At times the hoof will develop the internal digital cushion and ungular cartilage - the appendage of the ungular cartilage which helps form the heel buttress can develop and expand quicker than the heels can, which gives a very strange appearance to the caudal hoof.

We must allow the horse to integrate these changes successfully, both in the hoof and the body, and we need to reassess what that 'support' might look like if we are to promote soundness and longevity in our horses.

In other words, if we try to make the hoof look pretty, or fit into 'healthy ideals', or mimic the wild horses hoof shape (in winter or when under stress) in order to fit current belief of what the hoof should look like, we will interfere with this process and restoration will halt.

We have found that during this process, the hoof at the bottom, furthest from where it grows from, might look different from the new growth at the top. If we try and alter the bottom to match the top, we might remove structure which is essential for protection and stability. In addition, if we try to change the top to match the tissues at the bottom, we again interfere with the process and limit the capability of the hoof to restore.

What might a developing hoof look like?

The following images are of a hoof of a 19 year old welsh section D x cob horse in hoof rehab. We are documenting the changes throughout this process and will be sharing the results in time.

In the image below, one might appreciate that the hoof isn’t within healthy parameters considered ‘ideal’, which we could summarise as:

  • 60:40 heel:toe ratio (barefoot horse) around the centre of rotation (COR)

  • Dorsal wall and heel angle within 5 degrees

  • Straight hoof pastern axis or HPA (thus indicating healthy palmar/plantar P3 angle and phalangeal alignment)

From this image, we could determine the following:

  • Unhealthy 69:31 heel:toe ratio (thus we could determine the toe is too long and the heels under run)

  • Dorsal wall angle of 55 degrees, heel angle of 39 degrees, thus the heel is under run and/or too low

  • Broken back HPA (65 degrees pastern angle and a 55 degree dorsal wall angle) and without radiographs to confirm, we can estimate there is a low palmar P3 angle and lack of phalangeal alignment.

How do we successfully restore or rehab the hoof to 'healthy ideals'?

We have several options to improve this hoof;

  1. Do not intervene

  2. Intervene by applying a reductive trim method to improve the ratios by actively shortening the heel and toe, and thus improving the toe:heel ratios

  3. Intervene and apply a shoe which will further improve the toe:heel ratios, with or without a trim or wedge

  4. Intervene and apply a reductive trimming method and hoof care approach which seeks to facilitate optimum restoration and development of both the internal foot and outer hoof

The image below was taken just shy of 5 weeks after the first image and after option 4 was applied (trimmed every 1-2 weeks). A hoof boot (cloud boot) and worn cloud pad was used to protect from unwanted wear and comfort/stimulus afforded by the pads, which conform to the sole.

From this image we could determine the following:

  • Improved toe:heel ratio of 67:33 (thus we could determine the toe is shorter and the heels further back towards the widest bart of the frog)

  • No change in the dorsal wall angle of growth, and an improved heel angle of 46 degrees (thus we could determine the palmar P3 angle hasn't changed but the heel health is improved and is less under run)

  • No measurable change in HPA and presumably therefore the palmar P3 angle

  • Increased vertical depth of 0.32cms from COR to the ground surface (thus we could determine that as the sole is level with the white line and inner wall, the sole depth has increased)

  • Increased heel length of 0.14cms and an increase in the heel bulb length of 0.37cms which = a total increase in length from hairline to heel of 0.51cms (thus we might determine that there is both heel growth and changes in conformation of the internal structures in the caudal foot - we believe the appendage of the ungular cartilage is less curled under and is moving up and out, and as this is part of the foundation of the heel buttress, the heels are following suit and growing at a steeper angle (see the image below)

  • A decrease in angle of the coronet band

The change in the heel angle, coronet band angle, caudal hoof measurements and toe:heel ratios, alongside the absence of change in the HPA and dorsal wall angle leads me to believe the caudal foot and hoof is improving. The wall has been trimmed to meet the white line/functional sole junction so the increase in vertical depth of the hoof at the COR leads me to believe there is an increase in sole depth.

The image below is a close up of the caudal hoof, depicting previous heel angle and height of this hoof, as well as anticipated heel angle and conformation of the caudal hoof in approximately 6 months time, maybe less.

Are current (common) trimming methods adequate to create and maintain truly healthy ideals and fully functioning hooves?

On the whole, NO. Absolutely not.

We believe the healthy ideal supporting a close to 50:50 toe:heel ratio (in shod horses) and close to 60:40 in barefoot horses is correct. However, the manner in which this is often achieved usually results in inadequate vertical depth to the inner foot and outer hoof and appropriate phalangeal alignment. Further more, it forces the inner foot to deform (or adapt) and the posture to adapt, creating the issues already mentioned.

Let us explain why... in a horse with excessively worn or trimmed heels, which represents the vast majority of horses in the UK, it will have a lower palmar or plantar P3 angle. In other words, if you place the back of the pedal bone closer to the ground; which is what happens in this instance, the dorsal angle of the pedal bone gets lower and the toe appears long.

If you map the hoof or use a hoof mapping too, you will find that as the heel grows, it will at a low angle, as will the toe and this hoof morphology will create a longer toe ratio and less than the ideal ratio. As hoof care professionals aim to improve the ratio, they do so by removing heel material and toe material, sometimes also adding a wedge, which superficially improves the ratios. However, this doesn't address or resolve the issue and the horse isn't provided with the opportunity to heal and restore the hoof to optimum balance and functionality. The longer this situation occurs, the greater the chance of the horse developing serious and even life threatening trauma and disease, which impacts not only the hoof BUT THE WHOLE HORSE. - impacting soundness, behaviour, reproduction, performance, train-ability, emotional regulation and so on and so on. But lets start calling this for what it is - unnecessary suffering and unnecessary pain.

These observations we have made here call to question the validity of relying on objective data to guide the trim where trimming methods seek to improve ratios and measurements to create healthy ideals AND where the outcome thins the sole, shortens the heel height, de-stabilises the coffin bone or reduces the health of any of the internal structures, and in particular the caudal foot, which is largely responsible for proper function and appropriate phalangeal alignment.

As an independent, progressively-thinking equine podiatrist, I understand the need for a shoe or other intervention beyond barefoot, where it is appropriate, but I also use the tools I have at hand (which as a non-farrier, are barefoot trimming, boots and pads). I have documented the changes where the horse is allowed to organically develop its' optimum hoof in a safe and efficacious manner, as befitting to the individual horse, over time, using a reductive trim, and at times, boots and pads (which might be wedged).

I am contacted regularly by horse owners who have often tried a variety of approaches and trimmers and/or farriers having realised their horses hooves are the wrong shape and that it is impacting their comfort and performance. What surprises me the most is that they are often alerted to reassess their horses hoof balance and function by their body workers, which can be physios, chiropractors, osteopaths or other therapists.

Which makes me ask one very important question....

Why is it that non hoof care professionals are owners able to recognise a hoof issue and lameness when the clients farrier, trimmer or EP often cannot?

This is a serious industry wide issue impacting not only horses, but owners well-being and on the whole, it is 100% completely unavoidable IF the industry evolved and improved.

Below is an image of the potential hoof morphology as it continues to restore.

This hoof would meet current guidelines for 'healthy ideals', as mentioned previously.

Does this hoof shape look anything like the horse you own, ride, care for, or trim, as an owner or professional?

This representative image could fit what is considered ‘healthy hoof ideals’. However, I would argue that this couldn’t be achieved via a reductive trimming method which involves lowering the heel, to falsely ‘bring the heels back’, over trimming the toe or sole, or applying a shoe to artificially creating healthy ideals, both of which could be at the expense of optimum balance and functionality of the hoof, and therefore whole health of the horse, given the stimulus afforded and the trim cycle typically used.

I do not believe optimum function and form can be achieved using common trimming approaches AND where unhealthy hooves are commonly trimmed in 5-8- week cycles

I feel strongly about this because I use to approach hoof trimming in this way. The aim of any hoof care is to facilitate well-being and performance of the horse. The challenge arises when the environment doesn’t allow for this to occur naturally or when the horse is in pain and an intervention beyond a reductive trimming method or typical trim cycle is required to facilitate comfort, positive balance, and growth. But you only know what you know, and until you know otherwise, how can you do better?

I do not believe there exists a trimming school in the UK currently which creates an environment which is appropriate to help a horse create and maintain a truly healthy hoof, needed for optimum whole horse soundness and longevity. Approach both trim and management needs to improve to achieve this... period.

So how to evaluate the hoof and therefore choose the correct intervention to create and maintain the healthy hoof?

Firstly, it depends on what one considers a healthy hoof. I feel there is a lack of knowledge and understanding of what a healthy hoof looks like, so how can we help the horse achieve and maintain this? As an independent hoof care professional with a wide educational background in horse health, and aiming to support the horses hoof and body, I feel we need to be evaluating the hoof from a holistic perspective. As such I use a hoof scoring tool. This helps with my assessment and also informs the clients in terms of usability of the horse, and which intervention might be appropriate to protect the horse from harm and improve or maintain the current level of health. It also informs us both of progress.

With this approach, an owner can make an informed choice as to how they care for their horse, with an awareness of the consequences this might bring. For example, if an owner chooses to exceed spectrum of usability outlined in the hoof score, they are knowingly placing their horse at risk of injury, pain and lameness.

The lack of education and understanding rife in the hoof care and equine industry I feel is placing more and more horses at risk of unnecessary suffering. From my perspective, there are too many horses being trimmed too short and in an inappropriate way/cycle, and the vast majority of horses hooves have insufficient depth and lack of phalangeal alignment, with concomitant lameness and tissue breakdown all over the body as a result of this poor hoof balance. There needs to be further research on healthy hooves to redefine the current paradigm and understanding of what is healthy, and seek to achieve this in a more informed and efficacious way.

The dangers of ignorance in caring for the shoeless horse

Keeping horses barefoot, the use of hoof boots and other non-shoeing interventions have become increasingly popular, and hoof boots are often used in place of horse shoes, without owners and often, hoof care professionals really knowing how to care for the barefoot horse.

Neither horse shoes nor boots will necessarily protect the soft tissues within the foot from trauma and the intervention chosen to support a horse must be carefully considered...

Only fully developed barefoot hooves; as befitting the individual horse, will ultimately provide the best protection and comfort to the horse, and this is very rarely achieved in domestication, which is rather alarming, given what is being asked of performance or even leisure horses. However, an intervention involving an appropriate shoeing package should be used where indicated, either short term or long term, and where the environment would otherwise not protect the horse, either due to owners choice, disease or any other limiting factor which could place the horse at harm.

Hoof scoring used well can indicate what intervention might be appropriate, when considering the inside and outside of the horses foot, and also the rest of the horse and should be used to proactively protect horse’s from harm first and foremost, and secondly, to help promote healthy hooves and horses.

The horse featured in these images above currently scores around 5.5/10, as he has yet to develop sufficient digital cushion and he does not have phalangeal alignment/HPA yet. This horse could be asked to do very low level intensity ridden work as he meets the absolute minimum for careful and diligent ridden work, of low intensity and duration, on a non-abrasive, conforming surface, which is a score of 5/5.

Most horses I see in the UK are scoring around 3 to 5/10, whether they are shod or barefoot/booted. Many don't have sufficient health for retirement and most certainly don't have sufficient hoof or body health to be asked to perform under saddle, at any level, as befitting their hoof score. This simply isn't good enough, and only vets benefit from this depressing situation.

Choosing a hoof care professional

Rehabbing horses hooves van be immensely rewarding, however, when approached incorrectly, it can have devastating, and even long terms negative effects on your horses whole health. We urge all horse owners and professionals seeking better health for their horse, or the horses they help, to carefully consider the plethora of approaches claiming to improve hoof health.

Do your homework and seek appropriate advice from an experienced hoof care professional, who understands optimum hoof health, from a holistic or integrative perspective. Perhaps ask them what they believe a healthy hoof should look like. Ask them to show you pictures.

I recommend owners ask their hoof carer the following questions:

  1. What do you consider 'healthy' (ask for a picture and compare this to what you will find on our site for instance, or other podiatrists or farriers sites or social media pages where they too are seeking to achieve healthy ideals such as Yogi Sharp; ‘The Equine Documentalist’ or Wayne Turner; ‘Progressive Equine Services’ for instance)

  2. What guidelines might you use to help you assess and implement an intervention plan to create or maintain healthy ideals?

  3. How would you be able to assess whether a horse is at risk of injury or ready for ridden work and do you consider phalangeal alignment and posture?

  4. Are you using guidelines which appreciate and support healthy palmar/plantar P3 angles and how do you address the heels?

If their answer involves trimming the heels and lower them to ‘back to the widest past of the frog’, or ‘trim them to create frog pressure, as it should be on the ground’, or ‘trim them to just above the height of a healthy frog’, and/or trim them on a typical cycle of 5-8 weeks (which is only appropriate if the hoof is fully formed and restored and is wearing and maintaining balance itself), I anticipate they won’t be able to help the horse create a fully functioning hoof using their current approach. I might be wrong of course but my documentation and experience says otherwise.

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, clients, or simply want to track and monitor progress of your horses hooves and the impact their hoof care has on their posture.

Please feel free to share, ask questions or reach out for further support!


Beccy Smith BSc ADAEP EBW

Diploma in Advanced Applied Equine Podiatry and Independent 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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