The fix for long toes is easy; it is really a simple trim, and not rocket science at all. You will want to pay special attention if your horse tends to stand "camped under" behind; that is, with the cannon bones forward under the body. If this is the case, run your fingers firmly down either side of your horse's hindquarter just below the backbone. Often, these horses will flinch and "duck away" from pain in these muscles.
Below is a blog post on a new client of mine, who has been having hind-limb lameness off and on for several months now, including "gluteal pain;" that is, she flinched strongly when these muscles were palpated. An hour after her shoes were pulled and her feet trimmed, Lacey no longer had any pain in her gluteal muscles.
Lacey is a new client of mine. We pulled her shoes on June 28th, 2012. Lacey has been having issues with hind end stiffness/lameness. She also showed pain when her "gluteal" muscles, on either side of her tail, were palpated. Here is Lacey's typical stance with shoes:
This stance is typical of horses with long toes on their hind feet. A 2011 study showed a correlation between gluteal pain and long hind toes. The abstract is available here.
Here is how Lacey immediately stood when the shoes were removed:
Do you see the sigh of relief and relaxation? I believe that Lacey was accustomed to going right into this stretch when her shoes were removed. The change in her stance was literally immediate.
Here is a photo of her left hind hoof. This has been the leg she has been "off" on. The vet diagnosed hock arthritis based on a positive lameness exam after a flexion test of the hock. The photo has been marked to show the broken line made by the front of her hoof and the front of her pastern, and the approximate the position of the coffin bone inside the hoof capsule. Notice the "negative palmar angle;" that is, the bone is tipped back (the bottom is supposed to be "ground parallel" on the hind feet):
Here is Lacey's left hind hoof after the trim. Notice the improved palmar angle. To note how much height was taken off the toe region, notice how much closer the nail holes are to the ground. Lacey's hindquarter muscles had to pull all her weight over this 1/2 inch (minimum) of extra height in her toes, overworking them with every stride. Also notice that the hoof and pastern are now more or less in line with each other:
Now check out Lacey's left to right ("medial" to "lateral") balance on this foot. Can you see how much higher the inside wall is than the outside?
The horse's "live sole" (the waxy stuff under the chalky stuff) grows to the same thickness throughout the hoof, so is a good indication of where the actual inner structures sit in relation to the ground. I therefore balance the wall to the "live sole plane," e.g. the sole plane after the chalky soft stuff is scraped away. Here is what we came up with after trimming:
The balance is still "off" as you can see, but it is much closer. Because Lacey had such an extremely imbalanced hoof and was just coming out of shoes, I was a bit conservative with this first trim. Once she begins wearing her feet the way she wants without a shoe in the way, it will be easier to gauge exactly how much more medial (inside) wall can come off.
Now here are the sole shots. These were marked with a marker. To measure how much toe needs to come off the front, I find the widest part of the sole, then the very back of the frog material, and measure this distance forward on the toe and mark it. I learned this method at a very informative clinic put on by the folks at Daisy Haven Farm and it has proved invaluable when assessing deformed hooves to determine exactly how much toe to take off. The front line marks where Lacey's sole should end. Often on the hind feet, the sole can stretch past this spot and if you don't know better, you would think it is "live" but it is really extra material that should be removed:
And here is her left hind hoof after the trim:
Lacey's right hind had similar issues, and was also longer on the inside. You can see how crooked her right hind leg is when viewed from behind. Her left hoof has been trimmed, and her right has not. Part of the reason that her left hind is so crooked is because of all the height that was taken off. When one hoof has lots more height than the other, the horse stands with that hoof further under the body to compensate for the additional height:
You can see how much straighter and more open she is standing after the trim. Although I unfortunately didn't take before shots from behind before the trim, she was much more "base-narrow" due to her imbalanced hooves:
Here are the before and after shots of Lacey's right hind hoof for comparison. The after shot, the coffin bone didn't change position as much as I drew it to, but you can compare the different angle by noticing the position of the nail holes (it is now probably ground-parallel or close to it):
After her trim, this was Lacey's stance:
Our goal with trimming the hind feet is to get the cannon bones as close to perpendicular as possible, and we have almost done so. This is the only way the hind muscles can get a break. Lacey has been standing "under" with her hind feet for so long, that I have a feeling she will take a few trims to fully change the way she stands, and may always have a tendency to "camp under" from time to time.
The first few steps that Lacey took with her shorter toes were very strange. She placed no weight on her heels and walked on her "tippy toes." Initially I thought she was sore in her heels due to the shoe removal, but this seemed odd since I took almost no height off of her heels and she had decent frogs and heel structures. I now think that her muscles were so tight from battling those long toes that she took a few strides to realize that she could relax. She started walking normally after a few steps.
Another amazing thing about this first trim was that when her gluteal muscles were palpated after the trim (along the sides of her croup), she showed absolutely no pain. I really didn't expect these muscles to improve so quickly.
Finally, what we couldn't catch on camera (because it was dark) was Lacey tearing around the outdoor arena, showing no hoof tenderness, and very little hind-end lameness, 20 minutes after her shoe removal/first trim. Lacey's owner said she couldn't remember the last time Lacey was so animated and "like her old self" running around free in the arena.
Lacey's owner is giving her horse a break to get used to no shoes, after wearing them nonstop for about 10 years. When she begins ring and trail work again, she will purchase boots to help Lacey over the rocky trails near her home.
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