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Discussion Starter #1 (Edited)
I recently posted a thread on my suspicion that my TWH mare suffered from low / negative plantar angles, and asked for advice. I'll put my original post below. I received a lot of useful observations and advice from several forum members, especially @gottatrot @dogpatch @loosie and @4horses . Here's an update. And I welcome all comments and advice:

1) I reviewed all videos I have of my mare "stumbling" / "dipping " (under saddle) with her hind legs - in super slo-mo. In every case where she stumbled or "dipped", it was clearly caused by the knuckle-over of either right or left hind foot, after she placed her foot toe-first. And this ONLY occurred in the ring (deep sand) - and never on flat surfaces (road or trail). From what I've read, this is a symptom of LPA.

2) I noticed swelling in both of her hind fetlocks over a month ago. And I now suspect this was partly - if not wholly - due to her low plantar angles (hopefully now improved through trimming), as well as her occasional knuckle-overs. The swelling is almost all gone now.

3) After over a month of stall rest - transitioned to pasture turn-out - the outward bowing of her hocks is almost all gone, and only occasionally appears when walking on a lunge line (in circles, of course). When I film her walking in straight lines, I see no bowing, although her hocks seem "tentative" when she places her feet. Wringing? Don't know. But I do know that she has sickle hocks, which is apparently common - and even desirable? - in some TWH's and even jumpers. I believe that the higher angles (now) of her hind hooves, and muscular development, will marginally reduce her sickle hocks as time goes by.

4) My mare still shows an occasional shorter LH stride, but this seems to be improving daily now.

5) I have no intention of training my mare for "big lick" work. She is flat shod, and will remain that way for life.

6) My vet diagnosed, treated, and cured (go ahead and disagree with the use of that last word) my previous horse with EPM, after which she became a not-too-shabby barrel racer, jumper, pole bender, cow-sorter, and all-around cantering, galloping, and "running walking" versatile athlete. So yes, my vets and I are well versed in the symptoms of EPM. My new filly does not show symptoms. My vets are also fairly sure that DLSD is not evidenced by what they've seen.

7) Based on the video evidence, and the last two vet's gait exams of my filly, my farrier and vets will Xray her hind feet next week. Following what they find (she's barefoot now), we'll proceed with neural blocking, further Xrays, and / or remedial shoeing as necessary.

I'll update further when I have news. I welcome input, and hope this and my past thread are of help to others in the future. Here's my original post below.




"I bought a young TWH mare 5 months ago. When I looked her over, I noticed very long toes on all 4 hooves, very elongated hooves, almost no heel under coronet bands, and she had clearly not had any significant hoof care in months (lots of dead frog tissue and overgrown bars on soles). But when I took her for an easy ride in the ring, I didn't see or feel any problems.

I had her shoes removed for transport to my barn. Then I had my farrier trim her fronts (arrived with 45 degrees or sharper) and rears (arrived sharper than 50 degrees). My farrier trimmed her to increase the angles as much as we agreed was safe, trimmed her again 6 weeks later, then shod her again to allow her heels to grow out.

While riding her in the ring about a month ago - just flat walk or running walk, her hocks tended to bow outward (laterally), she would often take short strides with her left hind leg, and she would occasionally "dip" both hind legs - as though she suddenly lost strength. To me, it was obvious that she was in pain. Also: I noticed that her hind legs often appeared "stiff" when walking in the videos I took of her. And standing at rest, she often tended to "park-out" in a "sawhorse" posture. I have since learned that these are all symptoms of Low Plantar Angles. But she gives me no resistance when I manipulate her hind legs (no obvious signs of pain in fetlocks, hocks, or stifles).

I had my vet do a thorough gait exam. She basically determined that my mare had pain, but couldn't identify the specific area(s) - feet, fetlocks, hocks, stifles, or hips / pelvis.

I did some reading on low plantar angles, and am fairly convinced that that is the issue with my mare. I put her on stall rest, trimmed her two more times, and left her barefoot. Her last trim took her almost to what I believe are the ideal angles for her conformation (approx 50 deg in fronts and 56 deg in rears). She now has about an inch of heel under her coronet bands, her hoof walls seem to be gradually expanding, and hooves are more rounded (not elongated, as they were when I got her).

My question: I recently took her for a brief ride in the ring (flat walk and running walk) and filmed it. The bowing of her hocks is reduced - but not gone. The stride length of her left hind is only slightly shorter than right hind (and only intermittent). But I did see her do the hind-end "dip" thing twice in 15 minutes. So I know she still has some pain.

So my question is this, if anyone can answer it: Will it take very long for her pastern and canon bones (and ligaments) to adjust to her new feet (and, ideally, positive plantar angles)? She still shows some signs of pain, apparently. Should I keep her on stall rest a while longer?

FYI, she's still growing (has a much better diet, and appetite than when I got her), she's building bulk and developing muscle mass, and is on a supplement with MSM, Glucosamine, Chondroitin, Hyaloronic Acid, and Hydrolyzed Collagen).

Thanks!"
 

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Hi RichardX,
I don't remember how much I shared with you on your first thread, so some of this may be repetitive. But I'm hoping I can give you some timeline perspective with what's been going on with my 17 year old TWH mare since I bought her around Christmas, 2018.


Since we're talking plantar angles, I'll share some right hind sole shots of my mare from 1/10, which was her SECOND trim. I didn't have the guts to do what I did on the first trim.


The first picture is the Pre-trim picture of the right hind. I've outlined a very prominent toe callus, which mirrors the outline of the coffin bone. The material between this ridge and the hoof wall is lamellar wedge, the result of her toe being allowed to stretch forward, which drags along the heels and everything in between, thinning the sole. I believe this could contribute to negative plantar angles and a WHOLE lot of stress on the soft tissues.


The second picture is the right hind just after I beveled the wall and wedge to just in front of the toe callus. This was the beginning of her rehab. At this time, all four feet were plattered out like this. Eight months on, I am still dismayed at the amount of stretch in the white lines, but they are resolving, and should be pretty tight by next January.


The degree of "plattering" of her feet, the collapse of her heels and the internal stress on her legs, caused her fetlock joints to knuckle forward with toe-first landing, then the joints would "snap" back into place upon heel contact. Actually, I believe this motion was caused by caudal heel pain, as a result of soft tissue strain and degenerated caudal foot, which may or may not have involved negative palmar and plantar angles. I did not call on professionals, although in April, I had my vet come out for a lameness exam, which the mare passed, despite my knowing that she was not yet "right". From December through April, the mare was in padded hoof boots 23/7. She graduated out of boots when she could walk more or less without knuckling joints. (It is only within the last two months that this problem has complete resolved itself.) I did not get radiographs done, because unless there was something going on like sidebone, my approach would have been the same...relieve weight bearing/shear force on the walls and pad/boot the horse so she could walk comfortably, which promotes circulation and healing. I did not ride her until April, when she was BEGINNING to lose the clacking joints and achieve something closer to a flat or heel first landing.


So, the next picture is the left fore (which would involve palmar angles as opposed to plantar angles), shows the "deflated, run forward heel of the left fore on 1/10/19.


Following this, the same foot a couple of days ago. Seven months. As you can see, I haven't gained much in the angle of the toe, only about 1.5 degrees. That will come as a tighter connection between bone and wall continues to grow down. It's the heel that is important. If there's any "lift" occurring at the back of the coffin bone to correct the palmar angle, it is due to "uppening" as a result of internal caudal foot development. This heel is strong enough to land on, despite the fact that the foot is still remodeling, and may be for another year or more. The heel has developed because the toe has been kept back diligently and during her first four months of rehab, padded boots, which allowed her to move more comfortably and get the circulation she needed to rebuild those tissues in the heel.



Basically, what I'm offering is a sort of timeline of internal healing. When I began this process, there were times that I totally despaired of ever healing her. Her back was sunken and her right fore turned out at a 45 degree angle from compensatory movement. Those disabilities have corrected, but I would judge her to be very weak, so we are taking physical conditioning very slowly as her hooves continue to remodel. She is learning to gait (again?) where before she was very tight and pacey.


Take it slow and do not let yourself become discouraged.
 

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Notice in the sole shots her medial heel wall (the upper one) is curled underneath. She was like that in all four feet. Still having trouble with the left fore.
 

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Hi,

In every case where she stumbled or "dipped", it was clearly caused by the knuckle-over of either right or left hind foot, after she placed her foot toe-first. And this ONLY occurred in the ring (deep sand) - and never on flat surfaces (road or trail). From what I've read, this is a symptom of LPA.
Yes. Just not ONLY LPA. There are a range of things that can cause this. Of course, you haven't shared any pics, so I don't know the state of her feet.

I noticed swelling in both of her hind fetlocks over a month ago. And I now suspect this was partly - if not wholly - due to her low plantar angles (hopefully now improved through trimming), as well as her occasional knuckle-overs. The swelling is almost all gone now.
Yeah, 'LPA' or whatever other imbalances, stresses, combined with too much work especially(which can be minimal in a growing lass) first causes soft tissue damage, often including swelling, before, if chronic, it will cause joint & bone changes. Great that it's gone down, but IME, as mentioned, in the majority of cases, 'LPA' in hind feet comes from 'upstairs' issues, so you can't fix it SOLELY with hoofcare.

It's generally not something you can just 'trim your way out of' anyway. - Sure, you can change angles by trimming the toe wall shorter, leaving heels longer for eg, but this IME doesn't fix the problem, at least in the long term. I think the above eg is a good one to illustrate that - the foot was slightly 'run forward' to begin with. The Toe wall was shortened, but the heel platforms left, to 'raise the angle'. Unfortunately this has resulted in the whole foot being more 'run forward' and heel walls are now very long, forward, and starting to buckle under the pressure. While raising heel walls(in relation to the toe at least) will indeed raise palmer/plantar angles immediately, it is *support under the frog* which is needed, or else, being peripherally loaded on distorted walls, the internal foot will just drop down further over time.

Yeah, leg angles - such *** 'sickle hocks' can indeed change with hoof angle changes, but again, it's not necessarily *because* of hoof angles they're like that - and it may be a case of chicken or the egg - are her hoof angles a result of leg angles/upstairs issues? Certainly with combination of sickle hocks, bowing out at the hocks, short LH... I would be thinking it's far from ONLY plantar angles that are a problem.
 

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Loosie, I know I stuck my neck out with my post, If it's inappropriate, please delete if you are able. But please help me out. What does eg mean?

I have not left the heel walls long to gain height. They are barely above the sole plane and I take a little off each trim , but don't want to trim level with the sole. The walls were curled under at the heels when I got her, this foot being the worst.

I am now mortally embarrassed so will withdraw further comment. My apologies.
 

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No Dogpatch, sorry if I made you feel like that - I think your post is very appropriate & helpful, to better understand stuff.

Eg is just short for 'for example'.

Many vets & farriers want higher heels(or wedge shoes) to 'correct' the internal angles, but leaving extra to the heels does tend to make them distort/collapse for one, doesn't encourage them to grow more *strongly & straighter, to provide a good 'landing gear' for the back of the foot, and it doesn't support/help raise the *internal structure* where it's needed, but being further peripherally loaded, can allow matters there to become worse, as the internal foot 'drops' further.

So if you're not leaving heels long to 'gain height' why are you doing it? Why don't you want to trim them to the sole plane(or close), as with the rest of the foot? Long but 'run under' heels can be a reason for low or negative angles too.

What I would do in your case Dogpatch, (of course, only going off a few pics this is 'educated guess' as lots else to consider)would be to trim the ground surface to be uniform all round with the sole plane *depending on comfort - sometimes you might want to leave a tad of extra heel height, but I *guess* in her case, she'd be OK. I'd probably bevel the heels slightly, to 'relieve' the back of them & allow them to 'relax' back & become straighter. I'd keep the toes strongly bevelled, to allow the stretching there to grow out without undue force. And if her heels were too low/weak, I'd provide padding under the frog(you can get tailor made 'frog support wedges' off Easycare, to see what I mean), to support under the internal caudal foot, NOT under the heel walls - with more support under the frog, this will also take further pressure off those heel corners & allow them to become more vertical.

And many vets & farriers believe permanent support under the frog is the only way to fix NPA's - Eg(for example) Fixed shoes with pads - and that is certainly the easiest route for owners, no fiddling about, and it depends how much work, environment etc, but I (& others) have found that using frog support in boots just when the horse is working, or part time, is indeed helpful, so it is possible for the horse to stay barefoot for the most part & still help this. And fixed shoes, while I don't believe they're *necessarily* unhelpful in this sort of case, do, by their very nature, further load the walls, including, unless specially done, those heel walls that you DON'T want to overload.
 

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Discussion Starter #7 (Edited)
@loosie I wish I'd photographed her hooves when I got her. I didn't. All I have are her original, and current, hoof dimensions, which I have illustrated here. Since my "artwork" is so lousy, I didn't even try to sketch her frogs or bars. But the original dimensions were, to sat the least, alarming. And they were roughly the same for all 4 feet.

As I said in my first post, toes were very long and sharp, and almost no heel under coronet bands.

I'll take pics of her hooves next week, following her next trim.
 

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Discussion Starter #8
Thanks @dogpatch. Again, very useful info. Hope you get your horse healthy on all fours soon! And please don't hesitate to throw in your 2 cents worth. I wish my filly had had something approaching normal hoof dimensions when I got her. But months of neglect got her to where she was. I'll update more with vids tonight. Coming.
 

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Discussion Starter #9
@dogpatch and @loosie: I have to admit that I'm a "Technosaur". I deleted several youtube clips - not thinking they would disappear on this site. But here's a "compilation" of 4 different knuckle-overs I filmed between May and July - with both hind feet. PLEASE NOTE: I have hours and hours of footage from when I first started training my filly. Almost all of it is fine. But if you saw this video and nothing else, you might say, "My God! That horse is unsound and in deep trouble!" Remember: these are all 5-10 second clips taken from 10-20 minute rides over a period of months. I just dug through all my footage on my computer to isolate these knuckle-overs, then zoomed-in and ran in super slo-mo (I don't know how to do that with youtube clips, but maybe you non-technosaurs know how to do that?

Anyway, I now see clearly that this only occurs 1) in the deep sand of the indoor arena, and 2) when turning in circles. I have no footage of her doing this when walking in straight lines. And I've never felt her stumbling under me on flat ground or trails. But I think pain in her pasterns and fetlocks (from LPA as well as knuckle-overs - and yes, possibly other issues) may have caused problems further up her legs (hocks, stifles, hips?).
My plan now is to keep her walking in fairly straight lines, doing some uphill work (which seems to help a bit), and now focus on feet and fetlocks at my next vets' gait exam (with farrier) next week. I think these video clips will help my vets to better identify the issue(s) so we can start with feet Xrays and proceed with further imaging / neural blocking / remedial shoeing as necessary.


I'll post another clip of a ring ride recently, when I tried an experiment that a trainer I trust implicitly, as well as several forum contributors, recommended: take her on the trail, do some uphill work at a walk, then film her in the ring afterward to see if it helped or hurt.
 

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Discussion Starter #10
Here's a vid from a few days ago - after I took her for a 30 minute trail ride, at a walk, and did a couple of uphills. Looks to me like this actually helped: Less toe-stabbing and no knuckle-overs, no turning of hocks, and LH stride much improved (same length as RH stride, most of the time) with good overreach and break-overs.

 

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Those vids, again, show a prob which I'm guessing is not the feet. I'd still be getting a chiropractic vet involved to check her out all over. As I think I said, that's no slight on your 'normal' vet, if they don't pic up those sorts of details, but just like you don't expect a GP Doctor to suss out, let alone fix all sorts of body issues, but they might refer you to a specialist to do so, vets don't always understand bodywork/issues in great detail unless they have specialised.
 

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That last video looks so much better. I'd say close attention to trimming as you're doing along with gradual conditioning will work wonders for her. From what I've read, horses bred for big lick potential have lax tendons, and at her age they are even looser. Getting some muscle development will help tighten everything up and keep her from being wobbly.

I agree with @dogpatch that the hoof angle changes will come slowly as the hoof grows down tighter and you hopefully get more caudal development.

I'm somewhere between @loosie and @dogpatch in thoughts about correcting the negative angles. It's somewhat experimental for each horse. As @loosie points out, if you don't bring the landing surface of the heel back far enough, and create the heel buttress platform, those heel walls will keep collapsing and running forward. But also as @dogpatch says, if you take the heel too low you will never be able to get the tubules in the heel to grow down less angled.

What I've seen is that farriers who believe all you need to do is lift the heel, bring a platform back farther with a shoe, and then the hoof will grow better angles. But they don't trim the toe down enough to make the changes in the angle of the bones, and so the hoof keeps growing the same.

My belief is that you must approach both the toe and heel together. If you can get the horse's weight coming down through the hoof bones, the weight will stop crushing the heel. If radiographs truly show NPA, the horse will have enough sole under the coffin bone to be able to trim some off the toe and take the weight off the rear of the hoof.

If you just try to grow taller heels, it won't change the weight distribution of the hoof. You have to take more toe off than heel for each growth cycle until the weight is distributed better. If you simply take the heels down so the horse has a flat landing area, it won't help since the toe will keep preventing the heel growth.


Imagine in the above xray how massive of a heel wedge would have to be applied in order to correct the coffin bone angle, if you didn't take a lot of toe down. But what you can do is take the toe down some and equally important, get it back to the correct breakover point so the horse can begin to weight through the bones. That alone will begin to encourage the heel to stand up more, and keeping the landing platform of the heel buttress flat as far back as possible will help too. But it will take a long time for that toe correction to begin to help the heel growth, which will in turn help the toe connection grow in tighter and farther back.
 

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Discussion Starter #13
@gottatrot Thanks for all the advice. Did you see my rough sketches of her radical hoof dimensions when I got her - and how they are today (previous page of this thread)? It shows you just what my farrier and I have done over the past 6 months. The true test will be Xrays and another gait exam - next week.

Check this link from DVM360: http://veterinarynews.dvm360.com/negative-palmar-angle-syndrome-racing-horses

I'm hoping, of course, that, if plantar angles are the root of the problem, they are being resolved through trimming (grade 1 - photo 3 - third page - of the DVM360 article). My plan is to first address the very obvious hoof issues my filly had when I got her, then seek other, possible more subtle issues up her legs and body. So depending on the vet's Xrays and third gait analysis next week, we'll go from there. BTW, I've already had 2 acupuncture treatments for her, and will be open to anything my vets recommend once they have Xrays of my filly's now much more "normal profile" hooves.
 

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That is an excellent link. I hope you will post the xrays on here for our education.

It will be interesting to see how her coffin bone angles are after the trimming you've done.

From your diagrams, the severely long toes contributed a lot to her issues.
Although it's not technically wringing the hocks, one of my mares that had long toes on the hinds when I got her would set her foot down and twist it outward before picking it up rather than breaking over at the toe. Even though she had probably done this for years, once I brought her toes back she changed her way of going.
I had been told by several farriers that she walked like that because she was cow hocked and that made her hooves grow unbalanced, which caused the problem. Actually it was the fact that her hooves were unbalanced that made her twist like that.

It's good you are able to work on this while your mare is still so young.
 

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Discussion Starter #15 (Edited)
I think you're right on the money, @gottatrot ! The way I imagine my filly's feet when I got her is like this: It's as though you or I were wearing high-heel shoes, then permanently cemented all the bones of the feet and ankles in that position, removed the shoes, and tried to walk. What would happen? Normal "breakover" would be impossible with every step, so something would have to give - unless I just wanted to walk on my toes. But if I wanted to place my feet flat on the ground (heels too) with every step? Answer: I'd have to let my knees go sideways - causing lots of pain in my knees, hips, and back. And I'd probably tear some knee ligaments and cartilage in the process. I'd be completely lame.


On the other hand, my baby just keeps getting better every day now. Took her out for a short trail ride and hill work again today, then filmed her in the ring. Short LH stride almost all gone. No toe-stabbing or knuckling-over. Still more hock wringing, but she's got a lot of hind leg muscle development ahead of her that should help. Here you go (oh, and she was being annoyed by some deer flies in the ring, which is reflected in her occasionally pinned ears, swishing tail, and occasional odd strides. At least she didn't try to "karate kick them today - Haha!):


 

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I thought you said you weren't riding the horse, when it was suggested you shouldn't be, in the last thread. While yes, strengthening work is good for her as a rule, while she's still got issues, esp as she's still so young as well, I would definitely not be riding her. Get her straightened out first. At least, ride her only on a good vet's advice.
 

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I still seen an “offness”, and agree with Loosie, but....my DH’s TWH mare does this with him, but not with me, because I RIDE her, instead of just being a passenger. May I suggest that you gather up the reins a bit, so there is a little contact, the horse’s head will come up a bit, she will shift some weight from the front to the back, and be a LOT smoother.

She looks like a really nice horse!
 

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Discussion Starter #18 (Edited)
@greentree Others have told me to give her more free rein. And others have told me they think my contact with my horse's mouth is ideal. I didn't come on this forum to argue or hear how your riding style is better than mine. I'm seeking answers on experience with negative / low plantar angles. Thanks
 

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^While you're not asking for riding/training advice specifically & people should respect that, I took GT's suggestion as something that effects the way the horse travels, so relevant to this discussion.
 
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