Chronic Hoof Pain

You’ve heard it before: ”No foot, no horse.” Although it sounds trite, and it’s a no-brainer, the fact remains that you can’t overestimate how important the feet are to soundness, movement and attitude. Chronic foot pain leads to alterations in gait as the horse struggles to find a way to be more comfortable, and few things are more likely to dampen enthusiasm for work than having constant pain that you can’t escape.


Because more weight is carried on the front feet, most hoof problems occur in front. When there is severe pain in one leg and the horse is limping around, anyone can see it. Mild-to-moderate pain in both feet is another story. This is especially true if the pain comes slowly. The changes can be so gradual that they’re easy to miss. Symptoms include:

Be sure to get a thorough exam so you know what you’re dealing with. Your horse should land evenly on all four hooves. A horse who rests one certain foot consistently, especially a front foot, might be telling you something’s wrong. A hoof that is unbalanced and overdue for a trim will result in your horse moving poorly.

Abnormal Stance. There is a tendency for horses with heel pain to stand under themselves, with their feet back more toward their belly rather than directly underneath. The reverse holds for horses with pain along the toe/front of their foot. However, this isn’t absolute. The individual horse may stand either way regardless of where the pain is.

Weight Shifting. Sore-footed horses may ”tread,” shift weight from one foot to another, or, pointing feet in front of them. Alternately, they may decide it’s best to move as little as possible and will be rooted in place for prolonged periods of time.

Elbows Out. Horses with foot pain will sometimes stand with their elbows pointed out. This is often associated with atrophy of the triceps muscle, the large muscle above the elbow.

Rigid Head Carriage. Horses with foot pain will often carry their heads either higher than normal, or extended unusually forward and low. The normal head movements present at the walk and canter are reduced.

Shortened and Stiff Stride. ”Choppy” and ”wooden” are terms that usually describe how a foot-sore horse moves. Many horses with hoof pain also move low to the ground, in a shuffling-like gait. At the most extreme, the horse will have a ”walking on egg shells” look.

Stumbling or Tripping. Because they move low to the ground, stumbling or tripping may occur.

Preference for Soft Ground. This is almost universal with foot-sore horses but may be less noticeable if they are shod. When on hard ground, there is both more concussion and more vibration. Most of the weight is carried on the walls, so the walls spread slightly and the sole drops.

Shoulder, Back, Hind-End Stiffness. Nagging foot pain leads to the horse carrying his entire body in a stiff and guarded way. There’s less swing to the back, and weight is often shifted to the hind legs more than normal, both when moving and standing. Many horses with nagging front-foot pain are diagnosed as having back or hock problems, treated for that to no avail.

Reluctance to turn sharply or travel in a tight circle. These movements shift more weight to the leg on the inside of the turn and can increase the horse’s pain.

Ear pinning, ”bad attitude.” Can you blame them’

Causes of Foot Pain

The cause of a horse’s foot pain may be either external and related to hoof shape, trim and balance, or internal and caused by disease or damage to the bones, the joints or their supporting structures.

Navicular disease is real but diagnosed less frequently now as veterinarians have come to understand other problems that can cause pain in the the back of the foot. These include:

• Damage to the deep digital flexor tendon along its course through the foot or where it inserts on the coffin bone.

• Inflammation of the collateral cartilages (AKA sidebone).

• Inflammation/damage of the stabilizing ligaments of the navicular bone or the coffin joint.

• Problems involving the coffin joint.

Sole bruising and ”thin” or flat soles are common complaints. These horses are gimpy when moving on hard or irregular ground and over stones. While there are definitely individuals and family lines that tend to have more problems with this and other hoof conditions, there are also reasons other than genetics.

Landing hard on stones certainly can cause a bruise, especially if the sole has been trimmed too thin, but stones have been part of the horse’s life throughout time. The most common cause of sole pain/tender soles is loss of sole concavity.

Smoldering laminitis is an easily overlooked cause of nagging foot pain. Even if the horse has never had a full-blown laminitis episode, researchers have found changes in the laminae at the microscopic level.

Over time, this results in a widening of the white line in the hoof and many of the symptoms of chronic, nagging foot pain. Traveling downhill often worsens the pain. Pregnant mares and horses/ponies with insulin resistance and/or Cushing’s disease are particularly at risk.

Pedal osteitis is a term used to describe inflammation of the coffin bone itself. There may even be some loss of bone calcification and an increased risk of fracture.

Pain from unresolved abscess or blood/serum collections in the feet can drag on for weeks or even months, especially if the horse is treated with antibiotics and/or anti-inflammatory drugs that slow the process of these pockets draining through the sole or coronary band. This is common following laminitis.

Coffin-joint arthritis and ringbone round out the list of causes of foot pain. In addition to the symptoms listed above, horses with coffin-joint inflammation may show soft swelling above the coronary band, on either side of the extensor tendon running down the center of the pastern. This is caused by increased fluid in the joint capsule. Horses with ringbone may also have similar swellings or enlargements that are obviously bone.



It’s critical to work with your veterinarian to find out the exact cause so that it can be properly treated. A lot of time and money is wasted on improper treatments or continuing to try to work a horse that really needs to be rested.

Rest. Of all the conditions listed, usually only damage to tendons or ligaments will require a period of stall rest. However, there is no point in continuing to work the horse in activities that cause pain. Your vet, and the horse’s own reactions, will guide you with respect to whether or not riding should continue. Otherwise, the horse sh ould have plenty of paddock or field time to move around as he likes within his comfort level.

Pain medications. If your vet decides that a course of anti-inflammatories is needed to treat your horse’s problem initially, that’s one thing. Runaway inflammation is never good. Otherwise, masking pain can do more harm than good. Pain is the only way your horse knows he has damaged tissue and needs to take care of himself. Drugs can also interfere with the normal progression from an inflammatory response to actual healing.

Cold and heat. Cold is an excellent way to control pain and inflammatory reactions without side effects. Unless your vet advises against it in your particular horse’s case, ice-water foot baths or ice wraps to the feet will help you get acute inflammatory reactions under control and are helpful in blocking inflammatory reactions as the recovering horse is put back into work. Warm soaks are best for abscess treatments and horses that have hoof pain related to cold weather, which may trace back to poor circulation.

Paint-on treatments: Things like Venice turpentine and Tuf-Foot (, 888-TUF-FOOT) are commonly used to ease sole pain and encourage the sole to grow thicker. These topicals do often work but are not substitutes for getting to the root of the problem and correcting all you can correct.

Medical Conditions: Horses with nagging foot pain and stretched white lines should be tested for Cushing’s disease and/or insulin resistance.

Veterinary injections: Your vet may recommend hyaluronic acid or corticosteroid injections to quiet down coffin-joint or ligament/tendon problems.

Trimming and shoeing. Pain in the hoof originates from live tissues with a nerve supply, the horse’s true ”foot.” Shoes and boots can make a big difference, but the horse’s true ”shoe” is really his hoof wall, frog, sole and the digital cushion (a pad of connective tissue under the navicular area and coffin bone).

The first step in treatment is to make certain that this ”shoe” actually fits the foot inside it by trimming the horse so that these structures conform as perfectly as possible to the bones and joints inside. The hoof must be carefully balanced and positioned correctly underneath the horse for the hoof to work normally and be a comfortable ”fit.”


Even when special shoes or devices are being used, this basic trim must always be the first step. For example, horses with flat/thin soles that are tender-footed and prone to bruising often have toes that are too long and heels that contact the ground too far underneath them.

In a normally shaped, concave foot, the coffin bone is suspended high in the hoof capsule and the center of weight bearing is in the center of the bone. The center of the weight-bearing surface of the hoof directly lines up with this point.

When the hoof is allowed to grow too far forward, the support of the hoof gets out in front of the horse but the bone column doesn’t move along with it. This results in the center of weight-bearing of the sole moving forward toward the rim of the coffin bone. When the foot lands, the wall expands, the sole stretches and the nerve and vascular supply underneath the sole become pinched between the sole and the rim of the coffin bone, causing pain and bruising. A horse with a foot like this is also prone to heel pain and pedal osteitis.

Shoes. The example above of how sole pain can occur in a ”tender-footed” horse explains how shoes often help these horses. Shoes don’t provide enough ground clearance to protect the sole from rocky or uneven ground. What they can do, though, is limit how much wall expansion and sole dropping occurs. Shoes can also be used to move the horse’s ”hoof print”???the surface that contacts the ground???closer to where it should be if trimming alone cannot immediately accomplish this. Shoes can be fit back further, wider in the heels, etc.

Horses with weak walls that would be prone to excessive spreading???esulting in traction on the laminae, flares and hoof wall damage???are protected by shoes. Bar shoes stabilize the internal structures, much the way a cast stabilizes a fracture. When the shoe is beveled or rounded, it can also make breakover of the foot more easy and gentle, releasing tension on the hind-foot structures as the hoof comes up off the ground.

There are drawbacks to shoes, too. They increase vibration within the hoof, can lead to heel and frog contracture as well as atrophy of the digital cushion, and do not encourage the growth of a strong hoof wall. The pros and cons must be weighed on a horse-by-horse basis.


Pads and boots. Padding material inside boots or with shoes helps absorb concussion and vibration just like a well-made human sports shoe. This often benefits a sore-footed horse regardless of the cause. When there are areas on the bottom of the foot that are particularly tender, cut-outs can be made in the padding material to completely unload those spots.

Soft sole-packing materials are usually injected by a caulk gun and rest between the sole and either a full hard pad or a piece of netting to hold them in place. These absorb even more concussion and vibration and have the added advantage of increasing the surface of the hoof that is actually helping to bear weight, much like dirt.

Boots can be substituted for shoes in many horses, protect and cushion the feet well and have the added advantage of making frequent trims much easier. They can easily be fitted with additional padding or wedging as desired and can hold medications.

Bottom Line

The most important step in correcting nagging foot pain is finding out what is causing it. This is a job for your veterinarian, who will use a combination of tools including lameness exam, flexion tests, nerve blocks and X-rays to identify the source of the pain. When possible, ultrasound and MRI examinations can produce information that X-rays can’t.

Once you’ve determined the cause, you can proceed with proper treatment plans and end your horse’s pain. Be sure to incorporate your farrier in both the diagnosis and the treatment plan. Most will willingly work with your veterinarian, and the collaboration between a good vet and farrier is unbeatable in assuring your horse’s hoof health.

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