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CLUB FOOT
Anne Dick,
DVM, MVetSc, Dipomate American College of Veterinary Surgeons
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What is a club foot?
Club foot is a term used to describe an abnormally shaped, upright
foot. Club foot is occasionally seen at birth but most commonly develops
in rapidly growing foals between 2 and 8 months of age. In most cases
owners notice the steepness of the hoof when the foal is 2-4 months old.
Often there is an increase in length of the heel relative to the toe of the
hoof and failure of the heels to adequately contact the ground after
trimming. Eventually the foot develops a boxy shape with a dish along the
front surface.
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What causes a club foot?
To understand what is happening we need to review some lower limb
anatomy. The deep digital flexor tendon originates from muscle in the
upper limb. It runs down back of the leg, over the fetlock, and attaches
to the coffin bone (third phalanx) within the foot. The deep digital
flexor tendon also has an attachment onto the cannon bone just below the knee
called the inferior check ligament. In rapidly growing horses the deep
digital flexor tendon does not lengthen at the same rate as the cannon
bone. The tendon can't keep up with the rate of bone growth and begins to
pull on the coffin bone. As the pull of the deep digital flexor tendon
continues there is some separation of the coffin bone from the hoof wall
resulting in a concave appearance to the front of the hoof wall. Why this
occurs is multifactorial with genetics, diet, and exercise being the most
common causes. The deformity can also develop secondary to lameness
somewhere else in the limb. If lameness accompanies the deformity it is
important to determine the source of lameness.
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How do I treat a club foot?
Initial treatment of a club foot consists of
lowering the heels by trimming and reducing the dietary intake by mare and
foal. If the toe becomes excessively worn toe extensions can help protect
the toe. In mild cases, consistent trimming and diet changes can resolve
the condition. If no improvement is achieved after 1-2 months of
conservative treatment, or if the condition is more severe initially,
surgically cutting the inferior check ligament may be indicated. Cutting
the check ligament allows the tendon/muscle unit to lengthen and decreases the
pull on the coffin bone by the deep digital flexor tendon. Careful
trimming and shoeing (application of an extended toe shoe) are necessary to
maximize the results of surgery and minimize the risk of recurrence. Over
the course of three months the severed ends of the ligament will heal.
During this time it is critical to hold the foot in proper alignment to allow
the ligament to lengthen as it heals together. The hoof deformity will
grow out and be replaced by normal-appearing hoof wall in 4-6
months.
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