Joey, a handsome sorrel Quarter Horse, was a standout in the Houston Police Mounted Patrol Unit. “We’d had Joey since 1996 and he was the very best horse we had, able to go into any dangerous, high-stress situation and lead other horses in tactical formations,” says Officer Greg Sokoloski, who trains the patrol mounts. Four years ago, however, the gelding’s place on the force was in jeopardy. After initially showing soreness in his left front foot, Joey began to move like a horse in pain, taking progressively shorter strides and landing toe first. Rest and medication had no effect, and, finally, X rays confirmed bone changes consistent with the chronic heel pain known as navicular syndrome.

Joey was outfitted with a wedge shoe that lifted the heel of his left foot, reducing pressure on the sore area. He was also put on stall rest for several months and eventually returned to light work wearing the wedge shoe. But even after 10 months, he wasn’t getting any better. It looked like navicular syndrome would claim yet another horse’s career, forcing Joey into retirement.

Navicular syndrome has a well-earned reputation as a problem that is difficult to resolve. The condition, characterized by localized pain in the heels of the forefeet, exacts a heavy toll: chronic lameness, loss of usefulness and—in the worst cases—progressive deterioration that may make euthanasia the only option.

Not surprisingly, countless studies and thousands of research dollars have been devoted to understanding and solving navicular problems. As part of that effort, some experts have been investigating whether so-called “natural” hoof care, a philosophy that stresses the importance of trimming and lifestyle over shoeing, can alleviate navicular pain.

Natural hoof care advocates take a fundamentally different approach to navicular syndrome. Rather than utilizing egg-bar shoes or other corrective footwear, they believe that trimming the hoof to return it to a more natural state is a better solution.

Of course, no one treatment works in every case of navicular syndrome. Because of the many variables in each individual situation, one horse may respond well to conventional treatment of medication and egg-bar shoes and another won’t. But what is certain is that if the conventional treatments always worked, there would be no interest in trying a natural approach to begin with. Here’s a closer look at what the new direction entails.

Different Methodology

When it comes to the treatment of navicular disease, the aim of both traditional therapeutic shoeing and barefoot trimming is to decrease pressure on the painful areas in and around the navicular bone. The methods they use to achieve this, however, stand in stark contrast to one another.

Therapeutic shoeing typically attempts to “stand the horse up,”—increasing the angulation of the foot—by raising the heels using devices such as wedges, pads and egg-bar shoes. This is done to decrease pressure on the navicular bone from the deep flexor
tendon—thought to be a primary cause of heel pain—and to protect the rear third of the foot from loading pressure.

diagram of horse hoof

illustration by Celia Strain

Natural hoof care advocates believe that this protocol may provide temporary relief but actually makes things worse in the long run. In their view, it’s critical to lower the heel, distributing load-bearing across the frog, bars and sole and encouraging the horse to stride normally—with the heel hitting the ground first. They believe this method not only decreases pressure on the inflamed areas that cause the pain of navicular syndrome, but also helps the horse develop a healthier foot overall.

Although this is still a minority view as far as navicular treatment goes, it has the support of a scientific heavyweight: Robert M. Bowker, VMD, PhD, of the Equine Foot Laboratory at Michigan State University (MSU), has spent the last decade delving into the physiology and biomechanics of the equine foot. His findings have led him to believe that barefoot is the way to go in the treatment of navicular syndrome.

“You have to look at what the tissues inside the foot experience,” says Bowker, “and when you raise the heels, you are decreasing the load-bearing surface area of the foot—similar to when a woman wears a high-heeled shoe. This actually increases the biomechanic stresses—the force per unit area—on the inside of the foot, so you have made the situation worse, not better.

“The reason why horses with navicular often appear more comfortable when you raise the heels is that you have shifted the focal point of the load to a new area that is not inflamed—but this is often a temporary, symptomatic fix. In my experience, it is only a matter of time before that new area becomes inflamed and painful, so these horses eventually go downhill again.”

Physiologically correct barefoot trimming is better for navicular issues, Bowker believes, because it takes the opposite approach to traditional therapeutic shoeing. “When you take a horse barefoot,” he states, “you gradually lower the heels, which increases the surface area of loading on the bottom of the foot and allows the frog, bars and sole to share in the load bearing. These factors drastically reduce the biomechanical stresses inside the foot—like taking a woman out of high heels and putting her into a running shoe.”

Trim as Treatment

Bowker’s work has demonstrated that, in addition to increasing the load-bearing area on the bottom of the foot, physiologically correct barefoot trimming does something else that traditional therapeutic shoeing cannot do: It helps the digital cushion and lateral cartilages—internal support structures typically weak and underdeveloped
in horses with navicular syndrome—to become healthier and more robust.

Bowker’s research has revealed that when a foal is born, the lateral cartilages and digital cushion at the back of the hoof are soft, fatty and thin, but under natural conditions they will gradually thicken and strengthen over time to accommodate the growing horse’s increased body weight. These mature structures, he says, are essential to the support, protection and overall function of the foot. For these structures to develop properly, several factors must be in place:

• The horse’s foot must be trimmed (or wear on its own) in a way that provides optimal balance and allows natural function, e.g., expansion and contraction; proper breakover; frog, bars and sole sharing in weight bearing.

• The feet must have plenty of movement over firm terrain.

• The horse must land heel first to provide the back part of the foot with the pressure necessary to stimulate development.

Unfortunately, says Bowker, some farriery and horsekeeping practices—specifically, shoeing before feet reach their full size, restricting the activity of youngsters, housing and working horses primarily on soft footing, and improper trimming—inhibit the development of the lateral cartilages and digital cushion. The result is full-grown horses with “baby” feet that are vulnerable to pain, particularly at the back where there should be a robust, fibrous digital cushion to provide protection. Tellingly, Bowker says, “The lateral cartilages of horses with navicular disease have three to four times less mass [than a healthy horse], even though as foals they all have the same amount.”

before and after x-rays of trimming hoof to help navicular

images courtesy Robert Bowker, VMD, PHD

Complicating the issue is the fact that when the back of the foot is sore due to navicular disease or other sources of pain, the horse will often land toe first, which creates a vicious circle because toe-first landing does not provide the frog pressure necessary for developing the digital cushion and lateral cartilages. This is another reason why natural hoof care advocates disagree with the traditional notion of “protecting” the back of the foot of horses with navicular syndrome from environmental pressure.

The good news is that an adult horse with poorly developed internal structures isn’t necessarily destined for a life of lameness. Bowker’s research also indicates that the internal structures of a mature horse’s foot can become thicker, denser and more supportive when the foot’s natural form and ability to expand, contract and land heel first are restored. The treatment is to work toward achieving what Bowker calls the “physiological trim” (see page 29). “To do this trim,” says Bowker, “you need to be trimming frequently and keeping the toe short—that means backed up, not thinned from below—between the frog apex and the hoof wall, and keeping the frog and bars on the ground.”

Step-By-Step Progress

Exactly how this is best accomplished depends in part on the terrain where a horse lives and works. As Pete Ramey, a farrier who advocates natural hoof care, explains, “The bars and frog should be in a supporting role at impact. To achieve this, the horse must be comfortable enough to [land on] the ground heel first, and the shape of the foot must be such that the frog and bars bear much of the initial force. These two simple goals create a wide range of ‘correct’ trims for various situations. For instance, on a horse that lives and works in yielding or rocky terrain, the bars and frog might be considerably recessed within the ‘cup’ of the foot and still provide adequate support and frog/bar function. In contrast, a horse that lives and works on hard, flat terrain might need longer bars and a protruding frog to achieve the exact same support. Always remember that as these decisions are made, comfort and heel-first impact are top priorities. Any trimming decision that yields a voluntary toe-first [landing] will work against the navicular horse.”

Making the necessary changes, however, can backfire if done too quickly, says Ramey. “The hardest and most important part of trimming a horse with navicular is achieving a heel-first landing and thus the frog pressure required to finish developing the lateral cartilages and digital cushions,” he notes. “However, if you leave a navicular horse’s frog on the ground, and the inner structures of the foot are still weak and undeveloped, the frog may be so sensitive that the horse tiptoes in motion. This will get you nowhere.”

Trimming in stages is usually the answer, says Ramey. “Often we have to leave the heels a little longer for a few months when we’re treating a navicular horse. As the longer heels sink into footing, they reduce the pressure to the frog to a level where the horse can comfortably bear weight. This reduced pressure allows us to start making progress with digital cushion development.”

The addition of boots with foam insoles can greatly speed up this process, says Ramey. “A foam boot insole is often the only surface that many of these horses will actually land on with the back of the foot. Any other surface causes too much pain, and horses will land on their toes. This makes the pads a very important place to start. Progress cannot begin until the horse is voluntarily loading the frog.

“Getting this right takes some tinkering,” he continues. “Often a foam insole alone does the trick. However, if the heels are very contracted and the frog is deeply recessed between them, I tape a frog-shaped pad to the insole to dampen the vibration to the inner structures. If, instead, the frog is protruding, I might cut the frog shape out of the insole to reduce pressure for a while. Continued exercise in the pads rapidly develops the inner structures and, in my experience, soon the pads and boots are no longer necessary.”

Shoeing and Breakover

Natural hoof care advocate Gene Ovnicek, a farrier with 40 years of experience, agrees that trim is a key factor in alleviating navicular pain, and adds that how the horse’s heels are shaped also influences the breakover point, the part of the toe that leaves the ground last when a horse picks up his foot. A natural breakover point—as opposed to one dictated through trimming or shoeing—is crucial to normal hoof function, and to the prevention and treatment of navicular problems, says Ovnicek.

“Most domestic horses have only a moderately functional foot,” he says. “This is because what many of us consider a normal foot is actually a distorted one. Breakover is a big part of that.” An unshod hoof, Ovnicek explains, wears naturally to the level of the sole and the toe develops a smooth, beveled surface, which starts behind the leading edge of the hoof wall close to the tip of the coffin bone. This beveled surface reflects and contributes to the horse’s natural breakover point. On a shod horse the beveling is limited to the shoe surface. A forced, unnatural breakover of a shod hoof, he says, requires extra effort and will leverage the hoof wall to “a dish in the dorsal wall that is oftentimes unnoticed from one shoeing to the next.”

Despite the general emphasis in natural hoof care on going barefoot, Ovnicek believes that, at least during initial treatment, shoes sometimes offer the best way of facilitating a breakover point that puts less stress on the foot and helps make a navicular horse more comfortable. “We’ve found that breakover is a huge factor in relieving the strain to get a horse to be able to pivot over the top of his foot,” he says. “It’s great if you can do that when a horse is barefoot, but it can be difficult because you’re limited by how much you can immediately reduce breakover on a bare foot. If a horse has distorted hoof wall and a thin sole, you have to be particularly careful about making changes quickly because there is not a lot to work with, and therefore you may not get the comfort necessary to get such barefoot horses functional on day one.”

Ovnicek’s goal is to eventually allow a horse to go without shoes. But, he says, “Horses with proper breakover, whose frogs are on the ground, and who are landing on the back of the foot are going to have basically normal function, regardless of whether they are shod or unshod. The barefoot horse is going to have better function—by function I mean a solid, well-developed frog, healthy bars and suitable sole quality, all pain free and able to perform on a hard, abrasive surface—but the shod horse, especially if the foot is compacted with dirt, can have function that is almost as good.”

That means you can put away your hoof picks: Natural hoof care experts agree that a shod hoof packed with “clean” (free of manure) dirt is more supported and, in the end, healthier, than a shod hoof picked clean.

Like Ramey, Ovnicek puts great effort into getting a navicular horse comfortable and moving, noting that when this is accomplished the transformation can happen fairly quickly. “We most often succeed in a very short time simply by putting these horses in a sound state and back to work, and then allowing that to work in our favor,” he says. He explains that work is critical for both shod and unshod horses, because the internal components of the foot rely on the stimulus of exercise to stay healthy and function optimally. But in any case, he says, “If a horse has badly distorted feet—the heels are curled under, the bars are crushed in—just trimming all of that distortion and getting the feet back on the ground provides tremendous relief right away.”

Ovnicek adds that getting the horse comfortable and moving doesn’t necessarily mean he will be completely sound within two to three months. Other problems, such as adhesions of the tendons and ligaments, can develop in concert with hoof-distortion issues and may take longer to resolve.

Faced with the possibility of retiring one of his best mounts, Officer Sokoloski sought permission to take a new approach to treating Joey’s navicular syndrome. Sokoloski had been studying barefoot trimming and got the OK to see if that would help. He pulled Joey’s orthopedic shoes and trimmed the gelding’s hooves to shorten the toes and bars, which put his frogs in contact with the ground and encouraged a heel-first landing. “Two weeks later, I was riding him,” says Sokoloski. “Two weeks after that, we were riding him in one of the biggest, most unruly protests we’ve had to deal with, and we were sure glad to have him.”

Joey was back in action, but he improved even further when a barefoot trimmer suggested putting him in boots with foam insoles that cushioned his still-sensitive heel region until his hoof structures could recover fully. Before long, Joey’s feet were better able to bear up on hard, paved surfaceseven without his boots.

In fact, Joey continued to serve the force through 46 special events, parades, protests and dignitary assignments and is still sound today. He is now retired and relishing a second career, as a lesson horse at a local stable.