Management of Clubfoot in Horses: Foals to Adults

Clubfoot, or a distal interphalangeal (corono-pedal) flexural deformity, may affect the horse at any stage of life from neonate through adulthood. The deformity may be congenital or acquired and in many instances has a genetic basis. The etiology, clinical manifestations, management, and expectations differ between age groups; however, commonalities between the groups do exist. Treatment and longterm management vary depending on the age of onset, underlying etiology, severity, duration, secondary complications, and client expectations. The prognosis for long-term soundness is generally favorable with appropriate management but may be adversely affected by the severity of the deformity and/or the presence of secondary complications. The origin of the term “clubfoot” is unclear because it bears little resemblance to the clubfoot deformity in children referred to as congenital talipes equinovarus. Presumably, the term was coined to describe the upright or straight tubular appearance of the foot, where there is little expansion of the hoof capsule, giving a “club-like” appearance, but this is an overly simplistic definition. The clinical presentation in the horse can range from a mildly upright and a small foot to one that is buckled forward with an angle greater than 90° at the distal interphalangeal joint, or may have advanced pedal osteitis and hoof wall deterioration. A clubfoot has been classically defined as a hoof that meets the ground at an angle greater than 60° and can be further classified into two types: stage 1 or type 1, in which the hoof axis is less than or equal to 90°, and stage 2 or type 2, in which the hoof to ground angle is greater than 90°. A recently proposed classification system designates four grades of clubfoot. A grade 1 clubfoot has a hoof axis 3° to 5° greater than the contralateral foot and displays fullness at the coronary band but is mild enough that the hoof-pastern axis is aligned. A grade 2 clubfoot is slightly more severe, with a hoof axis measuring 5° to 8° greater than the contralateral foot. In a grade 2 foot, the hoof-pastern axis is steep and slightly broken-forward. Growth rings of the hoof are wider at the heel than at the toe, and after trimming excess hoof wall from the heel, the heel may not touch the ground. A grade 3 clubfoot is a more severe deformity, which has a broken-forward hoof-pastern axis and mild concavity present in the dorsal hoof wall. The growth rings are twice as wide at the heels as those at the toe, and, radiographically, there is demineralization and lipping along the apex of the distal phalanx. A grade 4 clubfoot is the most severe classification and has a