Horses With Uneven Feet: Causes, Assessment, and Management  

Dr. Jenny Hagen identified the three causes of asymmetric feet in horses and offered advice for improving these asymmetries.
Horse feet, horse hooves
In cases with natural skewness and laterality, sustainable correction of the hoof angles is possible when combined with training and management adaptations and manual therapy. | Adobe Stock

Asymmetric feet in horses, defined as a bilateral limb pair having different hoof angles or sizes, can result from one of three main causes. By understanding those underlying causes, practitioners can apply appropriate treatment, which might include any combination of frequent farriery, altered training protocols, and pain management.  

During the 2024 National Alliance of Equine Practitioners (NAEP) Saratoga Equine Practitioners Conference, Jenny Hagen, DVM, PhD, CF, associate professor, certified farrier, and certified specialist in equine rehabilitation, identified those three causes as: 

  1. Natural skewness, or the asymmetric development of bones, joints, and soft tissues between the left and right body side during maturation of the young horse (inherent plus secondary after birth). 
  1. Laterality or “handedness,” which is the asymmetric use of the left or right limb for motor tasks. 
  1. Pain. 

“There is the general thinking that a steeper hoof has an advantageous position to break over,” causing a faster breakover duration, she said. “The acute angled hoof has a higher leverage, and most practitioners care to ease the breakover of this foot. However, depending on the cause for uneven angled feet, this thought is not generally valid for all cases!”    

The basis for appropriate management of uneven feet is a careful and comprehensive assessment of the horse. Sometimes, uneven hoof angles in the front feet are signs of a problem in the hind feet (e.g., limb deformities, restricted range of motion at one side of the pelvis, pain) causing uneven weight-bearing in front, said Hagen, adding, “It’s important to appreciate that asymmetries in the hind limbs always affect the forelimbs too, so solving hind-limb issues may not require severe corrections in front. And correcting the skewness in the proximal locomotor system helps resolve unevenness of the feet.”  

She then presented three cases highlighting her treatment approaches for asymmetric feet. 

Case 1: Natural Skewness  

This horse had a 10-degree asymmetry of her hoof angle, with the left foot being flatter. The horse also had asymmetry of the shoulder and knees (one was more proximal than the contralateral side).  

“The structural asymmetry of this adult mare developed since she was a foal,” Hagen explained. “In this horse, the mechanical thinking was right. The steep hoof had a shorter breakover duration and the acute angled hoof the longer breakover duration.” Hagen corrected the hoof angles to 53 and 54 degrees.  

She noted that lowering the heels on the steeper hoof will cause higher leverage. “This needs to be considered in giving a palmarly placed point of breakover in the shoe for the steep hoof. At the flat hoof, the toe is shortened anyway, which automatically reduces the leverage for breakover,” described Hagen.   

However, the horse’s natural skewness cannot be solved by corrective shoeing alone. Within six weeks, the hooves started to return to their original angles and asymmetry.  

“We need to shorten the interval between shoeings, because the functionality of the body will always win,” said Hagen. “In addition, in these cases we can consider manual therapy such as chiropractic, osteopathy, and corrective training to correct the asymmetric function of the body. This usually supports the effect of corrective shoeing and the weight bearing and, thereby, the growth of the hooves is more even. 

“We won’t get a completely symmetric horse but can improve the situation,” she added.  

Case 2: Laterality 

Motor laterality describes one limb’s tendency to be more mobile and stable than the other. The stable limb fulfills a supporting task, with less range of motion but more muscles to actively support weight-bearing.  

“This causes a decrease of passive load at the corresponding hoof,” said Hagen. “In contrast, the mobile side often has less strength and muscles, causing more passive compression at the hoof, which results in a more acute angle.”  

Reasons for laterality include genetics, handedness, and monotone training. 

“Training can decrease laterality,” she explained. “Think about breaking your right hand and having to do everything left-handed for a few weeks … you will adapt.”   

Hagen presented a case showing a horse that experienced a unilateral load because of the nature of its athletic use (vaulting). The steep hoof was on the left leg, which is a trained vaulting horse’s supporting limb. The right side appeared more mobile but with a more acute hoof angle. The left, steeper hoof had a longer midstance duration but a longer breakover and a shorter swing phase.  

Hagen evened out that angle to create equal breakover. Although she corrected the structural asymmetry, the functional asymmetry of the movement—particularly in midstance—and breakover duration between the left and right front hooves increased after shoeing. The horse adapted with its structure to the load during training. But because the use of the horse didn’t change, correction of the hoof angles did not permanently resolve the underlying problem. 

“After six weeks, the horse was still symmetric in the swing phase but asymmetric in the timing of midstance, and breakover still increased,” said Hagen. “In this case we also need to change the training and include manual therapy. We need to train the horse more equally to achieve structural symmetry in the whole body and hooves.”  

Case 3: Pain 

Structural and functional asymmetry can develop even if lameness is subtle. If you decrease pain, you can equalize load. When a horse is painful, midstance duration decreases to reduce the weight at the limb. The dynamic phases, such as breakover or landing, are performed more carefully, causing an increase in breakover duration and landing at the affected foot. The painful foot usually has the steeper hoof angle; therefore, in painful patients, the mechanical thinking about hoof angles and breakover is no longer valid, said Hagen.  

“In podotrochlosis (the case she presented), the more severely affected limb has a steeper angle and long breakover and a shorter midstance,” she said. “This is in contrast to laterality or natural skewness cases. Angle adaptation between the hoof must not be the focus of shoeing. Instead, increasing comfort and decreasing pain should be the aim to increase symmetry in weight-bearing. An angle correction would make it worse for the painful patient.”  

Hagen emphasized that doing anything to change the angle will only make things worse.  

“The goal is to improve patient comfort,” she continued. “Shoeing with very soft pad/packing combinations and aluminum shoes without angle correction is the better solution for the presented case. This provides relief to the navicular region and pain management.  

“This disorder is unhealable, and the uneven feet are not correctable,” Hagen added. “Shoeing improves comfort and equal weight-bearing, but changing the angle is not the solution.” 

Take-Home Message 

When a horse has uneven feet, the practitioner must first identify the underlying cause. In cases with natural skewness and laterality, sustainable correction of the hoof angles is possible when combined with training and management adaptations and manual therapy. In cases with lameness-related asymmetry, pain reduction is required to equalize weight-bearing between the feet. In some cases, this can cause a slight equalization of the hoof angles again. 

“This presentation shows how crucial a comprehensive evaluation of the horse is and that in cases with uneven feet, the collaboration between farriers, veterinarians, and manual therapists is essential for an optimal case management,” concluded Hagen.  

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