The Veterinary Journal 198 (2013) e130–e136

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The Veterinary Journal

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Comparison of superficial digital flexor tendon loading on asphalt

and sand in horses at the walk and trot
N. Crevier-Denoix a,b,⇑, B. Ravary-Plumioën a,b, C. Vergari a,b, M. Camus a,b, L. Holden-Douilly a,b, S. Falala a,b,
H. Jerbi c, L. Desquilbet d, H. Chateau a,b, J.-M. Denoix a,e, P. Pourcelot a,b
a
Université Paris Est, Ecole Nationale Vétérinaire d’Alfort, USC 957 BPLC, F-94700 Maisons-Alfort, France
b
INRA, USC 957 BPLC, F-94700 Maisons-Alfort, France
c
Service d’Anatomie, Ecole Nationale de Médecine Vétérinaire de Sidi Thabet, CP 202, Tunisia
d
Université Paris Est, Ecole Nationale Vétérinaire d’Alfort, USC EpiMAI, F-94700 Maisons-Alfort, France
e
Université Paris Est, Ecole Nationale Vétérinaire d’Alfort, CIRALE, F-14430 Goustranville, France

a r t i c l e i n f o a b s t r a c t

Keywords: The incidence of superficial digital flexor tendon (SDFT) injuries is one of the highest of all equine
Equine musculoskeletal conditions. Horses with SDFT injuries commonly show no improvement of lameness
Ground surface on soft ground, unlike those suffering from distal bone or joint lesions. The aim of this study was to
Speed of sound
compare the SDFT loading in five horses at the walk and trot on asphalt and sand using a non-invasive
Tendon force
ultrasonic tendon force measurement device. Three horses were equipped with the ultrasonic device,
Superficial digital flexor tendon
whereas the other two horses were equipped with the ultrasonic device and a dynamometric horseshoe
(DHS); the DHS was used to calibrate the measured values of tendon speed of sound (SOS) converted to
tendon force, while a previously established ground reaction force pattern was used to calibrate SOS mea-
surements for the other three horses. Although the horses tended to be slower on S, maximal tendon
force was higher on sand than on asphalt at the trot (+6%); there was no significant difference between
the two surfaces at the walk. The duration of tendon loading was longer on S (+5%) and the area under the
tendon force–time curve was larger on S (+10%) at both walk and trot. SDFT loading is significantly
affected by the ground surface and the observed increase in SDFT loading on sand compared with asphalt
is consistent with clinical observations in horses with SDFT injuries.
Ó 2013 Published by Elsevier Ltd.

Introduction
Superficial digital flexor tendon (SDFT) injuries are amongst the
most common lesions in race and sport horses (Denoix, 1995;
Williams et al., 2001; Ely et al., 2004; Lam et al., 2007). Their eco-
nomic impact may be the highest of all musculoskeletal conditions,
especially in racehorses, where these injuries often recur (Marr
et al., 1993; Dyson, 2004). Affected horses commonly do not show
improvement of lameness on soft ground, unlike those suffering
from distal bone or joint lesions (Denoix, 1992, 1995; Ross,
2011). However, to date no study has elucidated the reasons for
this clinical aspect of SDFT injuries and no study has demonstrated
a significant effect of soft vs. firm ground on SDFT loading.
Riemersma et al. (1996b) implanted strain gauges in the four
palmar tendon structures of the distal forelimb (SDFT, deep digital
flexor tendon, DDFT, and its accessory ligament, AL-DDFT, and the
third interosseous muscle, or suspensory ligament, SL) of five
ponies and compared tendon loading at the walk and trot on as-
phalt and on a loose sand track. At the walk, there was a significant
⇑ Corresponding author. Tel.: +33 1 43967106.
E-mail address: ncrevier@vet-alfort.fr (N. Crevier-Denoix).
increase in the maximal strain on the DDFT and the AL-DDFT, and
(except for one pony) a significant decrease in the maximal strain
on the SL on asphalt compared with sand, but no significant differ-
ence was observed in the SDFT. At the trot, the maximal strain of
the AL-DDFT and SL (both passive structures) was significantly
increased on asphalt compared with sand; although the same ten-
dency was observed in both flexor tendons, the difference between
surfaces was non-significant. These results, obtained in ponies
with an invasive device, cannot explain the clinical observation
that the lameness of horses (most often examined at the trot) suf-
fering from a SDFT injury usually is not improved on soft ground.
In vivo investigations on equine tendon loading have remained
limited, since only invasive techniques were available until the last
decade (Ravary et al., 2004). A non-invasive ultrasonic technique,
based on the measurement of speed of sound (SOS) in the tendon
(Pourcelot et al., 2005) has been applied to the measurement of
SDFT loading in French trotters on two training surfaces
(Crevier-Denoix et al., 2009a). Since SOS in a tendon is mainly
influenced by the tendon’s material properties, especially its elastic
modulus (Vergari et al., 2012a), the SOS value at a given tendon
force may vary between tendons. However intra-individual repro-
ducibility of SOS measurements has been demonstrated in vivo in

1090-0233/$ - see front matter Ó 2013 Published by Elsevier Ltd.

http://dx.doi.org/10.1016/j.tvjl.2013.09.047
 N. Crevier-Denoix et al. / The Veterinary Journal 198 (2013) e130–e136 e131

horses at the walk and trot (Ravary, 2005), and reproducibility of

the SOS–force relationship in a given tendon has been established
in vitro (Crevier-Denoix et al., 2009b).
Under some assumptions, it is possible to calibrate SOS mea-
sures (expressed in m/s) determined for a given tendon in terms
of force (expressed in N) to compare tendon loading under differ-
ent exercise conditions. The calibration procedure requires the
simultaneous measurement of the ground reaction force (GRF);
however, when no dynamometric device is available, a previously
established GRF pattern (Merkens et al., 1993) can be used as an
alternative (Vergari et al., 2012b).
Using the ultrasonic technique and both types of calibration
procedure, the aim of the present study was to compare SDFT load-
ing in horses walking and trotting on asphalt and on sand. Given
the clinical observations, the hypothesis tested was that soft
ground would not induce a decrease of the SDFT loading compared
with asphalt.

Materials and methods

Horses

Five French trotters (2 geldings, 3 females; mean ± standard deviation, SD, body
mass 557 ± 32 kg; age 8 ± 4 years) were used in this study. All horses were clinically
sound, with no subjectively observed gait abnormality. The local Animal Care and
Ethics Committee advised that no formal approval was required for this study.

Experimental set-up

The right palmar metacarpal region of each horse was depilated then equipped
with an ultrasonic probe facing the SDFT by means of an adapted boot (Fig. 1). The
probe, composed of three transducers (1 MHz; one acting as an emitter, the other
two as receivers), was connected to an electronic module placed on a saddle. Each
horse was led in hand, at the walk and at the trot, along two 30 m long tracks, one
asphalt surface and one sand and fibre mix surface (sand). Ultrasonic recordings
(8 s, 100 Hz) were repeated 3–6 times at each gait on each surface in a random
sequence. From each trial (ultrasonic recording), 6–10 successive strides were
analysed.
Three horses (group 1) were equipped only with the US device, whereas the
right forehoof of the other two horses (group 2) was also equipped with a 3-dimen-
sional dynamometric horseshoe (DHS). The latter was composed of four triaxial
piezoelectric force sensors (model 9251A, Kistler) sandwiched between two alu-
minium plates (Chateau et al., 2009; Fig. 1). A non-instrumented horseshoe with
matching height and weight was attached to the left front hoof of these two horses.
The recordings of the DHS (sampled at 7800 Hz, then resampled at 100 Hz) were
synchronised with the US data. All electronics and portable computers for synchro-
nous acquisition were carried in bags placed behind or on the saddle and remotely
controlled via WiFi (UltraVNC Free Software Foundation).
The horses’ speed was maintained as similar as possible on both surfaces (each
horse being led by the same operator on both surfaces); speed was estimated by
dividing the known distance between two landmarks placed at the beginning and
end of each track by the time (measured with a stopwatch) taken by the horse
walking or trotting from one landmark to the other.
Data processing
Fig. 1. Experimental device to study the effects of ground surface on superficial
digital flexor tendon loading in horses at the walk and trot. The right forelimb of
each horse is equipped with an ultrasonic probe (1 MHz) facing the palmar
metacarpal area. The probe, covered with acoustic gel, is inserted in an adapted
(windowed) tendon boot and placed in contact with the skin (A). The probe in the
boot is maintained by an elastic band and connected to an electronic module placed
on the saddle. In two horses, the right forehoof was also equipped with a
dynamometric horseshoe composed of four triaxial piezoelectric force sensors (B);
the vertical component of the ground reaction force (GRFz) was directed proximo-
distally (perpendicular to the plane of the shoe). The corresponding electronic
devices are placed in saddle-bags. A WiFi-connection is used to acquire data
remotely.
Stride duration was also measured. In horses from group 1, hoof contact was
identified via a characteristic event on the SOS chart (correspondence of this event
with hoof contact was confirmed in horses in group 2 using the simultaneous DHS
measurements). In group 2, stride duration was measured directly from the GRFz.
For both groups, the maximal tendon force and corresponding time, the dura-
tion of tendon loading and the area under the tendon force–time curve were deter-
mined. The duration of tendon loading was calculated as the time during which the
tendon force was >100 N (which represents 3% of maximal tendon force at the
walk and 2% at the trot); this threshold was also used for the calculation of the area
under the tendon force–time curve.

The speed of sound (SOS) was measured as the speed of the first arriving signal
(Pourcelot et al., 2005), then converted to tendon force following two different pro-
cedures. In group 2, a tendon SOS–force calibration relationship was determined for
each horse using the SOS data measured at the trot on asphalt (in all the corre-
sponding trials) and the simultaneously recorded vertical component of the GRF
(GRFz) measured by the DHS. On the basis of the linear relationship demonstrated
by Jerbi et al. (2000) between the SDFT tensile force and the limb vertical compres-
sion force on isolated forelimbs vertically compressed in a mid-stance attitude
(average ratio between both forces 0.76 ± 0.13), the measured GRFz was multiplied
by 0.76 to obtain the SDFT force. The SDFT SOS–force relationship around mid-
stance (i.e. 25–70% of stance; Vergari et al., 2012b) was approximated with a loga-
rithm (Pourcelot et al., 2005), the inverse of which was then used to convert SOS
data of all trials of that particular horse to force values.
In group 1, since no dynamometric device was available, the measured GRFz
was replaced by the average values of GRFz (measured with a force plate and nor-
malised to body mass) reported by Merkens et al. (1993) for horses trotting on a
firm flat surface. The GRFz graph reported by these authors was digitised then inter-
polated. For each horse, the relationship between the GRFz thus evaluated (adapted
to each horse’s body mass) and the SOS measured in all trials at the trot on asphalt
was approximated to 25–70% of stance with a logarithm. The inverse of this loga-
rithm was used to convert SOS data of all trials of this horse to force values.
Statistical analysis
To compare the effects of the two surfaces on the parameters studied and to
adjust for repeated measurements within each horse, linear mixed-effects
regression models were used (SAS version 9.2). Results were considered to be
significant when P values were <0.05.
Results
The five horses were significantly slower on sand than asphalt,
both at the walk (speed mean ± SD: sand 1.58 ± 0.14 m/s; asphalt
1.61 ± 0.12 m/s; P = 0.0478) and at the trot (sand 3.12 ± 0.36 m/s;
asphalt 3.41 ± 0.46 m/s; P < 0.0001). As a consequence, stride dura-
tion was longer on sand than asphalt (P = 0.0008 at the walk;
P < 0.0001 at the trot; Table 1). The average tendon force–time
curves of each horse on both surfaces are presented in Figs. 2A
and B. At the walk, the tendon force–time curve typically showed
e132 N. Crevier-Denoix et al. / The Veterinary Journal 198 (2013) e130–e136

two peaks, the first one always being the highest, whereas a single
peak was present at the trot. Although this general shape was ob-
served in all horses, inter-individual variations in the SDFT loading
pattern were apparent at both gaits.
Although there was a lower speed on sand, the maximal tendon
force was higher on this surface than on asphalt at the trot (+6%;
P = 0.037); at the walk, there was no significant difference between
sand and asphalt at the first or second peaks (Table 1). The time of
maximal tendon force was delayed on sand at both gaits (and for
both peaks at the walk), when expressed in seconds (+9% in aver-
age; P < 0.0001 in all cases); when time was expressed in % of
stride duration, the difference between surfaces was significant
only at the walk (P < 0.0001 for both peaks). The duration of tendon
loading was longer on sand (mean + 5% when expressed in seconds
and +2% when expressed as % of stride duration; P < 0.001 in all
cases except at the trot when expressed in % of stride duration,
where P = 0.060). The area under the tendon force–time curve
was larger on sand (+10% in average), both at the walk
(P = 0.043) and trot (P < 0.0001).
Figs. 3A and B show the average vertical component of the GRF
(GRFz) measured with the DHS vs. time for the two horses in group
2. Both GRFz peaks were lower on sand than asphalt at the walk
(mean ± SD: first peak on asphalt 3434.8 ± 294.4 N vs. sand
3312.1 ± 204.7 N, P = 0.013; second peak on asphalt
3715.1 ± 357.7 N vs. sand 3652.3 ± 345.0 N, P = 0.016) and the sin-
gle peak at the trot (asphalt 5901.4 ± 226.1 N vs. sand
5771.0 ± 230.8 N, P = 0.001).
Discussion
Significant differences in loading of the equine SDFT on a soft
ground surface compared with an asphalt surface were demon-
strated in this study using the non-invasive ultrasonic technique.
SDFT force values were obtained after calibration of the SOS values
measured directly with the device. In both groups of horses, the
calibration procedure was based on the linear relationship previ-
ously demonstrated in vitro between the force applied to forelimbs
vertically compressed in a standing position and the corresponding
SDFT force (Jerbi et al., 2000). This relationship was determined by
combining limb compression tests (on four left forelimbs isolated
at the distal third of the humerus) with SDFT traction tests (iso-
lated from the same limbs). The four horses used in the study of
Jerbi et al. (2000) had characteristics (mean body mass
557 ± 83 kg; mean age 8.8 ± 1.7 years) similar to those of the five
horses in the present study, although the breed of horse was
different; Jerbi et al. (2000) used French Warmbloods, whereas
the present study used French trotters.
Using a unique ratio (0.76) to convert limb compression force
(or GRFz) to SDFT force may lead to systematic errors in the tendon
force calculation in a given horse, since this ratio is likely to be
dependent on the conformation of each horse and on the structural
and material properties of the SDFT. Furthermore, this ratio was
determined in vitro, neglecting the participation of the SDF muscle
and assuming that distal limb kinematics during compression tests
are the same as in vivo during mid-stance, which is likely to be an
oversimplification. However, it should be noted that Takahashi
et al. (2010), combining the use of an arthroscopically implantable
force probe in the SDFT and force plate measurements in seven
Thoroughbreds at the trot (3 m/s), found a ratio of maximum SDFT
force to maximum GRFz of 0.82 ± 0.24, which is similar to the value
used here.
Taking into account the variability of the ratio (0.76 ± 2 SD), it
can be demonstrated that the difference (in N) in the SDFT force
between sand and asphalt varies by ± 34%. In other words, a differ-
ence of 100 N between sand and asphalt with a 0.76 ratio would
become 66 N with a 0.5 ratio and 134 N with a 1.02 ratio. However,
the ratio value has no impact on the relative difference between
surfaces (i.e. when the force difference is divided by the SDFT force
on asphalt), and thus no effect on the average increase of 6–7% in
the SDFT peak force observed here on sand compared with asphalt.
Furthermore, the ratio has no impact on the SDFT loading pattern.
Thus, the inter-individual variations in the SDFT loading pattern
apparent in the present study, both at the walk and trot, which
confirm previous observations made from invasive measurements
(Jansen et al., 1993), would not be affected if a subject-specific ratio
had been used.
Calibration of SOS measurements using the GRFz pattern pre-
viously established on another equine population, instead of the
simultaneously measured vertical force from the same horse,
also introduces an error, as discussed by Vergari et al. (2012b).
In the present study, using the previously established GRF
pattern in group 2 horses would lead to an overestimation of
the SDFT peak force difference between the two surfaces by 8%
on average at the walk and trot (i.e. a difference of 6% between
sand and asphalt, when measured using the DHS, would become
6.5%).
Although the values of SDFT force obtained in the present study
are affected by the approximations and errors mentioned above,
these values are consistent with those obtained in horses using
invasive devices, both at the walk and trot (Lochner et al., 1980;
Butcher et al., 2007; Takahashi et al., 2010). Furthermore, since
the same relation was applied to all trials of a given horse, under
the assumption that the SDFT SOS–force relationship is reproduc-
ible in a given tendon (Crevier-Denoix et al., 2009b), the calibration

Table 1
Mean and standard deviation (SD) of stride duration and superficial digital flexor tendon loading variables measured in five horses at the walk and trot alternately on asphalt and
on a sand and fibre mix (sand) surface.

Walk Trot
Asphalt (n = 117) Sand (n = 121) P* Asphalt (n = 182) Sand (n = 156) P*
Mean SD Mean SD Mean SD Mean SD
Stride duration (s) 1.156 0.053 1.178 0.057 <0.01 0.717 0.043 0.749 0.043 <0.01
Maximal tendon force (walk first peak) (N) 3517.6 480.1 3609.7 548.8 0.5 4715.6 572.0 4976.3 339.8 <0.05
Maximal tendon force (walk second peak) (N) 2076.0 629.8 2216.8 573.3 0.1
Time of maximal tendon force (walk first peak) (s) 0.158 0.018 0.179 0.026 <0.01 0.150 0.019 0.159 0.023 <0.01
Time of maximal tendon force (walk second peak) (s) 0.422 0.046 0.455 0.042 <0.01
Time of maximal tendon force (walk first peak) (% of stride duration) 13.9 1.6 15.6 2.2 <0.01 21.0 2.3 21.3 2.9 0.2
Time of maximal tendon force (walk second peak) (% of stride duration) 36.7 3.7 38.9 4.0 <0.01
Duration of tendon loading (s) 0.613 0.072 0.641 0.073 <0.01 0.259 0.031 0.274 0.036 <0.01
Duration of tendon loading (% of stride duration) 52.9 4.4 54.4 4.5 <0.01 36.0 2.8 36.4 3.2 0.06
Area under the tendon-force time curve (Ns) 1172.7 201.7 1278.6 223.4 <0.05 820.7 133.8 907.5 133.8 <0.01
*
Significant differences between surfaces: P < 0.05.
 N. Crevier-Denoix et al. / The Veterinary Journal 198 (2013) e130–e136 e133

Fig. 2. Force in the superficial digital flexor tendon of the right forelimbs of five horses at the walk (A) and trot (B) on asphalt (dark grey) and on a sand and fibre mix (sand)
surface (light grey) during averaged strides (n = 19–34 strides per horse on each surface at the walk; n = 21–57 strides per horse at the trot). The time bases are standardised
to a complete stride.

procedures used here should not affect the comparison between
surfaces.
The present study demonstrated an overall increase in SDFT
loading on sand compared with asphalt; the duration of tendon
loading and the area under the tendon force–time curve were
significantly increased on sand, both at the walk and trot, and
tendon maximal force was significantly higher on sand at the
trot. This SDFT loading increase was observed even though the
horses were generally slower on sand and (in the two DHS
equipped horses) while the simultaneously measured GRFz was
decreased on sand.
The increased stride duration measured on sand has also been
described by Riemersma et al. (1996b) in ponies (weighing 165–
240 kg) on a loose sand track compared with pavement.
Although no significant effect of ground surface type on the
selected SDFT loading parameters could be demonstrated by
Riemersma et al. (1996b), the tendon strain charts presented
by these authors are similar to those of our study; the SDFT
loading (expressed as SDFT strain) duration was increased on
sand both at the walk and trot, as was the second peak of SDFT
strain at the walk and, to a lesser extent, the single peak at the
trot. Times of maximal strain (in % of stride duration) were also
delayed, as in the present study. The absence of a significant
difference between types of ground surface at the walk can be
explained by the fact that Riemersma et al. (1996b) only consid-
ered the maximal SDFT strain, i.e. only the first peak of the
curve, for which no significant difference was observed in the
present study, contrary to the second peak.
The absence of a significant difference in strain on the SDFT be-
tween types of ground surface obtained by Riemersma et al.
(1996b), although somewhat in contradiction with the presented
charts, could be explained by the distal limb conformation of
ponies. Ponies have small feet, with relatively high heels and a
short toe, which implies a reduced lever arm of the GRF acting
e134 N. Crevier-Denoix et al. / The Veterinary Journal 198 (2013) e130–e136
Fig. 2 (continued)
on the distal interphalangeal joint. Furthermore, ponies have a less
ample propulsion phase of the stance compared with horses, which
minimises the digital joint angle changes observed during this
phase. Maximal SDFT forces measured by Riemersma et al.
(1996b) in ponies at the walk (2.2–2.6 N/kg) and slow trot
(6.7 N/kg) were lower than those obtained in horses (6–7
N/kg at the walk; 8.5–11 N/kg at the trot) in the present study
and by other authors (Lochner et al., 1980; Butcher et al., 2007;
Takahashi et al., 2010; Vergari et al., 2012b). This may also have
a link with the more subtle effects on the SDFT recorded in ponies
(vs. horses) when changing ground surface or hoof angle
(Riemersma et al., 1996a,b).
Riemersma et al. (1996b) measured the angle between the sole
of the hoof and the ground surface at the walk on sand and dem-
onstrated a small positive caudal angle, i.e. a hoof orientation sim-
ilar to an elevation of the heels. In all ponies, this heel elevation
hoof orientation increased during the stance phase by 4.8–12.6 °.
Compared with the situation on asphalt, where the hoof cannot
penetrate the ground surface, this forward rotation on sand implies
an increased distal interphalangeal flexion, which has been con-
firmed by kinematic studies (Scheffer and Back, 2001). Since distal
interphalangeal joint flexion provokes DDFT release, this move-
ment is accompanied by dropping of the fetlock (extension), as
demonstrated in standing horses (Denoix, 1985; Crevier-Denoix
et al., 2001) and horses at the walk (Chateau et al., 2004); this in
turn increases SDFT and SL loading (Denoix, 1994). Active contrac-
tion of the flexor muscles at the end of stance (propulsion phase),
which is necessarily increased on a soft, less reactive, ground than
on a firm surface, is also expected to increase the SDFT loading
further.
It is now established that firmer surfaces are a risk factor for
SDFT injuries in race horses (Williams et al., 2001; Reardon et al.,
2012), probably because of an increased SDFT loading rate at high
speed. The results of the present study nevertheless demonstrate
the rationale of rehabilitating SDFT injuries on firm ground
surfaces at slow gaits.
 N. Crevier-Denoix et al. / The Veterinary Journal 198 (2013) e130–e136
Fig. 3. Vertical component of the ground reaction force (GRFz) measured with a dynamometric horseshoe placed on the right forehoof of two horses at the walk (A) and at the
trot (B) on asphalt (dark grey) and on a sand and fibre mix (sand) surface (light grey) during averaged strides (n = 24–34 strides per horse on each surface at the walk; n = 44–
57 strides per horse at the trot). The time bases are standardised to a complete stride.
Conclusions
The results of this study demonstrate that the SDFT loading is
significantly affected by ground surface, with increased loading
on sand compared with asphalt. The combined increases in maxi-
mal SDFT force, duration of tendon loading and area under the ten-
don force–time curve during stance observed in the present study
are consistent with the clinical observations that horses suffering
from SDFT injuries generally do not show improvement of their
lameness when examined on soft ground.
Conflict of interest statement
None of the authors of this paper has a financial or personal
relationship with other people or organisations that could inappro-
priately influence or bias the content of the paper.
Acknowledgements
The authors thank the Conseil Régional de Basse-Normandie,
the Fonds Unique Interministériel, the French Ministry of Agricul-
ture, the Fonds Européen de Développement Régional (FEDER) and
the Institut Français du Cheval et de l’Equitation (IFCE) for their
financial support for this project. We are very grateful to Fabrice
Cavé and Jean-Michel Goubault, farriers (IFCE), as well as Elodie
Paumier-André, technician (CIRALE), for their participation, and
to the CIRALE and IFCE for loaning horses. The authors also thank
Romuald Glowacki and the Pôle de Compétitivité Hippolia for their
logistical and administrative support, as well as Guy Launay for
assistance with the manuscript.
e135
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