The Veterinary Journal 195 (2013) 361–365

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The Veterinary Journal

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Variation in foot conformation in lame horses with different foot lesions

Kate Holroyd a, Jonathon J. Dixon b, Tim Mair c, Nick Bolas d, David M. Bolt a, Frederic David a,
Renate Weller a,⇑
a
The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
b
Rainbow Equine Hospital, Rainbow Farm, Old Malton, Malton, North Yorkshire YO17 6SG, UK
c
Bell Equine Veterinary Clinic, Butchers Lane, Mereworth, Maidstone, Kent ME18 5GS, UK
d
Hallmarq Veterinary Imaging Ltd., Unit 5, Bridge Park, Guildford, Surrey GU4 7BF, UK

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

Article history: Foot conformation in the horse is commonly thought to be associated with lameness but scientific evi-
Accepted 11 July 2012 dence is scarce although it has been shown in biomechanical studies that foot conformation does influ-
ence the forces acting on the deep digital flexor tendon (DDFT) and the navicular bone (NB). The aim of
this study was to determine the relationships between foot conformation and different types of lesion
Keywords: within the foot in lame horses. It was hypothesised that certain conformation parameters differ signifi-
Horse cantly between different types of foot lesions. Conformation parameters were measured on magnetic res-
Foot conformation
onance images in the mid-sagittal plane of 179 lame horses with lesions of their deep digital flexor
Navicular bone
Deep digital flexor tendon
tendon (DDFT), navicular bone (NB), collateral ligaments of the distal interphalangeal joints and other
Lameness structures.
Conformation parameters differed significantly between lesion groups. A larger sole angle was associ-
ated with combined DDFT and NB lesions, but not with NB lesions alone. A more acute angle of the DDFT
round the NB was associated with DDFT and NB lesions, and a lower heel height index with DDFT injury.
The larger the sole angle the smaller the likelihood of a DDFT or NB lesion with odds ratios of 0.86 and
0.90, respectively. This study shows an association between foot conformation and lesions but it does not
allow the identification of conformation as causative factor since foot conformation may change as a con-
sequence of lameness. Future studies will investigate foot-surface interaction in lame vs. sound horses,
which may open a preventative and/or therapeutic window in foot lame horses.
Ó 2012 Elsevier Ltd. All rights reserved.

Introduction
Deep digital flexor tendon (DDFT) and navicular bone (NB)
pathology are common causes of lameness in the horse (Dyson
et al., 2005). The NB (or distal sesamoid bone) maintains a constant
angle of insertion of the DDFT and increases the moment arm of
the DDFT around the distal interphalangeal (DIP) joint thus reduc-
ing the force in the DDFT (Wilson et al., 2001). A moment is the
product of the force and its moment (lever) arm. On the extensor
side the moment is the product of the ground reaction force
(GRF) and its moment arm; on the flexor side it is the force through
the flexor tendons and their moment arms. To prevent a joint from
collapsing the flexor moment (rotational force acting on the flexor
side of a joint) has to equal the extensor moment (rotational force
acting on the extensor side of a joint). The moment arm around the
DIP joint influence the forces acting on the DDFT and navicular
⇑ Corresponding author. Tel.: +44 1707 666333.
E-mail address: rweller@rvc.ac.uk (R. Weller).
bone (Moleman et al., 2006). At the level of the DIP joint, the flexor
moment = ForceDDFT  MADDFT, where MA is the distance from the
centre of rotation of the DIP joint to the DDFT. Thus, an increase in
MADDFT will decrease the force through the tendon with a given
extensor moment.
The DDFT exerts compressive forces on the NB, which may be
implicated in the development of NB disease (Wilson et al.,
2001). Foot conformation influences the forces acting in the DDFT
and NB by influencing the moment arm of the DDFT and the
ground reaction force around the DIP joint (Willemen et al.,
1999; Eliashar et al., 2004; Moleman et al., 2006). It has been dem-
onstrated that a steeper sole angle will decrease the force in the
DDFT and NB, and it was proposed that, as a result, horses with a
flatter sole angle would be predisposed to lesions of the DDFT
and NB (Eliashar et al., 2004). However it was recently shown that
there was no significant association between a variety of confor-
mation parameters measured on radiographs (including sole angle)
and injury category (Dyson et al., 2011). The same study also indi-
cated that there was a large variation in the degree of concavity of
the distal phalanx (Dyson et al., 2011).

1090-0233/$ - see front matter Ó 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.tvjl.2012.07.012
362 K. Holroyd et al. / The Veterinary Journal 195 (2013) 361–365

It has been suggested that the sole angle of the border of the
distal phalanx should be between 2–10° (Parks, 2003); however,
the DDFT does not attach to the border of the distal phalanx but
centrally and it may be a more appropriate to measure the angle
of the distal phalanx at the actual attachment side (concave sole
angle) than the sole angle, which depicts the sides of the distal
phalanx. In a preliminary study, non-lame horses showed a ten-
dency to have a steeper concave sole angle compared to horses
with DDFT injuries, although the difference was not significant
(Smith et al., 2004).
Heel conformation has also been associated with forces in the
foot and hence with injury (Colles, 1982; O’Grady and Poupard,
2003; Eliashar et al., 2004; van Heel et al., 2005; Moleman et al.,
2006). However, a collapsed heel conformation has also been found
in 52% of sound horses (Turner and Stork, 1988). To date, there are
limited data available on how biomechanical effects of foot confor-
mation translate to the relationship between foot conformation
Fig. 1. Measurements taken to assess the association between type of lameness and
and injury.
hoof conformation: C, sole angle; D, toe angle; H, heel angle; N, deep digital flexor
The use of magnetic resonance imaging (MRI) has led to a more tendon angle; PL1, plumb line 1; PL2, plumb line 2; MA1, proximal moment arm;
accurate diagnosis of foot lesions and is currently the preferred MA2, distal moment arm; SI, distal phalanx length; LC, toe length.
diagnostic technique to assess horses with pain localised to the foot
(Busoni et al., 2005; Dyson and Murray, 2007). MRI allows the visu-
alisation of the foot in 3D and hence can be used to perform more Distances

accurate conformation measurements in the mid-sagittal plane
compared to radiographs, which sums up 3D data in a 2D image.
The aim of the present study was to determine the relationships
between foot conformation and different lesions within the foot in
lame horses. It was hypothesised that certain conformation param-
eters differ significantly between different foot lesions; more spe-
cifically, we hypothesised that (1) there would be a significant
difference in foot conformation parameters between horses diag-
nosed with DDFT and NB lesions and those diagnosed with other le-
sions in the foot; (2) a decrease in concave sole angle, angle of
deviation of the DDFT around the NB and/or lower heels would be
associated with a DDFT/NB lesion, and (3) the flexor moment arms
would be significantly smaller in horses with DDFT/NB lesions.
Materials and methods
For this retrospective study, the files of 205 horses that had undergone MRI of
the front feet at one referral hospital between 2007 and 2009 were reviewed. Stud-
ies where the quality of the images prevented the precise measurement of the con-
formation parameters were excluded, as were horses with laminitic changes on
MRI, and any studies performed purely for research purposes. This resulted in
179 horses being included in this study. Age, breed, discipline and lameness score
were recorded.
Horses were categorised according to the injured structure, namely, (1) horses
with a lesion of the DDFT alone; (2) NB alone; (3) NB/DDFT combined; (4) collateral
ligament of the distal interphalangeal joint (CL) alone; (5) DDFT/CL combined; (6)
NB/CL, combined; (7) DDFT/NB/CL combined; or (8) OTHER. The group ‘OTHER’
comprised horses with lesions of the distal sesamoidean impar ligament, the mid-
dle phalanx, the distal phalanx, the lateral cartilages of distal phalanx, the DIP joint,
the proximal interphalangeal joint, the annular ligament, the collateral sesamoi-
dean ligaments, the straight sesamoidean ligament, the oblique sesamoidean liga-
ment and the metacarpophalangeal joint.
All MR images were acquired in the standing horse using a 0.27 T U-shaped
open low-field MRI scanner (Hallmarq Veterinary Imaging) and data were inter-
preted by the same experienced, veterinary surgeon (RCVS specialist, DECVMI,
AssocECVDI). For the conformation measurements, the multiplanar reconstruction
facility of dedicated DICOM reviewing software (Image Viewer, Visbion) was used
to identify and display the mid-sagittal T1 weighted image of the affected foot. If
both feet were diagnosed with abnormalities, the foot with the higher lameness
score prior to blocking was used. All measurements were performed only by one
operator, who had no knowledge of any other data related to this study.
The following measurements were performed and are illustrated in Fig. 1.
The centre of rotation of the DIP joint to the centre of the DDFT tendon proximal
to (proximal MADDFT) and distal to (distal MADDFT) the NB at 90° to the DDFT; toe to
a plumb line originating from the centre of rotation of the DIP joint and bisecting
the sole (PL1); heel to a plumb line originating from the centre of rotation of the
DIP joint and bisecting the sole (PL2); internal surface of the sole (distal phalanx
length); coronet to sole (toe height); proximal border of the heel bulb to sole (heel
height), and coronet to the border between the laminar and solar corium (toe
length).
Ratios
Ratios between the vertical measurements and the moment arms and the distal
phalanx lengths were calculated to allow comparison amongst individuals irrespec-
tive of size. The proximal and distal MADDFT were normalised for size by expressing
them as a percentage of toe length. Heel collapse index (HCI) and heel height index
(HI) (Eliashar et al., 2004) were calculated to determine whether collapsed hoof
conformation was associated with different lesions. HCI was defined as the ratio be-
tween heel angle and toe angle. HI was defined as the ratio between the dorsal cor-
onary band height and heel height.
Repeatability of the measurements
Repeatability was determined for all measurements in a preliminary study by
performing two repeat measurements on the same image in 44 horses. To assess
the effect of repeat positioning on the measurements the scans were repeated twice
in 12 horses with the foot being repositioned between acquisitions. The repeatabil-
ity coefficients (Bland and Altman, 1986) lay between 0.54 and 1.61 mm for dis-
tances and 0.71° and 1.54° for angles, which was deemed acceptable by the authors.
Data analysis
Data were assessed with a one-sample Kolmogorov–Smirnov test to confirm
that there were no significant departures from normal distribution. Differences in
conformation parameters between injury groups were assessed with a one-way
analysis of variance with a Bonferroni test used post hoc when there were signifi-
cant differences. Differences between DDFT and NB categories and non-DDFT and
non-NB groups were assessed with independent sample t test. Direct logistic
regressions were performed to assess the association between conformation
parameters and the likelihood that horses would have a DDFT lesion or a NB lesion.
All analyses were performed using SPSS 19 (IBM); significance was set at P < 0.05.
Results
Study population

Angles The mean age ± SD of horses included in the study was

The concave sole surface of the distal phalanx to horizontal angle (sole angle);
10.54 ± 3.73 years, and the mean ± SD lameness score was
the dorsal hoof wall to horizontal angle (toe angle); the palmar heel wall to horizon- 3.0 ± 1.2 on a 1–10 lameness grade. Breeds included Warmbloods
tal angle (heel angle), and the angle of the DDFT around the NB (DDFT angle). (37), Thoroughbreds and Thoroughbred crosses (51), Irish sports
 K. Holroyd et al. / The Veterinary Journal 195 (2013) 361–365 363

Table 1
Means ± SD of conformation measures for each injury group (DDFT, deep digital flexor tendon; NB, navicular bone; CL, collateral ligament).

Measurement DDFT NB DDFT/NB CL DDFT/CL NB/CL DDFT/NB/ OTHER P*

CL
PL 1 (mm) 60.9 ± 5.1 60.7 ± 6.4 61.6 ± 5.7 59.9 ± 4.8 60.4 ± 4.7 63.6 ± 4.4 60.1 ± 4.1 61.8 ± 5.2 0.540
PL 2 (mm) 69.1 ± 5.3 70.8 ± 5.2 72.0 ± 5.6 68.8 ± 5.3 68.7 ± 9.7 67.9 ± 7.2 68.6 ± 8.0 72.0 ± 6.7 0.147
Distal phalanx length (mm) 130.0 ± 8.2 131.5 ± 8.3 133.6 ± 7.8 128.7 ± 8.0 129.1 ± 11.9 131.5 ± 9.3 128.6 ± 9.1 133.8 ± 9.4 0.183
Toe height (mm) 66.2 ± 5.3 64.8 ± 5.8 68.5 ± 7.3 68.1 ± 9.6 69.5 ± 8.1 68.6 ± 4.7 73.6 ± 6.9 70.4 ± 7.0 0.031
Heel height (mm) 21.5 ± 3.9 22.9 ± 5.7 23.3 ± 6.0 24.5 ± 5.3 20.8 ± 4.3 22.9 ± 5.0 25.4 ± 6.1 28.0 ± 5.7 0.016
Toe length (mm) 54.3 ± 5.3 55.4 ± 4.7 57.0 ± 5.30 56.3 ± 5.35 55.2 ± 5.8 53.9 ± 3.2 56.6 ± 5.9 57.4 ± 5.0 0.326
Sole angle (°) 16.1 ± 6.2 17.5 ± 6.5 12.1 ± 3.9 19.3 ± 5.5 9.6 ± 3.1 13.3 ± 6.7 12.5 ± 2.9 21.4 ± 6.6 <0.001
Toe angle (°) 53.1 ± 4.1 53.5 ± 4.9 57.2 ± 4.0 60.5 ± 3.8 58.1 ± 6.1 58.8 ± 3.6 60.0 ± 5.16 57.8 ± 4.3 <0.001
Heel angle (°) 51.1 ± 5.6 54.5 ± 9.1 55.4 ± 5.5 60.4 ± 3.6 56.6 ± 5.6 57.4 ± 5.1 59.4 ± 5.4 55.8 ± 5.4 <0.001
DDFT angle (°) 132.4 ± 7.0 129.9 ± 7.6 129.9 ± 7.5 134.9 ± 6.6 127.4 ± 4.8 129.6 ± 8.7 129.0 ± 4.7 133.3 ± 7.6 0.007
PL 1: PL 2 0.88 ± 0.09 0.86 ± 0.12 0.86 ± 0.12 0.87 ± 0.08 0.89 ± 0.12 0.95 ± 0.11 0.89 ± 0.12 0.86 ± 0.09 0.356
Heel collapse index 0.96 ± 0.09 1.02 ± 0.17 0.97 ± 0.09 1.00 ± 0.02 0.98 ± 0.09 0.98 ± 0.12 0.99 ± 0.06 0.97 ± 0.07 0.424
Heel index 0.33 ± 0.05 0.35 ± 0.07 0.34 ± 0.06 0.36 ± 0.04 0.30 ± 0.05 0.33 ± 0.06 0.34 ± 0.06 0.38 ± 0.06 0.002
Size corrected proximal moment arm 0.24 ± 0.02 0.24 ± 0.02 0.24 ± 0.01 0.24 ± 0.02 0.24 ± 0.02 0.22 ± 0.01 0.24 ± 0.02 0.24 ± 0.02 0.006
Size corrected distal moment arm 0.24 ± 0.02 0.24 ± 0.02 0.24 ± 0.02 0.24 ± 0.02 0.25 ± 0.02 0.24 ± 0.01 0.26 ± 0.02 0.25 ± 0.01 0.148
*
Measures for which there was a significant difference between injury groups (P < 0.05) are shown in bold; PL, plumb line (see Fig. 1 for more details).

horses (22), Irish draft horses and Irish draft crosses (15), Cobs (11)
and other various breeds (43). Horses were affected by lesions to
the following structures: DDFT (26/179), NB (17/179), DDFT/NB
(47/179), CL (33/179), DDFT/CL (15/179), NB/CL (12/179), DDFT/
NB/CL (12/179) and other lesions (17/179).
Conformation parameters
Conformation parameters for the different injury groups are
shown in Table 1. The following parameters differed significantly
between lesion categories: sole, toe, heel and DDFT angle and toe
height, heel height, HI, and the size corrected proximal MADDFT
around the DIP joint.
Sole angle was smallest in group DDFT/CL, followed by DDFT/
NB, and largest in the group OTHER, followed by group CL. Heel an-
gle was largest in group CL, which was significantly larger than in
groups DDFT, NB and DDFT/NB. DDFT angle was largest in group CL
and was significantly larger than for group DDFT/NB and group
DDFT/CL. The largest HI was found in the group OTHER, which
was significantly larger than the DDFT and DDFT/CL groups. No sig-
nificant difference was found between any other groups. HI was
largest for group OTHER, followed by group CL; both were signifi-
cantly larger than DDFT/CL.
Size corrected moment arms of the DDFT around the DIP joint
were extremely similar with very small standard deviations be-
tween all groups with the exception of the group NB/CL for which
the moment arm ratios were significantly smaller compared to all
other groups.
Deep digital flexor tendon lesions and conformation parameters
Table 2 shows conformation parameters for horses with and
without DDFT lesions. Sole, toe, DDFT angle, HI and HCI were sig-
nificantly smaller in the DDFT compared to the non-DDFT groups.
For all other parameters no significant differences were found.
Once assumptions were met, the linear regression model con-
tained six independent variables (sole and DDFT angles, size cor-
rected MAs, HCI and HI). The model was statistically significant,
v2 (6, N = 178) = 43.86, demonstrating that it was able to differen-
tiate between horses with and without DDFT injury. As a whole the
model explained between 21.8 (Cox and Snell r2) and 29.2% (Nage-
lkerke r2) of the variance in injury category, and appropriately cat-
egorised 77.5% of cases. Only sole angle had a unique statistically
significant effect on the model with an odds ratio of 0.86 (95% con-
fidence interval 0.80–0.92).
Navicular bone lesions and conformation parameters
The means ± standard deviation of the conformation parame-
ters for horses with and without NB lesions are summarised in Ta-
ble 3. Sole and DDFT angle were significantly smaller for horses
with NB lesions compared to non-NB lesion horses. There was no

Table 2
Means ± standard deviation of conformation parameters for horse with and without deep digital flexor tendon (DDFT) lesions.

Measurement DDFT (n = 85) Non-DDFT (n = 94) P*

PL 1 (mm) 61.0 ± 5.2 61.0 ± 5.3 0.976
PL 2 (mm) 70.4 ± 6.7 69.8 ± 6.1 0.558
Distal phalanx length (mm) 131.3 ± 8.9 130.8 ± 8.7 0.681
Toe height (mm) 68.7 ± 7.1 67.8 ± 7.9 0.459
Heel height (mm) 22.8 ± 5.4 24.4 ± 5.5 0.042
Toe length (mm) 55.9 ± 5.5 56.0 ± 4.9 0.969
Sole angle (°) 12.8 ± 4.9 18.5 ± 6.5 <0.001
Toe angle (°) 56.6 ± 5.0 58.3 ± 4.8 0.045
Heel angle (°) 54.9 ± 6.10 57.6 ± 6.2 0.003
DDFT angle (°) 130.0 ± 6.8 132.7 ± 7.6 0.014
PL 1: PL 2 0.87 ± 0.11 0.88 ± 0.10 0.705
Heel collapse index 0.97 ± 0.08 0.99 ± 0.10 0.096
Heel index 0.33 ± 0.06 0.36 ± 0.05 0.001
Size corrected proximal moment arm 0.24 ± 0.02 0.23 ± 0.02 0.119
Size corrected distal moment arm 0.25 ± 0.02 0.24 ± 0.02 0.062
*
Measures for which there was a significant difference between injury groups (P < 0.05) are shown in bold; PL, plumb line (see Fig. 1 for more details).
364 K. Holroyd et al. / The Veterinary Journal 195 (2013) 361–365

Table 3
Means ± SD of conformation parameters for horse with and without navicular bone (NB) lesions.

Measurement NB (n = 88) Non-NB (n = 91) P

PL 1 (mm) 61.5 ± 5.5 60.6 ± 4.9 0.292
PL 2 (mm) 70.7 ± 6.4 69.5 ± 6.5 0.181
Distal phalanx length (mm) 132.2 ± 8.3 130.1 ± 9.1 0.108
Toe height (mm) 68.4 ± 7.1 68.2 ± 7.8 0.855
Heel height (mm) 23.5 ± 5.8 23.5 ± 5.3 0.991
Toe length (mm) 56.2 ± 5.1 55.7 ± 5.4 0.600
Sole angle (°) 13.4 ± 5.2 17.2 ± 6.7 <0.001
Toe angle (°) 57.1 ± 4.7 57.5 ± 5.3 0.672
Heel angle (°) 56.1 ± 6.4 56.4 ± 6.1 0.729
DDFT angle (°) 129.7 ± 7.3 132.6 ± 7.0 0.005
PL 1: PL 2 0.88 ± 0.11 0.88 ± 0.09 0.866
Heel collapse index 0.98 ± 0.11 0.98 ± 0.07 0.900
Heel index 0.34 ± 0.06 0.34 ± 0.05 0.829
Size corrected proximal moment arm 0.24 ± 0.02 0.24 ± 0.02 0.185
Size corrected distal moment arm 0.24 ± 0.02 0.24 ± 0.02 0.550

Measures for which there was a significant difference between injury groups (P < 0.05) are shown in bold; PL, plumb line (see Fig. 1 for more details); DDFT, deep digital
flexor tendon.

significant difference in any other conformation parameter be-
tween NB lesion and non-NB lesion horses.
Once assumptions were met, the linear regression model con-
tained four independent variables (sole and DDFT angle, size cor-
rected proximal MADDFT and distal phalanx length). The model
comprising all predictors was statistically significant, v2 (4,
N = 178) = 21.72, P < 0.001, demonstrating that it was able to dis-
tinguish between horses with and without NB injury. The model
as a whole explained between 11.5% (Cox and Snell r2) and 15.3%
(Nagelkerke r2) of the variance in injury category, and appropri-
ately categorised 62.4% of cases. Only sole angle had a unique sta-
tistically significant (P < 0.001) impact on the model. The odds ratio
was 0.90 (95% confidence interval range: 0.849–0.958).
Discussion
This study investigated the relationship between foot confor-
mation and lesions in lame horses. In accordance with our hypoth-
eses there was (1) a significant difference in some conformation
parameters between different injury groups, and (2) certain con-
formation parameters appeared to be associated with different le-
sions. Hypothesis 3 was rejected since there were no significant
differences in the absolute flexor MADDFT between injury groups,
although there was a significant difference between the CL/NB
group and the rest of the injury groups in MADDFT when normalised
for size.
This study suggests that lame horses with a larger sole angle are
less likely to have a DDFT or NB lesion. The smaller distal phalanx
angle in DDFT and NB lesion horses agreed with the theory re-
ported by others that a 1° change in sole angle can lead to a 4% in-
crease in the pressure exerted by the DDFT on the NB (Eliashar
et al., 2004). The mean difference of sole angle for horses with
and without DDFT lesions was 5.6°; therefore there was a 22.6% in-
crease in pressure exerted by the DDFT onto the NB in horses with
DDFT lesions. The 3.8° reduction in sole angle for NB lesion horses
is equal to a 15.3% increase in force on the navicular bone in NB le-
sion horses. Similar findings were reported by a preliminary study
where this finding was significant in Thoroughbreds (Smith et al.,
2004).
Weak, non-significant associations were also found between
sole angle and injury category in a recent study (Dyson et al.,
2011). The reduction in sole angle moves the point of zero moment
towards the toe, and consequently the moment arm of the ground
reaction force around the DIP joint increases and hence the exten-
sor moment increases. As the flexor moment must equal the exten-
sor moment it also increases to prevent the joint from collapsing.
The DDFT moment arm is relatively constant (Eliashar et al.,
2004) therefore the force in the DDFT increases to maintain equi-
librium. Flexor moment arms were found to be positively corre-
lated to hoof size. The present study showed that flexor moment
arms of the DIP joint are constant across injury categories thus val-
idating the theory that a reduction in sole angle leads to an in-
crease in DDFT tension (Eliashar et al., 2004). However, our study
was undertaken in static horses and it would be appropriate to fur-
ther investigate whether moment arm length remains similar in
horses during movement.
Sole angle was largest in group OTHER followed by group CL,
which are the only two groups without any NB or DDFT lesions
incorporated. Sole angle for NB horses was significantly larger than
DDFT/NB by 31.2%. The theory that navicular disease is caused by
vascular compromise has not stood up to scientific scrutiny
(Rijkenhuizen et al., 1989; Rijkenhuizen, 2006), and increasing evi-
dence supports the biomechanical theory (Bentley et al., 2007;
Trotter, 2001) that abnormal forces on the NB may arise due either
to excessive loads being applied to a foot with normal conforma-
tion or to a normal load being applied to a foot with poor confor-
mation (Trotter, 2001). In the case of this study when navicular
lesions occurred without a concurrent DDFT lesion there was no
associated decrease in sole angle, thus supporting the theory that
navicular disease may be caused by excessive loads applied to a
foot with normal conformation or, as suggested by Wilson et al.
(2001), abnormal gait. Furthermore the results of our study dem-
onstrate a three-way relationship between NB lesions, DDFT le-
sions and sole angle, which supports the theory that in the cases
where NB lesions are a result of conformational changes DDFT ten-
sion is an important factor (Dyson et al., 2011).
Sole and toe angle were both smaller in the DDFT group, which
supports results from other studies suggesting that such changes
lead to an increase in DDFT strain (van Heel et al., 2005; Moleman
et al., 2006). While HI was significantly smaller in horses with a
DDFT lesion, no difference in HCI was found between DDFT and
non-DDFT or NB and non-NB horses. Thus this study supports pre-
vious research that showed that HI was related to DDFT and NB
forces and hence risk of injury (Eliashar et al., 2004).
Heel angle was also significantly smaller in the DDFT group. It
has been suggested that collapsed heels lead to a more acute angle
of deviation of the DDFT around the NB (Parks, 2003) and an in-
crease in tension through the DDFT leading to NB lesions (Colles,
1982; Bushe et al., 1987; Hickman, 1989; Wright, 1993; O’Grady
and Poupard, 2003). However there was no correlation between
heel and toe angle in the current study, which does not support
 K. Holroyd et al. / The Veterinary Journal 195 (2013) 361–365
the suggestion that collapsed heels are associated with a more
acute DDFT angle. DDFT angle was significantly larger in the CL
group than the DDFT/NB and DDFT/CL groups, respectively. This
finding agrees with previous studies which proposed that the DDFT
angle is proportional to the force in the DDFT and, furthermore, on
the NB (Willemen et al., 1999; Eliashar et al., 2004).
As this study only evaluated lame horses, the differences we
found may be a consequence rather than a cause of disease, as
horses change their foot-surface interaction with certain lesions
(Wilson et al., 2001). Furthermore, only the conformation of the af-
fected limb was measured. Left–right asymmetry in hoof angle
may be indicative of motor laterality and/or chronic asymmetry
in limb-load (lameness) and significant asymmetry in hoof confor-
mation has been identified even in clinically sound horses (Weller
et al., 2006).
Conclusions
Previous studies have shown that certain conformational traits
(sole angle in particular) increase forces acting on the DDFT and NB
in sound horses. This study supports these findings by showing
that in lame horses different conformational parameters are asso-
ciated with DDFT and NB lesions. Future studies will focus on dy-
namic conformation by investigating foot-surface interaction and
left–right differences in lame vs. sound horses, which may open
a preventative and/or therapeutic window for horses developing
lesions within the foot.
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.
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