> LOW HEEL / HIGH HEEL SYNDROME - UNRECOGNIZED PROBLEMS & CONSIDERATIONS > > by Dr. Kerry J. Ridgway, DVM
Assessment of High Heel / Low Heel Syndrome: Commence assessment of the forelimbs by observing the horse's posture, its joint positions and angles from several directions. To be meaningful, the horse must be on a flat even surface. The horse must be standing "squared up" on all four feet, and allowed to be bearing weight in its chosen posture. Ideally, the assessment is best performed after the horse has been trimmed, balanced and is ready to shoe. Having one hoof placed even 3 to 4 inches ahead of or behind the other can alter the accuracy of the evaluation. Start the observations from six to eight feet away in a position directly in front of the horse. Observe progressively from the foot upward the position and relative heights of the joints. The foot with the lower heel will usually be significantly larger - the greater the size difference and the longer the low heel / high heel condition has been present, the more difference that will be evident. Difference in hoof size is a prime indicator that this condition exists. (Also while in this observation position, evaluate the coronary band for possible evidence of medial lateral balance. Note this is only one factor in medial lateral balancing and may be misleading) The fetlock joint on the lower heel side is generally lower than the higher heeled side. Next check the position of the styloid process of the radius. This is the "bump" or "top of the shelf" on the upper medial side of the knee (carpus). It is commonly lower on the low-heeled side. As the next step, evaluate and compare the height and symmetry of the points of the shoulder (scapulo-humeral joint). Generally it will be noted that the joint appears lower on the low heel side, and that there is hypertrophy of the descending pectoral muscles on the side with the higher heel. With practice it can become evident that the shoulder point on the lower heeled side will also be placed more rearward. For an overall picture of the asymmetry, it can be very helpful to look at the spatial symmetry created by the inner margins of each limb and of the ventral aspect of the chest wall. In other words, look not at the limbs themselves but use them as a "picture frame" of the space between the limbs. Next, stand several feet away at the shoulder at a 90-degree angle from the horse's direction of stance. From this position it is easy to see difference in pastern angle. In many instances, from this position, the pastern axis can be observed to be "broken backwards." Broken pastern axis is accompanied by varying degree of subluxation of the pastern and coffin joints. The toe may appear to be longer on the low heel side. The shoulder joint can now often be seen to be anywhere from ½ inch to 2 inches rearward of the limb with the higher heel. The difference in heel height is best seen by positioning one's self another 45 degrees toward the rear of the horse and from about six to eight feet away. Next the horse should be evaluated from behind and slightly above the croup. In order for a short person (or when examining a very large horse), to adequately make this evaluation, it helps to stand on a sturdy object of some sort. It will be noted that the shoulder of the limb with the lower heel will usually appear to have a significant lateral "bulge" and it will appear to be higher than its counterpart. This is because the scapula has been displaced or rotated into a more vertical position. The shoulder with the higher heel will often appear to slope or fall away in an exaggerated manner. Judy http://icehorses.net http://clickryder.com
