Expert Q & A

Managing club foot: a conversation with Stephen O’Grady, DVM

By Adam Marcus

Stephen O’Grady, DVM, has worked around horses for more than 50 years, but he took a less conventional path to his career as an equine veterinarian. Dr. O’Grady, who now practices in Virginia, started out as a farrier, shoeing horses for a decade before deciding to go back for his degree in veterinary medicine. As a result, he speaks with particular authority about the importance of the breakover point, the pastern axis and all other matters of the hooves on horse health. The Modern Equine Vet spoke with Dr. O’Grady about his recent article in Equine Veterinary Education about the management of animals with club foot, how to manage the condition in foals and adults, when to shoe and when to perform surgery, and more.

MEV: What percentage of foals with club foot in your experience are amenable to surgery, and what percentage can be helped with farriery?

O’Grady: If I had my way, all foals with a true club foot would have surgery. It’s not utilized enough. The surgery can render the animal basically normal for the rest of its life. I think a lot of people don’t understand the mechanics of club foot. In our paper, we consider a club foot to be when the distal interphalangeal joint, or coffin joint, is broken forward, as opposed to a high-heeled foot, in which the alignment of the digit is straight from the fetlock down to the ground.

The surgery is relatively simple. It probably takes about 10 minutes, especially if you have a bit of experience with it. I’ve done a pile of them over the years. It usually takes longer to get the patients prepped and asleep.
You transect the inferior check ligament, which acts as a sort of safety mechanism to keep horses from overloading the deep digital flexor tendon. By transecting the ligament in half, we allow extra length of the tendon, which allows the foot to be placed back into normal alignment. When the animal heals, it fills the gap in the ligament created by cutting it; however, it fills in with fibrous tissue. You may have a little weak spot there, but I’ve never seen it bother a horse.

MEV: Does the procedure affect an animal’s ability to event or perform other challenging activities? Or is it like Tommy John surgery for pitchers—they can bounce back as strong, if not stronger, than before?

O’Grady: It doesn’t affect performance at all. It puts the structures in the hoof into a better conformation.

MEV: What’s the recovery time?

O’Grady: Aftercare is typically a month that’s a little intense, and then another month in a small paddock so they don’t overdo it. One difference between surgery in foals and adults is that in foals, it has to be done under general anesthesia, whereas in adults you can sometimes manage with local anesthesia. But you’re better off having the animal asleep because there’s nothing worse than a patient starting to move in the middle of surgery. Another reason is that you need to be very careful with the soft tissue structures during surgery. You don’t want to cause any additional trauma to the area because that can prevent the muscle and tendon from healing properly.

MEV: How important is proper farriery in a successful recovery?

O’Grady: Extremely! You have to pay close attention to the foot that was operated on, because there’s a mechanism that we don’t quite understand yet, almost like a kind of muscle memory. The foot will try to revert back to its original conformation. So the farrier needs to keep the foot and heel in the proper conformation. That’s also important for the veterinarian to watch, too. The farriery should be just as much a part of the post-surgery regimen as changing the bandages or walking the patient.

MEV: With your experience in farriery, you come at this topic from a somewhat different perspective than most equine veterinarians. What has evolved in your thinking about how to manage these patients?

O’Grady: For whatever reasons—and I really don’t know the answer—we did not see as much of this foot conformation when I was a farrier. I think sometimes breeding is to blame; if you see a foal with a pretty significant club foot, go to the mare, and you will generally see a club foot on her, too. It really has a significant genetic component to it. Some people have also blamed nutrition, and some blame intrauterine positioning, vaccinations, and certain kinds of forage.

But farriery can also play a role. When I was doing my veterinary practice, we would go to farms with 2 or 3 foals whose hooves had become upright. We’d look at the farrier and see that, when they were trimming, they were trimming the foals too short, which caused them pain. What happens then is that the foal does not want to put its full weight on its foot, and they start walking on their toe. The tendon shortens due to what’s called a myotatic reflex—there’s something in the muscle belly above that says, ‘Well, okay, there’s a little less tension in this tendon, we’re going to pull it tight.’ Once that happens, you’re not going to go back. It’s here to stay.

MEV: What are some red flags owners and veterinarians can look for in young horses to spot an impending club foot?

O’Grady: Even if you have 1 foal or 20, paying attention to their limbs and feet from 0 to, say, 6 months of age at least, is very important. After that, so much of the tissue in the legs matures, and you can’t do as much about it. So periodic checks—once a month, maybe once every other month—with the veterinarian and, preferably, the farrier together are essential.

And one of the first things you would see if you put them on a flat, hard surface is 1 foot becoming a little bit more upright—a little steeper. You can also see that the coronary band will start to be a little swollen. You might have just a little concavity in the dorsal hoof wall. If that starts to happen, you can back down on exercise and slow down on the carbohydrates in the feed to reduce growth, and pay attention to trimming. I think that sometimes that’s neglected. I think a lot of these problems could be prevented with a good foal program.

MEV: It seems one take-home message here is to befriend a good farrier!

O’Grady: Always befriend your farrier! I just went to see a case where the farriery was inappropriate. Here you have to discuss the case with the farrier without being critical, so when we go back to see the horse the next time, we’ll approach it together on the same page. And by the end of the day, you’re shaking hands and going to have a beer. MeV