Many front-leg problems strike both sides, such as low-grade laminitis, ringbone, sole pain, corns, navicular disease or heel-pain syndrome. These problems often go unrecognized until they either reach an extreme phase or cause a secondary problem. The horse appears to move evenly, so people are thrown off track.
With bilateral foot lameness — or lameness in both feet — that telltale head bob and shortened stride we normally look for in lameness isn’t there. However, with a little detective work, you can catch bilateral lameness before it worsens or causes secondary problems, which develop due to the compensations the horse makes in an attempt to deal with the pain.
Horses with any foot pain usually have an abnormal way of landing. A normal horse lands heel first. With foot pain, he usually either lands flat-footed, “plopping” the foot down, or toe first. This footfall is most obvious when observing the horse at a walk on a smooth surface. Think in “slow motion” as you watch.
Watch, too, for rigid head and neck carriage, which are common with bilateral foot pain. Some horses carry their heads higher when there is foot pain, while others extent the head and neck out in front of them in a somewhat exaggerated way.
The head-high horse will have a shorter stride, with higher action, but seems to put his feet down forcefully, usually with the “plopping” motion. This happens because he rushes to unload the foot that is on the ground and experiencing pain, causing him to come down harder than normal on the other foot — which also causes pain and keeps the cycle going. You can imagine how quickly this leads to frustration and training/control issues.
Horses built somewhat “downhill” in the first place are most likely to go to the head-extended method of avoiding the pain. The head-high horse wants to keep his feet off the ground, while the head-low-and-extended horse works at putting them farther out in from of him and away from the line of gravity. This results in a horse that moves much like a well-schooled pleasure horse or show hunter — except that he is rigid. There is no “give” to the mouth or poll, and the legs move stiffly and mechanically with more of a shuffling motion. While the head-high horse tends to move faster than normal, the head-low-extended horse will tend to move slower.
Unusual stumbling at the walk, and sometimes even the trot, is a dead giveaway. Both the flat-footed and toe-first landing patterns result in the toes contacting the ground sooner than normal. The horse is also in a bit more of a hurry to unload the foot, getting the heels up quickly, which causes the toe to jam into the ground and act like a brake.
When walked uphill, the toe-jamming effect is especially noticeable. Walking downhill is quite painful, may cause stumbling and will exaggerate either the head-up or head-extended posturing.
The horse will also often signal foot pain by the way he stands. If one foot is somewhat more painful, that one will be kept pointed forward, while its opposite will often be placed behind the correct straight-up-and-down position. A common stance is with both front feet somewhat out in front, appearing as a less-exaggerated version of the classic laminitis position.
It may be easier to make the horse’s leg “buckle” by a brisk tap behind the knee. This occurs because the horse avoids locking the knee and bearing full weight through the ankle and pastern/foot axis. The horse may also show a tendency to pivot on the front feet rather than willingly pick them up when asked to move in the stall.
External signs may be subtle or absent. Some swelling just above the coronary band may indicate increased fluid in the coffin joint. The hoof wall may or may not feel abnormally warm or cold and pulses over the sesamoids may/may not be increased. Jogging the horse off after elevating the toe on a block may exaggerate some types of heel pain.
X-rays are often not indicative, since they only reveal long-term bone changes. The best diagnostic test by far is to ask your veterinarian to perform nerve blocks.