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. 2022 Nov 16;101:skac374. doi: 10.1093/jas/skac374

Short Communication: changes in gait after 12 wk of shoeing in previously barefoot horses

Katelyn E Panos 1, Kristin Morgan 2, Rachael Gately 3, Julia Wilkinson 4, Alexandra Uden 5, Sarah A Reed 6,✉
PMCID: PMC9838798  PMID: 36383438

Abstract

Farriery can impact gait symmetry and lameness outcomes, but there is limited scientific data documenting these effects. We hypothesized that shoeing previously barefoot horses with plain stamp shoes on the hind hooves would increase gait symmetry, alter hock angles and increase range of motion, and improve lameness scores more than shoeing with traditional fullered shoes. At the start of the study, gait symmetry via wireless inertial motion sensors (IMS), kinematic gait analysis (hock angle and range of motion), and American Association for Equine Practitioner’s (AAEP) lameness scoring were completed for 14 barefoot horses. Horses were then trimmed and hind hooves were shod (wk 0) in three-quarter fullered shoes or plain stamp style shoes. Horses were trimmed and re-shod at week 6. At the end of 12 wk, the IMS analysis, kinematic gait analysis, and lameness scoring were repeated. Differences between shod and barefoot values were calculated for each horse, and impact of shoe type was analyzed via t-test. Significance was determined at P ≤ 0.05. No differences were observed in the IMS scores, hock angles or range of motion, or AAEP lameness scores between horses shod in fullered or plain stamp shoes (P ≥ 0.08). As no variables were determined to be significantly different between the two shoe types, data from all horses were combined to analyze the differences between the barefoot and shod state. Shoeing increased the maximum angle of the right and left hocks (P ≤ 0.03) and the minimum angle of the left (P = 0.02) but not right hock (P = 0.23) relative to barefoot conditions. No differences in hock range of motion were observed in either hock. Lower AAEP lameness scores were observed in horses when shod compared with barefoot (P = 0.001). In conclusion, shoeing previously barefoot horses improved AAEP lameness scores and increased hock angles, regardless of the type of shoe.

Keywords: farriery, gait symmetry, horse, shoeing, soundness

Shoeing previously barefoot horses alters gait characteristics at the trot.

Introduction

Athletic horses may experience musculoskeletal conditions over the course of a career, which can impact their well-being and performance. It is commonly recognized that appropriate farriery, shoeing in particular, can improve performance and lameness outcomes. Although some observations have focused on how common shoe modifications (such as lateral extensions) change the way the horse uses the limb to mediate lameness (Hood, 2006; Newman, 2000; Willard, undated), others have focused on changes in hoof morphology resulting from shoeing (Leśniak et al., 2017; Malone and Davies, 2019). The focus on hoof morphology is likely due, at least in part, to the difficulties in objectively measuring lameness. However, it is unclear how these changes may relate to lameness and/or gait symmetry.

The metal surface of a shoe results in less traction than unshod hoof material (Khumsap et al., 2001), which allows a forward movement of the foot upon impact (forward slide) therefore reducing concussion within the hoof capsule as well as the joints proximal to it. Traditional fullered shoes have a crease three-quarters the length of each branch of the shoe and the nail holes are punched within this fullering. Fullering picks up dirt and many types of footing. Plain stamp shoes lack any type of crease or fullering in the shoe. The ground surface is flat with only punched nail holes. Because plain stamp shoes lack fullering which packs with footing, they may have less grip than fullered shoes. This may provide increased slip, and therefore reduced forces on the hind limb during the slide phase of impact. Over time, this decrease in concussion may improve different variables related to lameness and gait symmetry. However, whether plain stamp shoes improve gait symmetry or measures of lameness compared with traditional fullered shoes is currently unknown.

Current measures of gait symmetry and/or lameness are varied. Lameness is commonly assessed using American Association of Equine Practitioner (AAEP) lameness scores (Committee, 2020) in clinical practice. Inertial motion sensors (IMS), which use inertial sensors to detect asymmetries between the right and left halves of the stride, have become more popular in equine sports medicine practices and research settings (Kramer et al., 2004; Keegan et al., 2011; Pfau et al., 2016; Faramarzi et al., 2017). Gait kinematic data are used less frequently in clinical practice but have been useful in measuring gait dynamics in research settings (Khumsap et al., 2001; Hobbs et al., 2006; Wiggers et al., 2015; Hobbs and Clayton, 2019; St George et al., 2021). The objective of this work was to determine if shoeing previously barefoot horses with plain stamp or fullered shoes on the hind hooves would impact measures of gait symmetry, range of motion, or lameness scores. We hypothesized that shoeing previously barefoot horses with plain stamp shoes on the hind hooves would increase gait symmetry, alter hock angles, increase range of motion, and improve lameness scores more than shoeing with traditional fullered shoes.

Methods

Horses

All animal procedures were reviewed and approved by the University of Connecticut Institutional Animal Care and Use Committee (A20-013). Fourteen horses (6 Morgans, 6 Thoroughbreds, 1 Friesian Morgan, 1 Andalusian) in the University of Connecticut riding program were used for this study. All horses were barefoot, trimmed every 8 wk, and out of work for 6 mo prior to the start of the study because of campus closures due to COVID-19. Horses completed 6 wk of exercise reconditioning using the same reconditioning protocol (barefoot) before the start of the study and stayed in consistent work throughout the study. All horses participated in the University of Connecticut riding program and were exercised 4 to 5 d per week at a moderate intensity. All horses were housed in the same facility in stalls bedded with shavings. Horses were fed a second-cutting grass hay and ration balancer (Balancer Gold, Triple Crown Feed, Wayzata, MN) to maintain appropriate body condition. Horses were turned out overnight in large paddocks. All riding was done in the same indoor arena, with IGK Equestrian TruStride footing consisting of wax coated silica, synthetic fibers, and rubber granules. Horses were assigned to one of two shoe types—plain stamp or traditional three-quarter fullered. Treatment groups were balanced by sex, breed, use, and AAEP score at the start of the study.

Farriery

One farrier completed all of the trimming and shoeing before and during the study. While horses were out of work in the 6 mo prior to the study, they were maintained barefoot and trimmed every 8 wk using the standards set by the AFA certification book (Association, 2018). During the study, horses were trimmed and shod on all four hooves at wk 0 (after data collection) and week 6 by the same certified journeyman farrier using the standards set by the AFA certification book. Plain stamp shoes were handmade by the same two certified farriers for the duration of the study and were produced to the AFA passing standard (Association, 2018). Fullered shoes were Kahn Forge Keggers. All hind shoes were 3/8-inch thickness and were quarter clipped. Shoe width (3/4 or 7/8 inch) was determined by the size of the foot shod. Front hooves on all horses were shod for the duration of the study in fullered shoes.

Inertial movement sensors

Horses wore wireless inertial movement sensors (IMS; Lameness Locator, Equinosis, LLC, Columbia, MO) on their poll, right front pastern, and sacrum as directed by the manufacturer and were trotted in hand in a straight line for approximately 18 strides for each run. Data were collected from three runs per horse at wk 0 (barefoot) and wk 12 (shod; prior to reshoeing). Automated interpretation and degree of evidence (AIDE) data provided by the IMS software were assigned to a numerical AIDE score where no lameness detection was 0, detection of a very mild lameness was 1, detection of a mild lameness was 2, detection of a moderate lameness was 3, and detection of a severe lameness was 4 to allow for statistical analysis of the IMS data. The AIDE scores were averaged for the whole horse (all four limbs), the front limbs, and the hindlimbs.

AAEP lameness scoring

Two veterinarians independently evaluated each horse based on the AAEP lameness scoring system (Committee, 2020) at wk 0 (barefoot) and wk 12 (shod; prior to reshoeing). For assessment, horses were trotted in hand on a straight line away from and toward the veterinarians, and on a 20-meter circle on the lunge line in both directions. In the AAEP lameness scoring system, a score of 0 indicates no lameness present, 1 indicates lameness hard to discern, 2 indicates that lameness is apparent only in certain situations but not at the walk or trotting a straight line, 3 indicates that lameness is present in all circumstances, 4 indicates lameness is present at the walk, and 5 indicates minimal weight bearing or the inability to move. Veterinarians were blinded to the treatment groups (shoe type). Scores from the two veterinarians were averaged for each horse.

Kinematic gait analysis

At wk 0 (barefoot) and wk 12 (shod; prior to reshoeing), horses were marked with squares of colored duct tape over the wing of the ilium, point of the buttock, patella, point of hock, cranial side of hock, lateral aspect of hock, lateral aspect of the hind fetlock, and cranial side of the hind fetlock. Horses were trotted in hand in a straight line perpendicular to a video camera in both directions. Maximum hock angle, minimum hock angle, and hock range of motion were measured for left and right hindlimbs using Noraxon MyoResearch 3 (MR3) software (Noraxon U.S. A. Inc., Scottsdale, AZ USA). Marker trajectories were collected at 30 frames per second and tracked using the Noraxon MR3 2D marker tracking analysis. Joint kinematics were extracted for each limb during the gait trials by calculating the angle between limb segments from the marker data.

Statistical analysis

Post hoc analysis was completed for differences in AAEP score, IMS AIDE scores, or kinematics data (hock angles or range of motion) between fullered and plain stamp groups prior to shoeing at the start of the study using a t-test in Prism 6 (GraphPad, Inc., San Diego, CA). For all variables, the difference between barefoot and shod was calculated (Δ = shod – barefoot) for each horse to account for individual differences in natural movement. Differences between shoe types were determined using a t-test in Prism 6. As no variables were determined to be significantly different between the two shoe types, data from all horses were combined to analyze the differences between the barefoot and shod state. These data were analyzed by paired t-test. Data are reported as means ± SEM in the text and presented as scatter plots with the mean indicated in figures. Significance is reported at P ≤ 0.05.

Results

This study combined multiple methods of gait symmetry analyses to determine the impacts of plain stamp and fullered shoes on previously barefoot horses. Post hoc analysis confirmed no differences in AAEP score, IMS AIDE scores, or kinematics data (hock angles or range of motion) between fullered and plain stamp groups prior to shoeing at the start of the study (P > 0.15). Further, to account for variation within each horse’s natural movement, data for horses shod in fullered and plain stamp shoes are presented as the change between the shod and barefoot conditions.

Plain stamp shoes compared with fullered shoes

There were no statistically significant changes observed in IMS AIDE scores in the front, hind, or full horse measures between horses shod in plain stamp or fullered shoes (Figure 1A–C; P > 0.08). There were no differences observed in minimum or maximum hock angles (Figure 1D,E,G,H), or range of motion (Figure 1F, I) in the left or right hock in horses shod with fullered or plain stamp shoes (P > 0.21). Interestingly, horses shod in both fullered and plain stamp shoes had maximum left and right hock angle differences greater than zero, suggesting an increased maximum angle due to shoeing. There was no change in AAEP score observed in fullered compared with plain stamp shoes (Figure 1J; P = 0.66), however both groups had lower AAEP scores after shoeing as indicated by the negative values.

Figure 1.

Figure 1.

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Shoe type did not affect gait symmetry and lameness variables. Previously barefoot horses were shod with plain stamp or fullered shoes. Before shoeing, and after two shoeing cycles, inertial motion sensors were used to collect gait symmetry data for the whole horse, front, and hind limbs (AIDE scores; A–C), maximum and minimum hock angle, and hock range of motion for the left and right hock were measured from video (D–I), and horses were scored by two veterinarians using the AAEP lameness scoring system (J). For each measurement, Δ = shod – barefoot measurement. Box plots with individual horse values and the mean (horizontal line) are shown. Abbreviation: AAEP, American Association for Equine Practitioner.

Barefoot compared with shod conditions

Because there were no differences observed between shoe types and some of the data suggested changes from the barefoot condition, the data for all horses were combined and the effects of shoeing were evaluated. No significant differences in AIDE scores were observed between barefoot and shod for the front limbs, hind limbs, or whole horse measures (Figure 2A–C; P ≥ 0.23). Shoeing increased the maximum angle of the right and left hocks (Figure 2D,G; barefoot right: 163.6 ± 0.9°; shod right: 167.1 ± 0.8°; barefoot left: 160.2 ± 1.3°; shod left: 164.6 ± 0.5°; P ≤ 0.03). Shoeing increased the minimum angle of the left hock (Figure 2E, barefoot: 118.9 ± 1.7°; shod: 124.0 ± 1.7°; P = 0.02) but no difference was observed for the right hock (Figure 2H; barefoot: 124.6 ± 1.5°; shod: 126.3 ± 1.7°; P = 0.23). No differences in hock range of motion were observed in either hock (Figure 2 F, I; P ≥ 0.51). Lower AAEP lameness scores were observed in shod horses (Figure 2J, barefoot: 1.8 ± 0.2; shod: 0.8 ± 0.2; P = 0.001).

Figure 2.

Figure 2.

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Effects of shoeing previously barefoot horses on gait symmetry and lameness variables. Previously barefoot horses were shod with plain stamp or fullered shoes. Before shoeing, and after two shoeing cycles, inertial motion sensors were used to collect gait symmetry data for the whole horse, front, and hind limbs (AIDE scores; A–C), maximum and minimum hock angle, and hock range of motion for the left and right hock were measured from video (D–I), and horses were scored by two veterinarians using the AAEP lameness scoring system (J). Box plots with individual horse values and the mean (horizontal line) are shown. * P < 0.05 compared with barefoot. Abbreviation: AAEP, American Association for Equine Practitioner.

Discussion

The objective of this work was to determine if shoeing previously barefoot horses with plain stamp or fullered shoes on the hind hooves would impact measures of gait symmetry, hock range of motion, or lameness scores. We demonstrated that plain stamp and fullered shoes impact IMS AIDE scores, hock angles, and AAEP lameness scores similarly. We have also demonstrated that 12 wk of shoeing previously barefoot horses increases maximum hock angles at the trot and is associated with lower AAEP lameness scores.

Inertial movement sensors

The IMS measures asymmetry in the movement of individual horses (Keegan et al., 2011) and less symmetrical movement can be associated with lameness (May and Wyn-Jones, 1987; Buchner et al., 1996; Audigié et al., 2001; Kramer et al., 2004). Inertial movement sensors can detect minor changes in movement asymmetry within individual horses. In one study, IMS were utilized to identify alterations in gait with small changes in farriery (Pfau et al., 2016). Using IMS, this group was able to discern small, yet significant changes in symmetry of movement between shod (just before reshoeing), barefoot before trimming, barefoot after trimming, and after reshoeing. In a study using road nails to increase grip, Day et al. (2020) observed small but significant changes in pelvic movement asymmetry in response to use of a road nail, which is designed to increase traction. Hind limbs make a more sliding movement over the surface than forelimbs (Back, 2001; Gustas et al., 2004) and shortened slip times are assumed to be associated with higher forces on the musculoskeletal system after impact (Back et al., 2001; Johnston et al., 1995; Willeman, 1999). If foot deceleration is the result of friction between the shoe and the ground, then the craniocaudal force should be higher during foot slide with a shoe with higher grip. However, excessive slip is also undesirable and is associated with injuries (Gustås et al., 2001; Pardoe et al., 2001). The lack of change in AIDE scores between horses shod in plain stamp and fullered shoes suggests that these shoes may interact with the footing in a similar manner. Future work should investigate different footing types and the specific interaction of the foot and the ground when shod in each shoe type. Further, the lack of differences in AIDE scores between barefoot and shod conditions indicates that overall gait symmetry was not significantly impacted by twelve weeks of shoeing in previously barefoot horses. This could be due to horses starting with gait scores that reflect relatively symmetrical gait (i.e., associated with sound horses). Starting with horses that had greater gait asymmetry may result in more improvement in gait symmetry measures and is an area for future work.

AAEP lameness scores

No differences were observed in AAEP scores in horses shod in fullered compared with plain stamp shoes, suggesting that the shoe types impacted clinical lameness scoring similarly. However, AAEP lameness scores were significantly reduced after 12 wk of shoeing previously barefoot horses. The range of AAEP scores after 12 wk of shoeing represent “very mild to mild lameness” to “no to very mild lameness” and support shoeing to improve the athletic performance of the horse. Shoeing has also been shown to impact athletic performance in other work. Standardbred horses competing shod had reduced risk of disqualification by galloping or other behaviors (not staying in gait) compared with unshod horses (Solé et al., 2020). Further, barefoot horses had reduced range of motion in the forelimb at the trot compared with shod horses (Stutz et al., 2018). Reduced range of motion in barefoot horses may not only indicate increased foot sensitivity (Stutz et al., 2018) but may also reflect less weight on the hoof/leg, although this has been shown to vary by individual horse (Willemen et al., 1994). However, it is also important to recognize that shoeing can increase the impact vibrations that are transmitted to the distal limb (Willemen et al., 1999; Horan et al., 2022). This also has implications for injury, which suggests a need for balancing the increased range of motion and impact vibrations to optimize movement in each horse.

Kinematic gait analysis

The quality of the hindlimb movement is recognized as essential for optimal athletic performance in most disciplines (Van den Bogert et al., 1994). Hindlimbs are responsible for propulsive forces (Merkens et al., 1993) and increased flexion of the hock is correlated with higher trot scores in performance tests of Swedish Warmbloods (Holmstrom et al., 1994). Kinematically, a reduction in range of motion, hock angles, and stance time are often associated with individuals suffering from lower extremity injuries (Mousavi et al., 2019). Kinematic data analysis has also been used to identify how lameness alters gait symmetry as well as how shoeing impacts lameness and gait symmetry (Hobbs et al., 2018). Although no differences were observed between horses shod in plain stamp and fullered shoes, the maximum angle of both the left and right hock were increased in shod horses compared with barefoot. The increased maximal hock angle suggests improved hindlimb use, which may contribute to increased force production and larger push-off forces at the end of the stance phase. However, the lack of change in range of motion suggests that this may not be a large enough change to impact gait quality at this time. Further research is needed to determine if this change impacts other aspects of the horse’s gait under these conditions.

Lower AAEP scores in shod horses were consistent with increased hock maximum angles in shod horses, indicating that AAEP scores agree with kinematic data. However, the IMS did not identify significant changes associated with shoeing or type of shoe. This may be due to the relatively mild asymmetry observed, with very few horses identified as “lame” by either the veterinarians or the IMS system. Previous work has demonstrated agreement between IMS data and veterinary lameness evaluation in identifying the limb in which lameness occurs (McCracken et al., 2012; Donnell et al., 2015) and the presence of lameness (Keegan et al., 2011; Keegan et al., 2012; Keegan et al., 2013; Faramarzi et al., 2017). However, gait asymmetry and lameness can be difficult to distinguish, and even experienced observers may disagree (McCracken et al., 2012; Starke et al., 2012; Keegan et al., 2013). Movement symmetry can be quantified accurately using IMS (Pfau et al., 2005; Walker et al., 2010; Keegan et al., 2011; McCracken et al., 2012; Keegan et al., 2013). Quantitative measures from IMS can detect movement asymmetries below 20%, which is lower than the limit of most observers (Parkes et al., 2009). While some expert observers may be able to detect less than 20% movement asymmetry, this is likely not the case for most individuals (Dyson, 2014). However, IMS use data from displacement in a few specific locations on the horse’s body, while a clinician observing a horse takes into account the whole animal. In our case, the clinical veterinarians were not lameness specialists, but were representative of veterinarians in mixed large animal practices. Thus, the disagreement between the IMS data and AAEP scores may be due to the increased sensitivity of the IMS, or the specificity of the IMS measurements relative to clinical observations.

This study was originally designed to test the differences between plain stamp and fullered shoes. As no differences were identified in the effects of shoe type, we analyzed the differences from the barefoot to shod condition. Thus, a limitation is that the study was not designed to include a barefoot control group, and while our data suggest that shoeing did impact the outcomes, we cannot definitively state that there were no other factors (such as continued exercise) that may have also contributed to the outcome. Future work should address this question. Regardless, 12 wk of shoeing while in a consistent exercise program resulted in changes in AAEP lameness scores and maximal hock angle that suggest that shoeing supports athletic performance.

Acknowledgements

We thank Jack Trainor CF, Charlotte Quinn, Julia Brower for their assistance, and Lisa Streff for horse management. We thank the American Farrier’s Association for the donation of the publishing costs for this article. Farriery services were donated by Foxibary Forge and Farriery. The American Farrier’s Association provided funds for publication.

Glossary

Abbreviations

AAEP

American Association of Equine Practitioners

AIDE

automated interpretation and degree of evidence

AFA

American Farrier’s Association

IMS

inertial motion sensor

F

Three-Quarter Fullered Style Shoe

PS

plain stamp style shoe

Contributor Information

Katelyn E Panos, Foxibary Forge and Farriery, Brooklyn, CT, 06234, USA.

Kristin Morgan, Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA.

Rachael Gately, Department of Environmental and Population Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA.

Julia Wilkinson, Department of Environmental and Population Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA.

Alexandra Uden, Department of Environmental and Population Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA.

Sarah A Reed, Department of Animal Science, University of Connecticut, Storrs, CT 06269, USA.

Conflict of Interest

KE Panos is co-chair of the equine research committee of the American Farrier’s Association (AFA). The AFA donated publishing costs for this study but was not involved in the study design, data collection, or data analysis.

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