Abstracts / Journal of Equine Veterinary Science 31 (2011) 562-609
Materials and Methods: A total of 18 feet were collected from
Quarter Horse racehorses following euthanasia for reasons unre-
lated to the feet. In 15/18 feet, a crena was visible on the solar surface
of the foot, in the region of the white line. The crena was examined
microscopically in 2 feet. Each foot was cut parallel to the bearing
surface, and serial sections were made and prepared for histology,
from the white line crena to about halfway up the hoof capsule.
Results: The crena was found to be filled with horn tubules that
appeared similar to the tubules in the white line. There were no
secondary epidermal laminae, nor were there dermal elements
within the crena. In sections cut at the level of the distal phalanx,
the tissue abaxial to the crena appeared to be normal laminar
junction, with tubular and intertubular horn filling the space
where the dermis exists in adjacent tissue (outside the crena). The
crena tissue had the histologic appearance of the laminar wedge
found in chronically laminitic feet.
Discussion: In gross and microscopic views of the normal laminar
junction, dermal elements exist between the epidermal laminae
where the laminar junction connects hoof wall to bone. The white
line is the laminar junction distal to the bone and connects the
wall to the sole. The white line contains no blood vessels or nerves,
and thus is a safe place for nails to be placed by farriers. The crena
at the solar surface appears in the white line, and in some feet the
crena extends proximally to the tip of the distal phalanx.
When the crena extends proximally to the bone, the laminar
junction in that region appears histologically characteristic of
white line tissue, lacking both blood supply and secondary
epidermal laminae. In fact, the crena has the appearance of the so-
called “ectopic white line” found in the laminar wedge with chronic
laminitis. This white line-like tissue in the proximally extending
crena may arise when epidermal cells adapt to mechanical stress.
Such tissue change is not by definition pathological, although it
may be part of a disease process if injury persists.
Various theories dating from the 19th century to recent
commentary on the crena offer competing ideas about its causes
and possible clinical significance. A microscopic view of the crena
raises questions about the integrity of the laminar junction in this
curious solar surface structure so familiar to farriers.
Conclusions and Clinical Relevance: No firm conclusions can be
drawn from this pilot study on crena histology. Further research
in a larger number of horses is needed to fully characterize the
crena. In feet with pre-existing pathology, the crena may be one
marker of toe wall health. Monitoring of the toe region in these
feet may prove clinically useful over the course of laminitis
treatment or other hoof rehabilitation.
The barefoot paradox
Patrick T. Reilly
Farrier Services, New Bolton Center, University of Pennsylvania
Take-Home Message: The choice of barefoot vs. orthotics in
equine hoofcare cannot be made objectively based solely on the
available scientific information. Any valid parallels with human
podiatry and sports medicine suggest the use of orthotics that
provide selected characteristics such as protection while mini-
mally changing the barefoot stride characteristics.
Introduction: Owing to the lack of definitive information
regarding equine hoofcare and foot health, any management
decision made by the attending veterinarian or farrier is a mostly
subjective one, based on limited research and anecdotal accounts.
The large amount of information available on the internet can be
helpful in educating horse owners about different aspects of
horse care, including hoofcare choices, but seldom is the infor-
mation presented by its author in a way that makes plain what it
actually is: opinion.
591
How does one decide on which information to base a hoofcare
practice? Which scientific papers and conclusions can be used as
the basis for decisions about hoofcare? And how can we, as
providers of hoofcare, justify our decision-making process to
owners who have been told that, as practitioners educated in the
use of horseshoes, we have interests other than the best interest
of the horse?
Even a cursory internet search reveals the disparity of opinions
regarding the barefoot ideal. One side of the discussion are the
purveyors of horseshoes and those educated in the treatment of
foot-related maladies for which shoes are used as a treatment
modality. On the other side are those who firmly believe that the
use of horseshoes is “cruel,” and that barefoot horses “live longer,
happier, less painful lives” [1].
Interestingly, this debate is not limited to horses nor to equine
health and performance. A similar debate is ongoing in the field of
human podiatry, between bare feet and the use of orthotics in
human health and performance. As with the horse, humans
evolved without shoes until relatively recent times, evolutionarily
speaking. But unlike the equine field, human podiatry research is
well funded and it benefits from advances in technology that are
largely unavailable to equine researchers.
There are several limitations in translating research findings from
humans to horsesdanatomical and biomechanical differences
between bipeds and quadrupeds, to name just a couple of obvious
ones. Even so, there are also some undeniable parallels. The book
“Born to Runda hidden tribe, superathletes, and the greatest race
the world has never seen” by author Chris McDougal tells of the
Tarahumara Indians of Mexico, who can stride effortlessly for
hours barefoot or in lightweight sandals. The scientific merits of
this book have been debated, but it has nonetheless developed
a following which has been described as “cultlike” or having
a “religious fervor” [2].
It is telling that such disagreement exists in the field of human
footcare, despite the financial and academic advantages, as well
as direct feedback from the subject: the person wearing the shoes
or going barefoot. In light of the limited resources available to the
equine practitioner, both farrier and veterinarian, an investigation
of the human literature might provide a useful perspective on the
equine barefoot debate and help in the decision-making
processes of veterinarians and farriers.
Are there morphologic differences between shod and unshod
feet?: A comparison of hoof morphology between feral and
domestic horses is an important topic of study. Selective breeding
has, to some extent, changed the shape and structure of the horse,
foot shape being one of the differences seen among different
horse breeds. But might our hoofcare practices also change foot
shape and structure?
In its earliest form, human footwear consisted of biodegradable
materials such as plant fibers, bark, and animal hides [3]. But it is
thought that even these minimalist types of footwear changed the
function of the foot, as the smaller toes would not dig into the
ground during locomotion. This effect is thought to have led to
a morphologic change in humans wearing shoes, as the meta-
tarsal bones of the smaller digits were less robust compared with
the corresponding bones of barefoot humans [4]. The larger issue,
however, is establishing causation between this change in foot
morphology and the likelihood of injury. This link has not been
firmly established in either equine or human research.
What is the potential for elite performance without
shoes?: Not every owner requires athletic performance of their
horse. It might even be argued that elite athletic performance is
not in the best interest of the horse. Nevertheless, it is worth
examining the question of whether shoes help or hinder elite
athletic performance. The barefoot model has been promoted by
some as offering a biomechanical advantage over the shod hoof,
both in terms of hoof function and for comfort and soundness
592 Abstracts / Journal of Equine Veterinary Science 31 (2011) 562-609
[1,5,6]. If these assertions are to be believed, then the barefoot
horse might be expected to outperform its shod competitors.
That has not proven to be the case in the equestrian disciplines at
the Olympic Games. While there is no official record of the foot-
wear worn by horses competing in the Olympic Games, there
appear to be no accounts of barefoot horses winning medals in
any equestrian events. It is possible that some barefoot medalists
have been overlooked. Even so, it would have to be considered
exceptional for a barefoot horse to succeed at the highest levels of
athletic competition. There are several accounts of endurance
horses training without shoes; however, many of these horses are
shod prior to some of the more difficult events such as the
Olympic Games.
When it comes to human athletes, there are several reports that
document potential advantages to performing barefoot. Oxygen
consumption has been measured to be 2% lower in barefoot
runners than in runners wearing shoes [7], which may translate
into ability to perform for longer before tiring. Also, individual
impact patterns are more varied in barefoot runners, with lower
impact force and the potential for decreased risk of injury,
particularly among runners with a mid-foot, lateral foot strike [8].
In addition, human runners take a longer stride when shod than
when barefoot, and they are more inclined to land heel-first when
wearing shoes [9], which may increase the ground impact force.
However, the potential for increased levels of performance is not
supported by track records. Since 1960, only two runners have
won Olympic medals barefoot. In 1960, Ethiopian marathon
runner Abebe Bikila established a world-record time in winning
the gold medal barefoot, and South African/Briton Zola Budd also
won medals competing barefoot. Interestingly, both athletes later
turned to competing with shoes. Bikila competed in the 1964
Olympic Games wearing shoes and set a new world record when
he won his second gold medal. Zola Budd, who trained and
competed both in shoes and barefoot during her career, now
states: “I no longer run barefoot. As I got older I had injuries to my
hamstring. I found that wearing shoes gives me more support and
protection from injuries” [10].
Is there sufficient information to justify the choice of barefoot
over shoes?: In the equine hoofcare field, the anecdotal evidence
far outweighs the scientific data, and the anecdotal evidence
could support either stance on the issue. Horses certainly evolved
over thousands of years without orthotics; however, foot prob-
lems appear to have been present even before horses were
domesticated. A study of fossilized equine remains suggests the
presence of navicular disease long before the time of any human
involvement with horses. Furthermore, the research indicates
that the severity of lesions in the navicular bone were related to
the size of the animal [11].
The United States Navy examined this question and concluded
that there was some evidence supporting the efficacy and safety
of barefoot-style running shoes, such as the Vibram FiveFinger
shoes which allow the foot to function naturally without added
support or cushioning. (These shoes were originally designed as
boat shoes.) The list of “pros” for the use of minimalist shoes
includes stronger feet, reduced impact force, heightened
Practical – Laminitis: Treatment by Design
Understanding and evaluating the unique lameness of horses
with chronic laminitis – Parts 1, 2, and 3
David M. Hood DVM, PhD
Hoof Diagnostic and Rehabilitation Clinic, Bryan TX
proprioception, and improved balance. The list of “cons” includes
less overall support and protection for the foot, and the need for
a transition period. Minimalist shoes are not recommended for
those successfully using foot orthotics or for those with pre-
existing foot problems. Ultimately, the Navy concluded that there
is insufficient evidence to either support or refute the efficacy and
safety of the barefoot-style running shoes for military personnel.
Conclusions: With all of the resources available in the field of
human footwear research, there is no consensus as to what
constitutes “ideal” footwear. Although there are many advocates of
barefoot running, the use of minimalist-style running shoes is more
common. Orthotics that provide selected characteristics such as
protection while minimally changing the barefoot stride charac-
teristics are now available from several different shoe companies.
While many advocates of leaving horses barefoot are opposed to
the use of any orthotics, in recent years there has been an increase
in the use and availability of many nontraditional orthotics for
horses, including various styles of hoof boot, molded urethanes,
glue-on shoes, and hoof casts. Although the use of any of orthotic
is, strictly speaking, not “barefoot,” it does represent an inter-
esting middle ground. Future studies that investigate the effects
of these orthotic devices on foot morphology, function, and
athletic performance might lead to the development of new
products designed to provide the horse with the mechanical
necessities while limiting undesirable effects of hoof orthotics.
So, where does all this science and anecdote leave the practitioner
considering whether to ditch the shoes? The “evidence is not
concrete for or against barefoot or shod running,” said Allison H.
Gruber, a doctoral candidate at the University of Massachusetts.
“If one is not experiencing any injuries, it is probably best to not
change what you're doing.”
References
[1] King M. Barefoot vs. shod. The Horse Magazine 2008. article: 12778.
[2] Phys Reynolds G, editor. Is running barefoot better for you? The New
York Times; 2009; Oct 21.
[3] Bedwell SF, Cressman LS. Fort Rock Report: Prehistory and environment
of the pluvial Fort Rock lake area of south-central Oregon. In: Aikens CM,
editor. Great Basin Anthropological Conference, Selected Papers.
Eugene: University of Oregon Anthropological Papers 1; 1970. p. 1-25.
[4] Trinkaus E, Hong S. Anatomical evidence for the antiquity of human
footwear. Journal of Archaeological Science 2008;35:1928-33.
[5] Strasser H. Shoeing: A Necessary Evil? 2nd edn. Sabine Kells, Qual-
icum Beach; 2000. pp 46–48.
[6] Teskey TG. The unfettered foot: a paradigm change for equine podi-
atry. 2006; http://www.easycareinc.com/TeskeyTrim.pdf
[7] Hanson NJ, Berg K, Deka P, et al. Oxygen cost of running barefoot vs.
running shod. International Journal of Sports Medicine 2011;32:401-6.
[8] Lieberman D, Venkadesan M, Werbel W, et al. Foot strike patterns and
collision forces in habitually barefoot versus shod runners. Nature
2010;463:531-5.
[9] Wegener C, Hunt AE, Vanwanseele B, et al. Effect of children's shoes
on gait: a systematic review and meta-analysis. J Foot Ankle Res 2011;
4:3.
[10] Friedman S. After the fall: Zola Budd's running story. Runner's World
2009; Oct.
[11] Thompson ME, McDonald G, Østblom LC. Equine navicular
syndrome in the fossil record. Hoofcare and Lameness; 76:34–40.
Take-Home Message: It's not just sore feet. Within the hoof,
multiple pathologic and physiologic factors combine to initiate
the signaling that produces the altered gait and stance which
characterizes the chronically foundered horse. In addition, non-
laminitic digital pathologies as well as nondigital pathologies