The extensibility or otherwise of tendon ....

Most studies of muscle/tendon extensibility in live subjects consider the muscle and tendon as a unit - for obvious reasons.  Histological studies of cadaver tissue have to replicate the complex biomechanics of the living animal - which is always difficult. 

Plus there's the fact that, just because something can stretch in certain situations, doesn't mean it should. 

When considered as a unit - the horse's digital flexors are highly extensible and it is agued that the digital flexor tendons themselves stretch by up to 10% of their resting length. 

Most skeletal muscle has a voluntary action - ligament doesn't and nor does tendon in isolation from its muscle; their action is automatic.  Joints have a certain range and direction of motion - if they go too far away from that, damage occurs.  To avoid excess strain (to the joint and other bones and muscle/tendon units), the voluntary control of the muscles which act across a given joint needs to be precise. 

This is why - as I always understood it - tendon is practically (in the sense of essentially) inextensible. Any significant degree of involuntary stretch in the tendon would reduce precise control.

Muscle both effects and controls movement by contracting (pulling) and playing out (lengthening).  It also can have a passive, stabilising (semi-automatic) action - and that's nowhere more obvious and important than in the role of the digital flexors in the horse. 

The front limb digital flexor muscles are part of the fetlock suspensory apparatus and, although they are normal contractile tissue and their action is voluntary,  the DDF muscle in particular has an important passive action and, because of the check ligaments, both muscle systems can act automatically - to a degree.

The digital flexor muscles have check ligaments that run from tendon to bone (cannon and radius) which allows the muscles to back up the suspensory ligaments by cutting off the muscle belly from excess strain -ie diverting it to bone. 

The suspensory ligaments can stretch massively because they are not true ligament - ie they contain muscle fibres - but their action is completely automatic i.e. the horse doesn't voluntarily lengthen or shorten them - which is why they are backed up by the flexor muscles. Without strong and balanced muscle systems, the suspensory ligaments will receive too much strain - acute or chronic - and break down. If the suspensory ligaments are too slack or are injured, the digital flexors receive too much strain.

If the digital flexor tendons were capable of a significant degree of automatic stretch, in addition to the extensibility of the muscle itself, why would the check ligaments be needed? And wouldn't an automatic stretch of the flexor tendons place the check ligaments at greater risk of strain? Ditto the suspensory ligaments?

In addition to aiding the automatic function of the suspensory ligaments in the fetlock suspensory apparatus, and the dynamic function of flexing the coffin joint, the deep digital flexor has a passive role in keeping the elbow joint in optimal extension in rest stance.  A certain tension of the DDF tendon and the weight of the DDF muscle (plus correct operation of the SDF system) hold the elbow joint in an optimal extension in rest stance - without which the horse cannot maintain optimal shoulder joint and scapula angles - and as a result cannot fully relax its skeletal muscle whilst upright. The consequences should be self evident but sadly are not.

The extensibility (the ability to lengthen and shorten) of the flexor unit  is (or should be) in the muscle - and a 10% automatic stretch of the tendon itself would reduce the flexor muscle / tendon unit's efficiency and precision in all its critically important functions.

This does not mean that the tendons are just passive cords - they store and release energy but not in any simplistic sense. Also - is the energy store and release of a compressed and released 'spring' different from that of a stretched and released spring?

We always need to remember that the horse has evolutionary imperatives which do not always fit with our ideas of what it should be able to do.  Left to its own devices it will seek to conserve energy and avoid injury and it will not normally choose to place the excessive stress on the suspensory apparatus of the fetlock joints which we impose on it by asking it to 'bounce' up and down with a rider on its back, gallop long distances or leap huge obstacles.

Have we bred greater tendon elasticity into horses as we have bred for longer legs, greater size? 

The greater the elasticity in a tendon - the less precise the control over the joint it attaches to. For the horse, the added force that might be gained from elastic tendons may be paid for in the greater potential for injury of a reduced control of position.

The much neglected stay apparatus

The stay apparatus (SA)  is a woefully neglected aspect of the horse's physiology. Ask even specialist vets about the stay apparatus and they are likely to describe the arrangements in the hind leg. I have even heard an equine vet state there is no such thing as a forelimb SA. When asked if he had any comment about a racehorse which was standing like a goat on a rock he said that was how the horse liked to stand.

Put simply - if a horse cannot engage its fore and hind limb SA, it is in trouble. The form that trouble takes, how bad it is and when it strikes are all dependent on the individual horse but trouble there will be.

Whether the trouble will be attributed to a failure of the SA is another matter  and therein lies the BIG issue for me.

A horse which falls down when sedated, a horse which buckles at the knees when it doses off, a horse which persistently stumbles, or which buckles when one leg is lifted off the ground - all are likely to be suffering from muscular weakness / discomfort  originating in a inability to engage the SA optimally. And the origin of that is very likely to be in the hoof. Even if it hasn't originated in the hoof, chances are the hoof will be a major part of the problem.

The horse is a prey animal; its defence is flight. It has evolved the incredible evolutionary advantage of long light weight limbs which grant speed and conserve energy. It also evolved the ability to rest mostly upright, which gives it a standing start. It achieves this feat by placing its limbs in a certain arrangement that utilises body weight, tendinous muscle, ligaments and fascia to hold the skeleton in balance - thereby allowing the bulk of skeletal muscle to fully relax without the animal falling in a heap.

Skeletal muscle is, for the most part, about movement; muscles act across joints to move the limbs. Muscle is not efficient at carrying direct persistent load. You can try this yourself by standing up and leaning forward as far as you can without falling over. See how long you can stay like that. Or lift your shoulders up towards your ears - and hold them there. Stress posture is used by some unpleasant humans because it is a very effective form of torture that doesn't leave visble scars.

The horse that is unable to fully relax the bulk of its skeletal muscle whilst upright cannot have healthy muscle. Asking it to then carry the load of a rider and tack and perform athletically is going to cause harm - of some sort, to some degree, at some point.

If horse owners and riders don't know this, there is some excuse. If they do know and they persist - there is no excuse.

Finally, to that vast array of professionals out there who make their living out of horses, if you don't understand this, may I respectfully suggest you take up golf.

Some more thoughts on the ground parallel pedal bone

The coffin joint is the first joint in the body to experience ground reaction forces (GRF).  The light weight pedal bone (P3) with its fine distal margins, is especially vulnerable to damage from both impact and unphysiological pressure.  The palmar/plantar processes of P3 are finer than the main body of the bone.  Everything about the way the hoof and limb should respond to load suggests the need for protection of the back of the foot from too much load; so why would or should the coffin joint extend further on touch down or as peak strain is experienced?

The common argument is that, to protect the coffin joint from extending below ground parallel under load (tilting backward), P3 must sit at a positive angle in rest stance.  There is no consensus on what this angle should be but, because the front limb carries about 60% of the horse's body weight at rest and is most prone to damage, the assumption is the fore limb P3 should sit at anywhere between 3 and 10 degrees above ground parallel. This often results in the hind hooves having the same or an even shallower angle than the fores  and in fact, long heeled, steep angled fores and low heeled shallow angled hinds are disturbingly common.

Because the horse gets most of its rest upright, and as a prey species its key evolutionary imperative is to conserve energy and avoid injury, its skeletal balance is critical to its overall health.  The further away from ground parallel the pedal bone is, the greater the impacts are on this essential balancing act.  High heels with a steepened P3 throw the balance out; heels that are too low and/or the presence of heel pain which the horse alleviates by for example elevating its pastern, will also throw the the balance out. 

The evolutionary advantage of a long limb with one hoof attached to it and no weighty muscle below the knee/hock, has the potential disadvantage of the loss of the shock absorption that is conferred by the pads and muscles of the multi toed limb. This is why the horse has a range of impact dampening and energy absorbing mechanisms - including the suspensory apparatus - to  dissipate the potentially harmful effects of concussion on bone and of excessive torque and lever forces on soft tissue. 

When in neutral (rest stance) the fetlock joint (FJ) is already extended. It is held in permanent extension by the suspensory ligaments (SL) and by the passive action of the digital flexors which have check ligaments that run from tendon to bone to cut off the muscle belly from excessive strain experienced as the fetlock hyper-extends. When the FJ is at full extension - the pastern can be at, or even beyond parallel to the ground, but, like many other things, just because it can, some of the time doesn't mean it should, all of the time.

The leaf spring action of the pastern is facilitated by the loading surface of the FJ being increased by the proximal sesamoids, to which the SLs attach. The SLs contain muscle fibres which allows a far greater elasticity than normal ligament. 

Ligaments in the coffin joint run from the distal sesamoid (navicular bone) to the back of the short pastern bone (P2) and the long pastern bone (P1). These are described as a suspensory apparatus also, BUT they are normal ligament and it seems to me that they do not facilitate extension of the coffin joint but limit over extension.   

The coffin joint is not capable of anything remotely like the extension enabled by the suspensory apparatus of the FJ. It's greatest range of motion beyond neutral is flexural; the fetlock's greatest range of motion beyond neutral is extension.  And the coffin joint's action is the first to be affected by the impact and resistance of the ground.  

Taking the front limb only in order to simplify things, the stance phase of the stride starts when the hoof touches down - which it does as the limb is being retracted and is travelling forward and downward.  The hoof touches down heel first but only fractionally. The faster the pace, the greater the load but the more fleeting any given part of the phase is. 

There is a very rapid deceleration as the hoof is planted - it goes from movement to planted in milliseconds and huge concussive and torque forces are at work. The faster the pace the more rapid the deceleration is.  Initial impact is dampened by several elements: the lateral expansion of the heels, the soft tissue of LCs and frog/DC complex, the blood in the hoof etc. 

GRF peak is in the middle of the stance phase when the full body weight passes over the planted  limb. Assuming all other things are equal - cannon and radius are vertical to the ground; the CJ and PJ are flexed (they should work together) and the FJ is hyper extended, with the SLs, backed up by the digital flexors, taking the load. This is the point of greatest strain on the suspensory apparatus of the fetlock joint.

The SLs have extensor branches which merge with the common extensor tendon at the extensor  process of P3.   As the SLs reach peak strain these extensions pull back on the extensor process and have the effect of making the toe more rigid -ie they help to stabilise the CJ.

Late stance is the initiation of break over where the body has to overcome the resistance of the ground on the toe of the hoof. The longer the toe and / or the deeper it has dug into the ground, the greater the effort required and the greater the lever force on the toe. 

How the limb actually meets the ground depends on a number of factors. The  fractionally heel first landing at speed is only visible under slow motion. 

The angle of the scapula is determined in part by conformation but also by the angle of the elbow - which is highly influenced by both the passive and active functions of the digital flexors and the deep digital flexor (DDF) in particular.  The weight of the DDF muscle, held in passive tension by the correctly tensioned DDF tendon, holds the elbow joint in extension. Change the insertion angle of the DDFT in the back of P3 or damage the DDF muscle and a domino effect is created.

For example, a long heel (or a too short toe) results in a steeper hoof-pastern angle. This alters the angle of insertion of the DDFT and with that the degree of elbow extension which results in a steeper angle of the scapula as the shoulder joint changes angle to accommodate.  With a steepened scapula the horse cannot raise its forearm as far; in effect the protracted limb is straighter and lower and the toe flips up - something which some people think is a good thing because it is seen as necessary for the much desired and grossly misunderstood  'heel first landing'.  A toe flip is NOT a good thing.

In other words, if there is too much extension in the knee and fetlock joints during protraction, the horse cannot swing the limb forward as far and the toe flips up, the coffin joint may be too extended when it comes into land. This is as damaging to the joints as the opposite where the CJ is flexed at touch down and the hoof lands toe first, and it is a situation in which the back of the CJ is highly likely to be stressed. 

Everything I know - and I may be missing some vital piece of the puzzle -  says to me that neutral position for the coffin joint is when P3 is at  or very close to ground parallel when the horse is in rest mode - ie that point when the musclo-skeletal system is in an alignment that best permits the relaxation of all major muscle groups.  The coffin joint needs to be in, or very  close to neutral at initiation of the stance phase as either too flexed or too extended risks stressing the CJ which has the capacity to absorb some stress - but nothing like that which the fetlock is structured to absorb. Even that will break down if the peak GRFs are too much for it.

Dynamic action, however extreme, is fleeting compared to the persistent loading in rest stance but it can (and does) result in catastrophic injury if peak strain exceeds the limits of any given part of the system. The ligaments in the horse's joints are so strong that bone fractures are more likely than dislocations.  In rest stance any damage done in movement is repaired. If the rest stance is compromised and as a result  repair of damage is impaired or slowed, the animal is more at risk of traumatic injury when peak load is experienced. There are also a whole constellation of other consequences. 

If the caudal hoof is deep and strong (ie vertical integrity of heels and bars, robustness of lateral cartilages, and of the frog/digital cushion complex); the suspensory apparatus is healthy, and there is a balance between strong healthy flexor and extensor muscle systems - I cannot see why P3 can or should tilt caudally either on initial impact or when the suspensory apparatus is under peak strain.   If it does occasionally do so in a healthy hoof which is being subjected to an extreme load, the structures of the CJ should be able to absorb it.  Problems arise when less than optimal structures are exposed to extreme load and this is made much worse when that load is repeated over and over.

All other things being equal, the horse will seek to conserve energy and avoid injury. WE make it do stuff that runs completely counter to that key imperative. We force it to run faster and further than it would ever choose or need to in nature; to leap obstacles it would prefer to go around, and to maintain display postures past the point even the most testosterone fuelled stallion would choose to - with the added burden of saddle and rider and the effects, on respiration, of a bit in its mouth. 

Too often the demands of utility - our needs - ride rough shod (pun intended) over those of the horse.   And too often healthy debate about these issues founders on the rocks of sectarianism and vested interest. 

Another case of no hoof, no horse .....

This horse was a galloper which won its owner a lot of money - I saw the photos below in the local paper when the horse was being prepared for a $100k race in Canterbury and was appalled at the state of the feet. 

I found the photos again recently and wondered what had happened to the horse as I'd had a bet with myself that he wouldn't make it past the age of seven.  I found out that he was put down in 2008 at the age of five.

He had fractured his off fore leg while recovering from surgery on the near-fore. According to the newspaper report, he was kicked in the leg two weeks earlier and was withdrawn from a race when it was discovered the injury was worse than first thought, then needed surgery because of its slow recovery - and while recovering from that, he fractured the other front leg.

I'd like to know the real story which I imagine has a lot to do with the grossly imbalanced feet - and that boxy, upright near fore in particular.

The poor animal was racing on distressingly bad hooves. He had the classic high/low syndrome in the fores and the equally classic, if less commented on, medio-lateral imbalance and long toe syndrome in the hinds.

That near fore is bolt upright and half the size of the splayed off fore; the near hind looks to be extremely inside high (or outside low), and the off hind is splayed and very long in the toe.

I can see enough just from these photos to know that this horse should not have been racing. Anyone with any understanding of equine anatomy and physiology will know that these sort of feet will be creating horrendous stresses on the rest of the body.

This horse could not land or break over evenly; he was deloading the near fore and over loading the off fore; his hind toes were too long,  and the quality of the wall horn suggests there was an on-going and severe inflammation - metabolic or mechanical, or both.

And, importantly - he would have been unable to utilise his fore limb stay apparatus optimally - and very likely would have developed hindlimb complications as well if he had lived longer.

Either the trainer, farrier, owner, race vets and officials and newspaper reporter were all ignorant of the wide-ranging ill-effects of these sort of hooves, or they were aware, but didn't care.

I am reminded of an equine vet I once accompanied to do a vet check on a race horse; when asked if he was concerned about the horse's 'goat on a rock stance', he said, 'that's just the way he likes to stand'. When asked about the effects on the fore limb stay apparatus of standing under so severely, he said 'there is no stay apparatus in the fore limb, only the hind limbs.'

I was so gobsmacked, I was speechless.

I'd lay odds that the unnaturally skinny, three-year old harness racer en route to Australia never made it past his sixth birthday either.

Arterial flow and bone alignment

Above is an x-ray of a horse with a severely rotated (broken forward) P3, with separation from the hoof capsule. It's pretty obvious that the heels are very high, there are compression areas of the horn below the coronet at the toe indicating long standing pressure there, and the bone has moved away from its normal anatomical position of being parallel to the hoof wall.

The P-angle is very extreme, with the bone almost standing on its tip.

Strasser argues that the arrangement of the bones of the coffin joint in such a hoof, mimics the situation that occurs for a split second as the fetlock joint descends under load.

Rotating the photograph so that P3 is about ground parallel and digitally removing the flared capsule, shows how this might occur.

The arrangement of the pastern bones relative to the navicular bone at the back of the coffin joint is the same as occurs under load. Strasser says this means that the momentary reduction in arterial flow that occurs normally on pastern extension, is permanent in such a hoof.  Obviously blood flow is not completely shut off as happens in full pastern extension for a split second, but it is impaired, which increases pressure in the arteries and results in a loss of bone around the artery entrance points.  

She also argues that, because the heel is supplied by an artery which branches off above the cut off point, the enervation of the heel region is unaffected, but the enervation of the toe region is affected which explains why a horse may continue to load even a badly damaged toe in preference to its heel. 

The P-angle

I want to get back to this issue of the palmar / plantar angle (P-angle)  and what the anatomically 'correct' range of angles is.

When a vet speaks about 'rotation', s/he is referring to the difference between the angle of the dorsal wall of the hoof capsule and the angle of the dorsal surface of the pedal bone (P3) - to a hypothetical ground plane.  

A front hoof may have a dorsal angle of 55 degrees with a pedal bone also at 55 degrees but that arrangement of the bones will not be considered to be 'rotated' even though the pedal bone is sitting at 10 degrees or so above ground parallel. 

In other words, the alignment of the bones of the limb may not be seen as pathological unless there is an obvious lameness, and/or there is a difference between bone and capsule angles. 

In this example, the bone is clearly at a different angle to the hoof wall and it is broken forward at the coffin joint.

The question is - does that steepened hoof form lead to lameness and to what the vets term, 'rotation'?

Strasser argues it does and she uses two different terms to delineate the situation where the boney column is misaligned (rotated out of its physiologically normal alignment to the ground and / or the other bones of the limb); and the situation where the bone and the capsule are no longer parallel to each other. She calls the bone misalignment 'rotation' and the difference in dorsal angles, 'separation'.

It is therefore possible to have rotation without separation; separation without rotation, or both. 

In a previous blog I said that a positive P-angle (forward of ground parallel) will be more easily tolerated than a negative P-angle. The effects of a persistent, slightly positive P-angle on the suspensory apparatus of the fetlock and that of the coffin joint, the laminar connection and the solar corium etc are less immediately obvious than the effects of even a slight negative angle. 

All joints have an optimal 'neutral' position and for the horse this is especially important because it is only when the joints of the whole body are in neutral range that the stay apparatus, with its system of lever forces, balances and alignments, enables the horse to fully relax its skeletal muscle whilst upright. 

The horse did NOT evolve to rest whilst recumbent - on the contrary,  it gets most of its 'rest and recuperation' as an adult whilst it is upright. The younger horse may cope well with misalignments that compromise its stay apparatus, it may even survive into old age, but there will be damage.  Depending on the indiviudal's genetic blueprint and its interaction with its environment, that damage may have an early onset and may be catastrophic, or it may manifest in symptoms and conditions that are not easily seen as having anything to do with a compromised stay apparatus.  

Put simply, a horse than cannot engage its stay apparatus optimally is en route to a host of locomotor and metabolic problems. 

The vexed question of course is what is optimal? We sit down and lie down to rest and to sleep and we may not easily understand from our own experience what it feels like to the horse not to be able to relax its skeletal muscle fully when upright. Try holding your arm out sideways at shoulder height for any length of time and that question is quickly answered. The horse's flexor and extensor muscles, like those in its back, are normal skeletal muscle, ie they are structured to act across joints to effect movement by contracting and relaxing/playing out, they are not meant to be persistently contracted.  Persistent contraction leads to energy deficit and damage.

You have only to look at the structure of the pedal bone to see how improbable it is - in evolutionary terms - for a bone of its shape and structure to sit at 10 degrees or so above ground parallel - especially  in the main load bearing limbs.  It is equally improbable that the hind hoof pedal bone, which is always steeper and more concave than the fore foot bone, should sit ground parallel and have a shallower dorsal angle than the fores.  So common is this in conventionally managed horses, skeletons in museums have been assembled with the fore and hind pedal bones reversed.

Many farriers 'dress' the front hoof to have a positive P-angle, and the hinds to be ground parallel. I would welcome an explanation of the anatomical and physiological logic of that. 

An argument for the positive P-angle in the fore feet is that the horse lands heel first, and if the pedal bone is ground parallel when the hoof is unloaded, the heel first landing will stress the back of the coffin joint. And indeed that may the case when the soft horn/soft tissue structures of the rear part of the hoof and the suspensory apparatus of the coffin and fetlock joints are compromised.

Heel first landing occurs as the limb is being retracted and the hoof not so much lands, as touches down heel first at faster paces. Generally the horse lands flat in a slow walk. At a faster pace, both the number of times a given hoof touches down and the impact force increase, but the time each hoof is on the ground decreases. The faster the horse is moving, the more fleeting any given point is, in other words, the number of touch downs increases, the time any part of the hoof is on the ground decreases. Full load occurs as the body weight passes over the vertical axis of the limb when the whole hoof and the coffin joint is equally and evenly loaded.

In an optimal limb the back of the hoof is strong and deep, ie the lateral cartilages are thick and not deformed, the frog pad is deep and strong, the digital cushion is not degenerated into fatty tissue, the wall and bars are strong and retain vertical integrity; the suspensory apparatuses of the fetlock and coffin joints are strong and healthy, and the flexor muscles are strong and healthy and in balance with the extensor system.

If the limbs of the horse are in optimal condition from ground to spine and the stride is normal, why would the coffin joint with a GP pedal bone over extend under load?

The fetlock and coffin joints have sesamoids to increase their surface area - to spread load and to enable them to go through a greater range of motion. The fetlock joint has a far greater range of motion than the coffin joint obviously and has a complex system of back up with first the superficial digital flexor tendon and then the deep digital flexor tendon coming into play with their respective check ligaments that serve to protect the belly of their muscles.

Problems for the suspensory apparatus of the coffin joint arise when the stay apparatus is compromised by persistent misalignments, and / or the back of the hoof is weak.

A common example of a weak caudal region is a long but low heel (underslung); deformed, splayed bars; deformed and thin lateral cartilages; thin prolapsed frog; degenerated digital cushion; compressed bulbs. Such a hoof exposes the back of the coffin joint to stresses.

But the answer to this hoof form is not to stand the pedal bone on its tip by elevating the heels, but to trim and manage the horse so it can regrow a strong heel that can retain vertical integrity.

Yep - easier said than done -and success depends on a fairly intact bone. So, the best answer is, don't let the hoof get like that in the first place!!!