Hindlimb lameness: what about the foot?

The foot and especially the navicular region is a typical localization for front limb lameness. However, foot lameness and navicular syndrome do also occur quite commonly in the hindlimbs. To our opinion, an important number of these cases remain undiagnosed for several reasons.

First, vets have always been instructed that foot lameness is essentially a front limb issue whereas hind limb lameness typically originates from the hock and stifle region. For this reason, a lot of vets don’t include the foot in their short list of possible localizations for hind limb lameness and therefore almost never block a hind foot. Furthermore, some of the horses with a hind foot lameness present with a misleading positive flexion; i.e. a flexion that suggests a hock or stifle problem but that becomes negative after blocking the foot and is thus directly associated with the foot lameness.

Second, foot lameness in a hindlimb may be bilateral, often quite symmetric, or may present in horses that have also (bilateral) front foot lameness. Typically, these horses present with a vaguer history: the rider has the impression that the horse is stiff, that it may have pain and tries to compensate whilst sometimes horses even become reluctant to work and compete. Empirically, a lot of these horses get diagnosed with back problems and receive multimodal treatments instead of an in-depth lameness exam with blocks and ridden evaluation to confirm the relevance of the lameness that has been blocked. Furthermore, unravelling multiple limb lameness has an inherent learning curve and is difficult because the lameness you detect is the result of the pain in that limb, the contralateral lameness and eventually a so called ‘compensatory lameness’ (i.e. hind limb lameness influences front limbs symmetry and vice versa). [...]