Effect of lateral heel wedges on sagittal and transverse plane kinematics of trotting Shetland ponies and the influence of feeding and training regimes.

Abstract: Lateral heel wedges are used to treat horses and ponies with patella fixation or bone spavin. However, these therapies are purely empirically based and lack scientific evidence. Objective: Lateral heel wedges would change joint motion in the sagittal, but mainly in the transversal planes, in healthy horses. This effect would be increased by restricted feeding and decreased by extra training. Methods: A group of 24 Shetland ponies age 3 years was used, as foals had been assigned to restricted and ad libitum (ad lib) feeding, and low and high level training groups of 6 animals each. An experienced judge evaluated passive patella luxation in the square standing pony, using a score of 0 (normal) to 4 (stationary patella luxation). The motion of the markers, glued to the skin covering skeletal landmarks on the left fore- and hindlimbs, was recorded 3 dimensionally at a frequency of 300 Hz using a modified CODA-3 apparatus while trotting on a treadmill at a speed of 3.0 m/sec, before and directly after 5 degrees lateral heel wedges had been applied to the hindlimbs. After data analysis, the kinematic variables in the sagittal and transversal plane, under these 3 conditions (wedge, feeding, training), were compared statistically using a multivariate repeated measures analysis, general linear model (P < 0.05). Results: In the sagittal plane, an acute change in hind hoof conformation resulted in a less animated trot with a less protracted forelimb and less hindlimb flexion. This is similar, although less pronounced, to the decrease in limb flexion reported previously as a result of restricted feeding. More specifically, lateral heel wedges resulted in significant changes in the transversal plane angles of all joints in the hindlimb. The stifle joint became maximally 1.8 degrees more adducted just before the end of the stance phase, while the tarsal joint was 2.9 degrees and fetlock joint 4.7 degrees more abducted (P < 0.05). In the restricted feeding group, stifle joint adduction was 85 degrees and tarsal joint abduction 5.6 degrees larger than in the ad libitum feeding group (P < 0.05). The patella luxation score was also significantly higher in this group (1.8) compared to ponies fed ad libitum (0.9). Conclusions: The acute effects of lateral heel wedges on the equine locomotor system in the transversal plane movement relieve tension from the medial patellar ligament and decrease pressure on the medial side of the tarsal joint. However, the fetlock joint experiences considerably more out of plane stress. Poor body condition resulted in a 2x worse patella luxation score, while the effect on stifle and tarsal joint movement in the transversal plane was almost 5x and 2x larger, respectively, than a lateral wedge. Conclusions: The clinical importance of general body condition for maintaining lateral stability in the equine hindlimbs is established, but future research may prove that wedges are beneficial to treat patella fixation and bone spavin in the long term.