On this page we will look at four different cases of Long–Toe Low–Heel (LTLH) syndrome. Until now this has been a problem that has been extremely hard to reverse. Once the hoof capsule collapses, the internal structure has also remodeled. Trimming and shoeing techniques MUST address the correction of BOTH the internal and external configurations. Any attempt to correct only the external structure will fail, as the remodeled internal structure can not support it. While it is POSSIBLE to make this foot look better and possibly perform better without correcting the internal structure; to do so may create even worse and irreversible problems later on. For example, we have isolated vascular structure deviations and bone remodeling in the foot (LTLH 4). Due to the unbalanced stress placed on the entire limb by LTLH, one has to assume adverse remodeling in those joints also. LTLH1 is a 12 year old Quarter Horse that had been lame for 6 months with out any specific diagnosis. LTLH2 is a 7 year Thoroughbred pony club project. He has been refusing jumps due to the foot pain suffered on landing. LTLH3 is a 10 year old field hunter that was sent to an Agent by his Owner because he could not keep him sound any longer in spite of "corrective shoeing". Owner thought he could be sold as a pony club project for flat work only. He was sold for much more than owner expected and is jumping well again. LTLH4 is a Coffin Bone from a 4 year old draft cross gelding owned by a Farrier, trimmed regularly, lived in 75 acre field with others, never stalled, only shod once (3 weeks prior to colic death).
LTLH 1 shows the long toe and low heel configuration. This type of foot is stressing the posterior portion of the foot and all internal structures including the Navicular bone area. This is a typical foot we see as “heel sore”	In this shot you can see that the wall to your left is beginning to flare allowing the foot to become flat in the sole. Tearing of the white line will be evident in a foot such as this giving us what has become known as “white line disease” This will manifest itself into a wall that will begin to crumble if left uncorrected.	In this shot you can see that the heels have contracted and are beginning to sink as well. This leaves little room for the digital cushion which is needed for shock absorption and to aid in expansion for proper blood flow.
LTLH 2 In this shot you can readily see that the foot has collapsed and the sole has become flat. There is very limited depth if you measure a vertical line dropped from the hairline at any place on this foot. This leaves no mechanism for shock absorption and greatly reduces blood supply to the entire foot.	In this view of the same foot, you can easily see that the walls are both flaring. That action aids in reducing concavity to sole as discussed on last view.	Here you can readily appreciate how much less width and depth the heel region has than even LTLH 1 has. This horse is hammering the Navicular Bone and fracturing the bars of his foot. (note you can hardly see the heels of shoe)
LTLH 3 Note that the toe of this foot is remodeling by developing "humps" part way down from hairline as a way to accommodate more flatness of sole due to tearing of the laminae causing lack of attachment to coffin bone. You can see reoccurring bumps along the length of the toe as the wall grows out. You can also see redness in quarters indicating internal hemorrhaging due to wall separations.	In this view, you can see the barshoe that they have been attempting to hold the foot together with so he can still perform. While it is possible to keep a horse showing this way, it will eventually catch up with him and turning him around will be a big job. It is also important to note that over time, there very well may be irreversible damage from lack of proper blood flow due to compression of the vascular structures.	This is the oppostite foot of the photos to the left. As well, he has been wearing a lot of repair material on this foot to give them something to nail to. You can see (after removing the bar shoe) that not only is there very little intact wall (most of wall is plastics) and the sole is extremely flat, but the heels do not come anywhere near to the back of the foot where the frog ends. When you look closely, you can also see where the bar shoe was digging into the frog at the rear.
LTLH 4 You can see in this photo the type of vascular damage I spoke of on the top of page. It would appear that there was so much overloading of this coffin bone that the insertion point of the Vascular Arteries into the posterior of the bone have remodeled. You can see that the one to the right is much smaller than the one to the left. In my research I have seen that many times, but ONLY in coffin bones that are not symmetrical.	This photo is the same coffin bone as it lays in the foot. You are looking at it from the front of the bone. You can readily see that there has been a lot of remodeling to this bone. To the right, for example, the bone is not as deep as the left portion.	This is the bottom of the same coffin bone with the toe at the top of photo. If you look at the toe region you can easily see that the bone has taken on two totally different circumferences/shapes. This type of degeneration seems to be related to too much compression at the toe of the foot due to excess toe length. © Martin D. Kenny 2006