High Heels I (High – Low Syndrome)

High/Low Syndrome


This horse exhibits what is sometimes called “high/low syndrome” with one foot having high heels usually on a contracted foot (which may or may not be a clubfoot),  and the other with low and sometimes underrun heels,  flat and  lacking concavity.  The horse usually stands in a scissor stance, with the high-heeled foot back behind him and the flat foot in front of him, due to the discomfort of weighting the back of the high-heeled foot, which creates a vicious cycle of exacerbating the high heeled condition.

lfaug04bef.jpg               redaug04-2.JPG     9904side-2.JPG   112404lfside2.JPG

Before                                      August                          September                         November

When the heels are high, the flexor/extensor tendon balance is disrupted. There is too much tension on the extensor tendon and too little in the flexor.  The excessive tension resulted in this injury of the extensor tendon leading to the swelling and convex appearance of the pastern. Withing three months’ time the heels have been lowered, the swelling has gone down and the pastern angle is not as steep. High heels are correctable with trimming, and are not prevented from doing so by a “contracted digital flexor tendon”, or from pressure in the digital flexor tendon.  The pastern angle is variable, not fixed, and rather determined by the height of the heels – as demonstrated by lowering the heels.


The other foot has begun to show some improvement in the underrun heels and shallow toe. The two feet are much more similar in terms of heel height. This better balance has beneficial effects throughout the horse’s whole body as he is able to use himself more evenly, reducing injury, soreness and incidence of arthritic conditions.

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  1. my horse has high/low syndrome and i dont know if i should leave his feet bare because right now we have pads put on him so i need some help

  2. Hi Erica,
    If your horse has this condition, it will be corrected with proper trimming, not whether or not he has pads on or even shoes.
    Most farriers mistakenly believe that when a horse has higher heels on one leg, he ‘wants’ to grow it that way, or even that the tendon is shorter on that leg. As you can see by these photos, it is possible to correct and equalize heel height by frequent trimming (something which is not possible with shoes). It is also important to remove all sources of heel pain by removing any excess sole or bar horn which is pinching or pressing the back of the foot, preventing your horse from weighting his heels, and thus allowing them to grow steeply.
    Whether or not he has pads on is neither here nor there. Another benefit of barefoot is (once sources of heel pain are removed), the horse can wear down his own feet between trims and this encourages equal heel growth.
    Please feel free to send your pictures to the email listed under ‘contact us’ for a more specific consultation and perhaps a recommendation to a trimmer closer to you.

    HOpe this helps.

  3. excuse me…but the high low syndrome produces lameness…thank you..

  4. Yes it does produce lameness. Once you have corrected it, you no longer have the lameness. What is your point?

  5. is it better for horses with high/low to be outside moving around a lot or is it better for them to be kept in paddocks so they do not wear the feet unevenly at a faster rate?

    • Well, the best thing for the horse would be to correct the high/low syndrome. It shouldn’t be that hard to do in many cases, starting with correct trimming and following up with bodywork, correct training, etc. Then the horse can be turned out as much as possible, which is preferable. Granted it is easier to correct high/low syndrome barefoot because you can trim little and often.

  6. sorry one more question, how do you know if it is a club or a high heel? my horse has nice wide heels on the more upright which makes the vet think it is not a “club”

  7. I have two horses with low heel high heel. One that is REALLY bad. Would you be willing to help me from a distance to fix this? I am willing to pay you and would send photos to correspond with you? Please let me know.

  8. I have a horse with stacked heels or high heels on both front feet what can i do to help this?

  9. HI Kerstin,
    High heels (or ‘stacked’ as you say) are not physiologically correct and are harmful to the horse.

    I would suggest getting a vet’s examination along with xrays, and proceeding on a course of gradually lowering the heels through successive trims. Trim more frequently if the heels grow back too quickly between farrier visits. You may need to remove shoes for a while until you accomplish this.

    Good luck.

  10. Christina,
    The condition you descibe is exactly what is going on with my horse. He is basically sound, and a lovely mover, but struggles with his canter on the left lead (high side), and is showing signs of imbalanced muscle development in the shoulders. I would like preserve the future soundness of this horse, and would really appreciate your help. We live in Texas, but I have photos and radiographs, and will happily pay you for your consultation. Thank you!

  11. Do you have photos of the horses shoulders and fronts and backs all the way up to the leg. This horse still presents with an underslung heel? My guess is his/her shoulders and possibly his fetlocks are still imbalanced.

  12. When my farrier shortened the heel height on the upright foot, my horse would not weight that foot and atrophy worsened in the shoulder. The Underrun heel shows no heel growth for height, just continues to roll under. I did not see new heel growth in your photo – can you tell me about any experience you have had with growing heel?

  13. Hi Callie,
    Thanks for your response and inquiry. What you describe is very common. It is of utmost importance to lower all areas of the back of the foot equally, not just the heel – you can’t simply shorten the heel. If you shorten only the heel without lowering adjoining areas of hoof horn, this results in pain on weighting and this is exactly what seems to have happened with your horse.

    It is a fallacy to believe that only the heels need or should be shortened on a high heel. What happens is the horse must then stand on bars that have not been lowered. This is actually more painful than the previous high heel condition; the bar is not meant to be the only weight bearing area. The weight distribution has to be shared between the heel points, the bar, and the frog. If the horse is weighting only the bar, the resulting pain causes him to unweight the heel and can result directly in muscle atrophy such as of the shoulder muscle as you describe.

    The heel height is correct in these photos – you do not want them to be higher. You are correct in that untrimmed heel will start to roll under and the result will be underrun heels. It is of utmost importance to keep bringing the heel weightbearing points (the triangular seat of corn) back to the widest point of the frog. This will allow the tubules to grow down in the correct angle, not angling forward as is the case with underrun heels.
    The September photo is actually the most correct in terms of the angle of the hoof growth – the tubules have started to roll under again in the November photo, due to backsliding in bringing the heels back IIRC.

    Do you still have this horse? If so I would recommend evaluating that foot and seeing if there is bar that is longer than the heel and impinging on the hoof causing the ‘heel’ pain.

  14. Yevette Welsh my phone # 641-856-7313

    First I’d like to thank you, your websight has been helpful.
    I bought a 10 year old Standardbred who had previously raced but was soppose to be completely sound. She had only a few hours on her back andis very green. I rode her very briefly and noticed she was a little “off”
    I asked the owner about it and he said her hooves were alittle long but assured me she was sound. I am a certigied farrier but have not been in the practice for over 10 years except an occaisional trim. When I got the mare home I was able to ride twice, then she could barely walk. She hates the saddle being put on (now I know why.) I had never even heard of this high low syndrom I have read everything I can find on it, she definitely has it. I live out in the middle of nowhere it would cost a fortune to have avet come out if I could find one willing. Its almost impossible to have a qualified shoer. I have photo of all her hooves from every angle. I have lowerd the high heel a little since the photos were taken. I would love to send you the photos and will pay for your service. I dont think I can take enough heel to be as low as low heel.
    I hate to put a wedge and shoes on I really need a second opinion If you are able to help please call me with charges. I am in the middle of moving so the internet will be difficult for me to use for awhile. If I can get an e-mail address where to send photos I can send them today.
    Thank you so much for your time.

    • HI Yevette,
      Thanks for the kind words. Please send pictures to barefoothoofcare@Verizon.net. The charges will be minimal. We can discuss by phone or email. Also if you’d like to tell me where you are located I can try and find out if there are any barefoot trimmers in the area, they do travel further than regular farriers. Otherwise since you’re a farrier I can try and tell you what needs to be done.

      As I described in the previous post, the most common error when lowering heels is not also lowering the bars along with them. If the heels are lowered without the bars and surrounding horn also lowered the bars become the highest, weightbearing point and this can cause heel pain.

      After the trimming you might need to do some followup body work on the shoulder (such as chiropractic) you might want to start looking for someone who can come out to you, or perhaps you can trailer the horse to someone.


  15. It’s funny how the first 2 pic are of equal wait on both fronts . The last 2 are of the left front loaded . That gives a false impression !!

    • Actually it gives a very true impression. That is how the horse chooses to stand – because he cannot evenly weight his feet until they are better balanced.

      • But why not take the first 2 pic of the horse loading wait on the left front too? So that way every one can truly compare.

        • Because the horse would not weight the left front. That’s the problem (that was corrected with trimming). You’d be ‘waiting’ forever for him to ‘weight’ that foot.

      • In another word what your are trying to say is the horse is non weight bearing on the left front? How does he walk? With out bearing weigh on LF . And if he couldn’t walk cause of being to lame on LF the owner would be calling a vet or a farrier , I would only hope so!! So since that did not take place I highly dout the horse was non weight bearing . I know like you know the pic looks better when he loads the LF , it drops the fetlock appears to b in a line with the hoof wall , but if the first two pic was taken the same way as the last two they would b almost the same. And p.s. he really only has about a degree or two different between the first two pic and the last two pic we as farriers can achieve that in one trimming too. So in my opion there was really no changes at all to talk about , but I can clearly see why the horse owners are confuse . False impression 🙁

        • The horse has to place weight on its LF foot when walking. When it has a choice not to, i.e. at rest, he opts for the most comfortable position for himself, in this case resting the unbalanced foot. Imbalance does not necessarily automatically mean lameness, although it can eventually lead to that.

      • But why not take All the pic the same? In the farriers and vets world if we r gonna to studies and comparison , befor and after has to b the same , other wise one can get highly confuse . In the future if one is gonna try to prove something it needs to be done correctly. Just a little info I thought I would share:)

        • Because, the point is you can’t get the horse to stand the same. If you can’t get him to stand evenly weighting both feet – until you have balanced the feet – how can you take a picture of what the horse won’t do. Th ‘point’ that is ‘proved’ is that the horse’s stance has been improved with balanced trimming. If he had already been standing square there would have been nothing to correct.

      • But you didn’t correct anything . Still has a slightly higher foot. Just appears not to be cause of the way you too the pic. If you went back and took the After pic the same as the before pic there would. Be slightly to no changes

        • Take a closer look. The angles are completely changed from the ‘Before’ shot to ‘September’. The pastern before is nearly upright, in September it is approximately at a 45 degree angle. Same with the tubules – in the previous shot they’re nearly straight up and down, in September they’re also at a 45 deg angle. If you don’t think the pastern angles have changed, what are you looking at?

  16. One of my horses has high/low syndrome. He also has a deep central sulci thrush infection in the high right hoof that I have been battling with. It was a case of occult thrush (hidden) that I didn’t know existed until fairly recently. It may have been present for a long time unbeknownst to me. I have begun to suspect this condition may have initiated the high/low syndrome. Have you ever heard of anything like thrush causing the syndrome to develop?

    • Hi Jean
      Thanks for your inquiry. It is telling that the thrush is in the “high” foot and not the low one. The high foot of a high/low pair typically has high heels, is contracted and deep collateral grooves. This is a prime environment for thrush to build up because the deep collateral groove traps manure and it doesn’t “pop out” of the hoof with movement. It is my belief that the thrush is a result, not a cause. And the cause is this hoof form which I just described. Correcting the hoof form will prevent occurrence of thrush. In your case because the thrush was “hidden” it sounds like your horse’s hoof is very contracted with very deep collateral grooves and long bars. I would start correcting this by lowering heels and bars which will shorten the depth of the collateral grooves. At this point you must treat the thrush aggressively though; the correction to the hoof form will prevent future reoccurences. Good luck!

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