The Fundamentals of the Four-Point Trim

    The technique that has recently come to be spoken of as the four point trim has provoked a diversity of responses from veterinarians, farriers and horsemen alike. It is not so much the objective behind the technique that sparks discussion, but the ethos that surrounds it. Dr. Ric Redden of The International Equine Podiatry Center, Versailles, Kentucky was outspoken in carrying his theories to their furthest possible application when speaking at the Bluegrass Laminitis Symposium in January. "This has given me a new meaning in caring for the horse," said Dr. Redden, "as well as a sense of pride in my work."

     What are the fundamentals of this apparently new development in equine foot care? The aim of the technique is to cultivate a long foot with a short toe as opposed to the 'long toe, low heel' which appears to manifest itself in today's thoroughbred. Indeed, according to Dr. Bill Moyer, another speaker at the Lamnitis Symposium, "We have bred the feet off thoroughbred horses." The intensity of the debate surrounding the four point trim does not correspond to the complexity of the technique ; as Dr. Redden says, "There is no work involved in the four point trim." The method involves pulling breakover back to within 3/4 to 1 inch of the apex of the coffin bone (P3) and the angle of the hoof in alignment with the horse's pasterns (P1 and P2). "By relieving what is in front of the apex," insists Dr. Redden, "you relieve pressure on the bones. Allow the breakover to be in a mechanical position and, provided that it is well conditioned, load the sole. In this way, you eliminate the handicaps that prevent the horse's foot growing." The heel is trimmed to the effect that its angle is at the widest part of the frog and thus there are four weight bearing points of the foot: two about 3/4 inch in front of either side of the apex of the frog and two the same distance from the back of the foot. The toe is finished by being rolled or squared and a shoe can be fitted.

     It is tangible results which give credence to any technique and this is no exception. Dorothy Crowell (nee Trapp) cites the four point trim as the reason for Molokai's sustained high performance at top level after the World Games in The Hague: " I have no doubt in my mind that it was this technique that enabled him to get as far as Atlanta. The length of his cannon bones, pasterns (P1 & P2), and toes conspired to cause considerable heel pain. The longer the toe, the more the heel collapsed and was susceptible to pain. I consulted Doug Hannum, therapist for the American team at both The Hague and Atlanta and he suggested the four point trim. My farrier became accustomed to the technique and continued to use it. When Molokai was shod before the Olympics, the official farrier reverted to a more conventional technique and the horse was withdrawn suffering from heel pain. Having seen and ridden with the results of the four point trim, I would certainly suggest it to be an effective means of therapy to increase the longevity of the performance horse, in particular the typically toed-out Thoroughbred with underslung heels." What is of considerable interest is that Mrs. Crowell, like many other horse owners and farriers, now employs the four point trim universally rather than as a means of 'corrective shoeing' owing to the positive effects on one horse. "If I had Olympic aspirations for a young horse now, I would start him off with the four point trim from an early age. Obviously with an old child's pony or trail riding horse, there would be no great need to change a healthy foot just for change's sake. A high quality competition horse, though, requires high maintenance foot care and this is a big factor in this technique's favor. I cannot see how, if performed properly, the four point trim can have an adverse effect on the soundness of a horse."

     Dr. Redden feels that his theory may be generically applied and unequivocally states that "all horses in training, regardless of breed, can be fitted with a four point shoe, modified to meet the breed requirements." He continues, "When I am told by horse owners that their horse has been crippled by the four point trim, I tell them that it is not the technique to blame, but the person who has been shoeing their horse. I can outline the technique, but I cannot teach skill." It is the dogmatism of its staunchest exponents that incites much of the scepticism that surrounds the use of the four point trim. Dr. Robert Hunt of Hagyard-Davidson-McGee in Lexington issues warning against blanket statements: "What has come into today's terminology as the four point trim is a technique to employ in moderation and in appropriate circumstances such as when a horse has excessive toe length and underslung heels, misshapen feet, cracks down the dorsal aspect or a 'chronic laminitic' appearance." Dr. Hunt also points out that each horse should be considered separately: "This technique has some very good points, but that should not mean that the farrier or veterinarian should stop treating each horse as an individual. It would be erroneous to think that some horses are not more sensitive than others and that a horse cannot be made lame by the toe being bruised from the sometimes aggressive nature of this technique. It must be understood that any time an inflammatory response is incited, it is potentially dangerous and can perpetuate a laminitic reaction. I would be wary of excessive sole loading: the sole should be a secondary weight bearer and should not be left susceptible to bruising."

     John Bates, a farrier at Keeneland and central Kentucky horse farms, is largely in accordance with Dr. Hunt's views i.e. he does not discount the four point trim, but stresses that he would prefer to look upon it "as an option rather than as the one and only technique." Mr. Bates continues: "The four point trim as an everyday method of shoeing seems to be a very drastic procedure whereby the shape of the toe is reduced thus leaving the horse more susceptible to bruising up the toe. The danger of the current trend lies in the many horse owners who are rushing to have their horses' feet trimmed with this method on the basis that Olympic riders have been known to use it."

     What has sparked off this "current trend"? Initially, it was suggested that this technique was based on research carried out on wild horses. A study of these horses showed their feet to have developed in an unconventional pattern, in spite of the fact that they had not been trimmed or shod. The hooves were short and the toe squared, there were four weight bearing points of ground contact and the quarters were unloaded, hence the four point trim. There are of course fundamental differences to consider between feral horses (the research models) and performance horses. Their environment differs: the mountainous, sandy public rangelands are likely to differ from horse farms in Kentucky. There is also a disparity in nutrition, exercise, physiology and, most significantly, shoeing. Wild horses are not shod and therefore this research does not account for the fitting of a four point shoe. "The wild horses used for research," says Mr. Bates, "are running barefoot over a rougher terrain and their feet are likely to grow into a different shape from performance horses." Dr. Redden now prefers to base his use of the four point trim on experience and the fact that he has had "consistently favorable results".

     Was this research really necessary to substantiate the four point trim and win over its doubters or is it that the technique is, as Dr. Hunt says, "The rebirth of an old concept"? Certainly the basic objective of the technique - the long foot and short toe - is not far removed from the principles of what Dr. Hunt describes as "a good, basic trim to facilitate the lever action at the toe." Indeed, Mr. Bates indicates that the principles of the four point trim have been in use as long as he can remember: "What is called the four point trim is not an entirely new concept - during my apprenticeship, eight years ago, the method was talked about as a remedial method of shoeing in certain cases where the point of breakover required correction."

     Dr. Hunt elucidates: "The four point trim is effectively a descendant - it follows the same principle of the age old rocker toed shoe and, latterly, the world class racing plate. People are now trying to dazzle the horseman with what is supposedly a new technique and apply it to every horse and every situation, however inappropriate. If the horse has good integrity wall, use it; if it has a good healthy heel, leave it alone. By similar token, it is not a cure for every ailment relating to the foot. It would, for instance be very unwise to four point trim a horse with a case of acute laminitis. The most significant development to have hit the horse industry in terms of hoof care was the study carried out in the mid-1980s which changed the centuries old conception of the correct angle of the hoof from 45-50 degrees to 50-55 degrees. In term of balancing the feet, this development is far more pertinent than anything that may have been said recently about the four point trim."

     The upshot of the publicity surrounding the debate is that it has unquestionably raised the public profile of the hoof. In essence what Dr. Redden and others are aiming for is the end of the 'long toe, low heel' and the four point trim has promoted this. Dr. Hunt asserts that: "The fact that it has brought people's attention to the dangers of the 'long toe, low heel' syndrome is by far the biggest plus of the technique." As a farrier, John Bates feels that the four point trim has "raised awareness of the importance of the foot." The debate lies in whether this much touted technique is actually a new concept or whether it is simply revisiting old ideas. There is also the question of whether it is, as Mr. Bates puts it, "part of a toolkit, rather than a cure-all." What cannot be in doubt, however, is that the current discussion initiated by the four point trim has rightly placed equine foot problems to the forefront of the horse owner's attentions.


Copyright © 1997 World Equine Health Network™ & World Equine Veterinary Review
send comments to editor@wehn.com

Presented with the author's Permission



Commentary:


Derek Poupard and I recently attended a veterinarian/farrier conference given by Gene Ovnicek at Rochester Equine Clinic in Rochester, New Hampshire. The seminar focused on the new balance trimming (Four-Point Trim). This method of trimming stems from research done on wild horses. When wild horses’ feet were evaluated, it was consistently observed that one-third of the length of the solar surface of the foot was anterior to (toward the toe) a spot just behind the apex of the frog and two-thirds of the length was posterior to (behind) this point. It was also observed that these horses had thick, callused soles; that the toe was rolled, with the breakover point about an inch in front of the frog and that the heel of the foot usually extended back to the widest part of the frog.

These are characteristics we would all like to see on the feet of our domestic horses. While our horses don’t generally live with the same footing conditions as wild horses, many of the principles of this study may be applied to their feet. The Four-Point Trim attempts to create or restore the conformation of the domestic horse’s foot to that found in wild horses.

Although I don’t believe that all horses need to be trimmed with the Four-Point Trim—good hoof health has been created and maintained through proper horseshoeing for centuries—this type of trimming may be another therapeutic option available for many pathologic problems, including the all-too-common long toe/underrun heel syndrome.

To successfully trim or shoe using the Four-Point Trim or natural balance technique, a thorough knowledge of the theory and mechanics of the procedure is essential.


 

Stephen E. O’Grady, DVM, MRCVS


© Copyright 2003 Northern Virginia Equine | All rights reserved