High/low syndrome in horses is a podal asymmetry characterised by a “high” foot (high heels, short toe) and a “low” foot (low heels, long toe). This condition results from an unequal load on the limbs, influenced by anatomical, biomechanical and postural factors. It can lead to joint and tendon pain and reduced performance. Management is based on a multi-disciplinary approach including appropriate trimming, veterinary monitoring and training adjustments to limit the effects on the horse’s health.
What is High/Low Syndrome?
High/low syndrome, also known as diagonal syndrome or scissor posture, refers to a marked postural asymmetry in horses. This disorder is manifested by one foreleg systematically placed forward (low) and the other behind (high), causing an overall imbalance in the body. When standing still or grazing, the horse always adopts this asymmetrical position, unlike a healthy horse which alternates its stance.
This posture is often the result of a blockage of the first rib, which modifies the muscular and ligamentary tensions in the shoulders and ribcage. In the absence of a clavicle, the horse’s scapulae depend on the surrounding muscular and connective structures. Blockage of this area disrupts the forces exerted on the body as a whole, leading to a vicious circle where the horse relieves one limb while overstressing the other.
This asymmetry is clearly visible on the hooves. The ‘high’ foot, located at the rear, is taller, shorter and often tight, with narrow glomes and a reduced frog. Conversely, the ‘low’ foot, at the front, appears flatter, longer, with low heels and a receding toe.
Possible causes include trauma, position in utero, natural laterality or early postural compensations (e.g. a large foal contorting to suckle). Poor trimming or intensive sporting use can also aggravate this asymmetry.
Diagnosis is based on observation of the horse’s posture at rest or when grazing, and analysis of the shape of its feet. If left untreated, this asymmetry can have major structural repercussions , affecting joints, muscles and nerve function.
What causes this syndrome?
High/low syndrome has its origins in several possible factors, although its causes remain unclear. One common hypothesis suggests an in utero position of the foal, particularly in large individuals who contort themselves to suckle or graze. This constrained position can lead to a blockage of the first rib (and sometimes the second), limiting the mobility of the corresponding foreleg. This blockage disrupts muscle development, creating asymmetry: one side strengthens excessively to compensate, while the other remains weak and less functional.
In some horses, this asymmetry mainly affects straightness and suppleness. However, in severe cases, it can cause functional blockages that make certain movements impossible. The horse, often perceived as ‘bad’, actually suffers from a physical inability to respond to the rider’s demands.
Other factors can aggravate or trigger the syndrome:
- An unsuitable environment, such as prolonged stabling, weakens the tendon system.
- Inappropriate equipment, particularly an ill-fitting saddle, disturbs the withers and shoulder.
- Poor trimming alters the shape of the feet, forcing the horse to adopt a compensatory posture.
According to Dr Regan Golob‘s research, blockage of the first rib reduces the C7-T1 space, causing nerve impingement. When grazing, the horse instinctively moves its limb forward to relieve this area. This postural adaptation then becomes a vicious circle, contributing to high/low asymmetry.
What are the consequences of this postural problem?
High/low syndrome has major consequences for the horse’s posture and locomotion, upsetting the overall balance of the body. When the forelegs do not position or function symmetrically, the horse develops muscular asymmetries, particularly in the shoulders and pectoral muscles. The ‘low’ limb, located in front, bears a greater load, while the ‘high’ limb, located behind, is less stressed. This compensation imposes an overload on the diagonal posterior, leading to osteopathic blockages and tension in the posterior muscle chains.
The “low” foot undergoes structural changes: it becomes flat, with low heels and a long toe, while the “high” foot is higher, tighter and shorter. These deformations modify the joint angles (pastern, fetlock, shoulder), causing visible asymmetries: a bulging shoulder on one side, a protruding elbow on the other. The saddle, badly positioned because of these imbalances, creates pressure points, aggravating muscular and bone tensions.
In the long term, these postural adaptations affect the tendons, ligaments and joints, with an increased risk of podotrochlear syndrome (navicular disease), particularly in the low foot. The horse adopts a diagonalized posture, transferring its weight onto a hind leg, which generates tension in the thoracic, lumbar and sacroiliac regions. This chain reaction affects the whole body, leading to chronic pain, restricted mobility and reduced performance. Osteopathic treatment and appropriate trimming are essential to break this vicious circle.
What can be done about it?
To remedy high/low syndrome, multidisciplinary treatment is essential, incorporating interventions on the feet, posture and associated pain. Regular trimming by an experienced groom corrects asymmetrical hoof growth. By adjusting joint angles, it reduces mechanical stress and promotes balanced weight distribution.
Osteopathic treatment targeting primary blockages (first rib, shoulders, withers) is essential to restore mobility and relieve chronic compensations. Combined with practices such as shiatsu and specific stretching, these interventions help to relax the muscles and re-establish a more symmetrical body shape.
Medicinal plants play a crucial complementary role in reducing inflammation and relieving chronic pain linked to postural imbalances. Some of the most effective are :
- Harpagophytum: Thanks to its anti-inflammatory and analgesic properties, this plant relieves joint and muscle tension, particularly on ‘low’ feet, which are often prone to conditions such as navicular disease.
- Meadowsweet: Rich in salicylates, it acts as a natural anti-inflammatory, ideal for reducing moderate pain and tendon swelling.
- Blackcurrant buds: With a draining and anti-inflammatory action, they support recovery by stimulating the natural functions of the adrenal glands, which contribute to the natural production of corticosteroids.
These remedies, administered in the form of powders, infusions or macerates, enhance the effectiveness of physical care and improve the horse’s general well-being.
Regular monitoring by a multi-disciplinary team (vet, osteopath, groom) is crucial to sustaining progress, improving locomotion and preventing relapses. Plants, combined with technical interventions, offer a global and natural approach to support the horse over the long term.
