Q: What is Ballerina Syndrome?
A: Ballerina Syndrome refers to the situation where a ‘normal’ foal changes within a few days of birth to having very upright pasterns, and walking on the tips of his toes.
Some suggest that the speed of the bone growth in these foals is too fast for the tendons to adapt, but this explanation does not fit with the speed at which the change from normal to tip-toe walking is seen. It seems more likely that the syndrome is caused initially by foot pain, and that the flexor muscles contract in response to this in an attempt to relieve the pain and give stability to the limb. With continuing pain the muscle goes into continuous contraction (contracture), which itself is likely to be painful. This therefore serves to accentuate the problem. With the contracture, the tightness of the deep digital flexor tendon is sufficient to hold the heel off the ground, and the foal walks on his tip-toes like a ballerina.
In some cases the foot pain is thought to arise as the ‘foal slipper’ grows out when there is just a small part of it left covering the toe. In some instances, this pointed cap of horn bends and distorts at the toe before growing out, and in doing so the tip of the pedal bone in the foot loses its support and presses onto the sole, causing pain. However, other causes have also been suggested.
Management
Initially the priority must be pain control to break the pain/contracture cycle, as until this is under control, the muscle cannot relax and lengthen to reduce the tension on the tendon. If the pain is felt to be due to loss of support at the toe, this area must be artificially protected and supported. The farrier may recommend putting a wedge on the foot underneath the heel to support the whole foot and thus reduce discomfort.
As the muscle then relaxes, the wedge is gradually reduced and then ultimately removed. Mild cases may settle down with just this management, but some may require a toe extension to be fitted onto the foot to stretch the muscle.
However, with toe extensions come the additional issues of stress damage to the foot and restriction of natural hoof growth.
Generally, during this time the mare and foal will be put on box rest, and the mare’s food restricted to try and slow the growth of the foal.