Club foot results in a vertical hoof wall compared to other feet, a dropped sole and a dished front (dorsal) hoof wall. It results from a deep flexor tendon that is effectively too short. Trying to trim the heels alone does not help, and may worsen the problem.

The inferior check ligament is also known as the accessory ligament of the deep digital flexor tendon (DDFT). Inferior check ligament desmotomy (cutting), is a surgical procedure that provides more length to the deep flexor tendon unit allowing the toe out and the heel down.

This surgical procedure should always be considered in cases of DDFT contracture in foals and adult horses. It may have some benefit in relieving chronic laminitis in adult horses. It is always used in combination with aggressive heel trimming and shoeing to a more normal conformation.

The procedure is usually done under general anesthesia. It is a short and usually simple surgical procedure. After the ligament is cut, the skin incision is sutured, and the limb is bandaged. After the surgery, the horse is maintained on stall rest, with a short course of NSAID drugs and gradually increasing hand walking over a 6 week period. At that point, a gradual return to work can commence.

Postoperative management includes stall rest with gradually increasing hand walking over a 6 week period, then conditioning for work may begin. If successful, the angle of the hoof is improved and is similar to the opposite hoof, and there is minimal dishing of the dorsal hoof wall. In most cases, there is minimal swelling or scarring at the incision site.