Sole Ulcers in Dairy Cattle: Associations with Season,
Cow Characteristics, Disease, and Production
ABSTRACT
Epidemiological associations, ex-
pressed as odds ratios between variables
obtained from dairy cow records and sole
ulcer occurrence at claw trimmings were
estimated with logistic regression analysis
on data from 2204 and 1124 cows in
lactation 1 and lactations 2 to 9, respec-
tively. Sole ulcer in one foot or more than
one foot occurred in 20.0 and 29.7% of
cows in lactation 1 and in 23.5 and 24.7%
of cows in lactations 2 to 9. The analysis
revealed several complicated interactions.
Trimming or calving in summer to fall
was strongly associated with sole ulcer.
Trimming later than 1 to 2 mo after calv-
ing was positively associated with sole
ulcer depending on milk yield, body
weight, or season of calving. If lactation
1 cows were treated for disease (limb,
metabolic, digestive, or severe reproduc-
tive disorders), sole ulcer in more than
one foot occurred earlier in lactation.
Milk yield in early lactation and body
weight were positively associated with
sole ulcer. Heel erosion was associated
with sole ulcer depending on season of
trimmjng and parity. Presence of sole ul-
cer but not heel erosion in a lactation
increased the risk of sole ulcer in the
subsequent lactation. The interval be-
tween trimmings appeared to be impor-
tant.
Received January 8, 1990.
Accepted August 30, 1990.
1991 I Dairy Sci 741284-1298
C. ENEVOLDSEN and Y. 1. GROHN
Section of Epidemiology
Department of Clinical Sciences
New York State College of Veterinary Medicine
Cornell University
Ithaca, NY 14853
1. THYSEN
National Institute of Animal Science
PO Box 39
DK-8830 mle, Denmark
(Key words: epidemiology, lameness,
dairy cattle)
Abbreviation key: CI = confidence interval,
DIM = days in milk, MF = more than one foot,
OR = odds ratio, SF = single foot.
INTRODUCTION
Sole ulcer (pododermatitis circumscripta) of
varying severity occurs in 10 to 80% of lacta-
tions in Friesian type cattle (2, 14, 16, 27).
Although sole ulcers must cause considerable
pain and discomfor&,only a small proportion of
cows are treated for “claw disorders” by veteri-
narians in each lactation (19,20). Because claw
disorders obviously are not recognized in herds,
the cows may suffer from pain and discomfort
for a considerable period of time and probably
have reduced productivity. The literature men-
tions the following risk factors: claw over-
growth, interdigital dermatitis, acute systemic
disease, “stress” associated with calving, m e n
acidosis, endotoxins, histamine, insufficient
supply of minerals and amino acids (cystine,
methionine), burdening (softness of bedding),
ratio of roughage to concentrate, excess protein
supply, milk yield, body weight, structure of
leg bones, size of claws, parity, time of year,
and lack of exercise. The heritability of sole
ulcer is between .10 and .30,and Friesian cows
seem to be most susceptible (6, 12, 15, 16, 17,
28, 29). Presently, most workers regard sole
ulcers as one manifestation of the multifactorial
metabolic disease laminitis (pododermatitis
aseptica diffusa).
Continuous measurement of disease inci-
dence and prevalence is essential to determine
efficiently the importance of such an endemic
1284
 EPIDEMIOLOGY OF SOLE ULCERS
disease in a herd, and subsequently, to select
the best and most efficient control strategies.
Knowledge about the cow’s health status is also
valuable when deciding which animals should
receive special attention or the highest culling
priority. An inexpensive convenient source of
information is recordings made by professional
claw trimmers or farm workers during the mu-
tine trimmings. The value of such data has been
recognized (5).
Efficient utilization of such routinely col-
lected data requires consideration of all the
information about factors that influence the dis-
ease risk of the animals. Season of year, stage
of lactation, season of calving, parity, body
weight, milk yield, and health status (both in
general and with respect to claw health) are
potential risk factors for sole ulcer which are or
could be available.
The purpose of this study was to estimate
the direction and magnitude of the epidemio-
logical associations between the potentially
available information about possible risk fac-
tors and recordings of sole ulcers in dairy cows.
Such estimates should be useful for problem
solving and monitoring the herd and for making
decisions about individual animals.
MATERIALS AND METHODS
Data
Data were from 23 Danish herds (average
number of cows = 82; SD = 25) composed of
Danish Black and White cows, which are some-
what comparable with Holstein Friesians. Data
were collected from 1978 to early 1982 to
investigate the effect of dairy cow housing
systems on health, reproduction, production,
and economics. Seven herds were kept in dif-
ferent types of tie stalls, and the rest were kept
in loose housing systems with either a solid or
slated floor. Eight herds were fed pasture one
or more summer seasons during the study.
Housing and management systems are
descrikd in detail elsewhere (27).
Technicians from the National Institute of
Animal Science visited all herds weekly and
were responsible for recording milk yield, body
weight at calving (actual weight at first calving
and heart girth measurement at the subsequent
calvings), body weight in spring and fall and at
culling, and dates of calvings and cullings.
1285
Animals were fed a feed ration of 5 kg DM of
folder beets, molasses, or beet pulp, approxi-
mately 7 kg DM of silage or hay fed for ad
libitum access, and 5 kg DM of concentrate.
The flat rate feeding principle was applied in
all herds. All treatments requiring injections or
use of antibiotics were performed by local prac-
ticing veterinarians who recorded all treat-
ments. Recordings were verified by the techni-
cians.
The claw health of each cow was recorded at
least twice in each lactation at the time of claw
trimming, which took place 4 times per year in
each herd. All claws of all cows were systemat-
ically trimmed during the first 3 to 4 mo of
lactation and again 6 mo later. Some cows
required claw trimming more frequently. The
same technician performed all trimmings and
recordings of claw health from the start of the
study until April 1, 1979. Thereafter, trimming
was performed by a local professional claw
trimmer, and claw health was recorded by one
staff member at the Institute. At each trimming,
a detailed evaluation of the digits was made.
The condition of the central part of each of the
claw soles was categorized as follows (21):
degree 1 = a yellow spot, degree 2 = light
hemorrhages occurring in stripes, degree 3 =
confluent hemorrhage, degree 4 = dark spot,
and degree 5 = exposed pododerm.
The heel region of each foot was similarly
examined for heel erosion (erosio ungulae). The
following categories (22) were recorded: degree
1 = superficial scattered erosions in the sole-
bulb junction, degree 2 = confluent erosions in
the sole-bulb junction, degree 3 = erosions
forming a distinct grove in the sole-bulb junc-
tion, and d e p 4 = as in degree 3 with podo-
derm also exposed.
AU data were storsd in the database at the
Danish Institute of Animal Science after correc-
tion of recording and coding errors revealed by
built-in logical checks in the computer pro-
grams.
statistical Analysis
The data were analyzed with a multivariate
logistic regression technique (8). The epidemio-
logic measure of interest provided by logistic
regression is the odds ratio (OR).An odd is
defined as the probability of an event or state
(in this case sole ulcer) occurring (p) divided
Joarnal of Dairy Science Vol. 74, No. 4, 1991
1286 ENEVOLDSEN ET AL.

by 1 - p. The ratio between odds, calculated for sevem-those diseases considered as risk fac-
individuals “exposed” to a hypothesized risk tors for claw disorders (summer mastitis, left
factor (e&, high BW) and those not exposed displaced abomasum, intestinal atony, peritoni-
(low BW), provides an estimate of the ratio tis, and severe metritis); 2) Limb-limb disor-
between the prevalences in the exposed and the ders of which the vast majority of diagnoses
nonexposed populations, i.e., the relative effect were interdigital phlegmon and periarthritis of
of the exposure. Odds ratios provided by mul- the hock (the specific diagnosis sole ulcer was
tiple logistic regression (the antilogarithm of excluded from the data set); 3) other-those
the coefficient for an independent variable) are diseases not expected to be important risk fac-
conditional upon all other variables in the mod- tors (e.g., other mastitis, retained placenta, and
el. If a 95% confidence interval (CI)includes mild metritis).
1.0, the corresponding OR is statistically non- A cow was categorized as having experi-
significant at 5%. The statistical analysis was enced one of these three classes of disease if at
performed in four stages: 1) data editing, 2) least one treatment for a given disease was
data reduction, 3) model selection, and 4) es- performed between 21 d before calving and the
timation of effect (18). day of claw trimming. To analyze the effect
of several diseases in combination, the follow-
Data Edltlng ing categories were created: 1) disease occur-
ring in isolation-severe, limb, and other;
Because the available data were not col- 2) two disease groups occurring-severe
lected for the specific purpose of estimating plus limb, severe plus other, and limb plus
associations to sole ulcer occurrence, the vari- other; and 3) all three disease groups occurring
ables were edited examining the data and using simultaneously-severe plus limb plus other.
infonnation from the literature. Three mutually The variables herd and year of calving were
exclusive classes of sole ulcers were created: 1) combined into one variable (herd-year of cdv-
cows with no clinical signs, 2) cows with signs ing) that indicated the calving year and the herd
in one or both claws of a single foot only, and identity. Calving year was from November 1 to
3) cows with signs in more than one foot. In October 31. The data set contained only 239
addition, cows with sole ulcers were assigned a observations during the fourth to ninth parity.
score equal to the highest degree of sole ulcer Consequently, these data were combined leav-
recorded in any claw. Because of the small ing the variable parity with four classes.
number of observations in degrees 1 and 5 , they
were combined with degrees 2 and 4. respec- Data Reduction
tively.
All independent variables were analyzed as The model to explain sole ulcer was deve-
categorical variables. For instance, the variable loped using SAS Logist (8). The Logist proce-
FCM (4%, kg) at the first test day was catego- dure fits the logistic multiple regression model
rized into seven classes with approximately to a binary dependent variable or to an ordinal
equal numbers of observations. The classes dependent variable using the maximum likeli-
with less than approximately 5% of the obser- hood method. The sole ulcer was handled as an
vations were avoided when possible and ordinal dependent variable. For the ordinal
reasonable. For example, the variable season of model, the basic assumption is that the cause of
calving, was categorized into 2-mo intervals the increase in score value of a dependent
starting January 1. Variables heel erosion at variable (e&, from 1 to 2) is an extension of
present trimming and heel erosion at previous what causes it to increase from 0 to 1. This
trimming were assigned a score indicating assumption was checked by examining the
degree of heel erosion recorded for the digit graphs of the logit cumulative probability
with the highest degree of sole ulcer. If no sole curves to see if they were parael (7).
ulcer was observed, the heel erosion status of With sole ulcer as the dependent variable, all
the left hind foot was assigned. the categorized independent variables were! ana-
The variable disease included only animals lyzed with Roc Logist (step l). No interactions
subjected to veterinary treatments. The follow- (product terms) were included in this initial
ing three classes were created initially: 1) analysis. The effects of different categories
Journal of Dairy Science Vol. 74, No. 4, 1991
 EmDEMIOLOGY OF SOLE u u = E R S
(parameter estimates) were then examined
graphically and a l l variables except herd-year
of calving were separated into high and low
categories based on two criteria: 1) if two
distinctly Merent groups or some “dose-re-
sponse-like” relationship occurred, then the
point that best separated the two groups was
selected as cutoff point, and 2) if no trend was
obvious two groups of approximately equal size
were formed.
Variables BW at calving and milk yield are
strongly associated. Such strong association
may negate the effects of closely related vari-
ables resulting in biased conclusions because of
collinearity problem. For this reason and to
reduce the number of independent variables,
milk yield (4% FCM,kg) at the first test day in
a lactation and BW (kg) after calving were
combined to one variable in the following way:
milk yield (FCM) and BW were both separated
into high and low categories, and these categor-
ies were combined into the four possible com-
binations high FCM plus high BW, high FCM
plus low BW, etc.
These newly created variables were then an-
alyzed (step 2) and excluded from further anal-
ysis if 1) no trends in the parameter estimates
in the first analysis (step 1) were evident, and
2) the probability of the chi-square values of
the parameter estimates in the second analysis
were above 25%. In the fmst and second step of
the regression analysis, the variable herd-year
of calving was included in the model.
Model Selecllon
The remaining variables were then analyzed
with interaction terms (all two-way product
terms) included in the model (step 3). The herd-
year of calving variable was not included in
any interaction terms. product and lower order
terms were removed from the model until the
difference in values of -2 log (likelihood) of
the models at the corresponding degrees of
freedom were statistically significant at 10%
(likelihood ratio test).
Effect Estlrnatlon
To provide epidemiologically interpretable
effect estimates for the interaction terms, com-
bined variables were created by forming indica-
tor variables as described above for the com-
1287
bined milk yield-BW variable. For instance, if
the final model included the terms, A, B, and A
x B (A and B both dichotomized into high and
low, and the times sign indicating interaction
between A and B), a model with the terms high
A plus high B, high A plus low B, and low A
plus high B (codedas indicator terms) provides
estimates of the effects of these terms relative
to low A plus low B. If the initial multiple
logistic regression analysis had revealed a clear
trend in the categories of a variable, or showed
that the variable was ordinal, effects were esti-
mated for all these Categories (indicator terms)
to provide a maximum amount of information
about the relationship.
RESULTS AND DISCUSSION
If the condition of the claws is to be re-
corded routinely and yet be objectively inter-
preted, recordings must be simple, quick to
perform, and have a high degree of repeatabil-
ity. The proposed classification was an attempt
to fulfill these demands and has the following
advantages: 1) many different recordings in
eight claws can be combined logically for use
in quantitative analysis, and 2) the classifica-
tion can be compared with classifications in
other studies. In the most frequently used
methods of total lesion scores, the same score
may represent one cow with one claw severely
affected or one cow with several claws mildly
affected.
Cows with sole ulcer in one foot (SF), and
those with sole ulcer in more than one foot
(MF) were analyzed separately, i.e., they were
both compared with cows without sole ulcer.
The purpose of this separation was to utilize the
information about the degree of sole ulcer
within each of the classes, SF and MF, and to
simplify the interpretation of effect estimates.
Drawbacks of this separation are 1) a decreased
precision of the estimates and consequently
lower power of the tests (because of the
reduced sample size), and 2) the estimates from
the two models cannot be directly compared
(because they are not conditional on each oth-
er).
Calving, particularly the first one, is
regarded as very important in the etiology of
sole ulcer (1, 16). Cows in first lactation expe-
rience conditions before and near calving that
differ markedly from conditions experienced by
Journal of Dairy Science Vol. 74, No. 4, 1991
1288 ENEVOLDSEN ET AL.

older cows. These two groups were, therefore, erosion, disease, season of trimming x disease,
and stage of lactation x FCM-BW (T.able 1).
analyzed separately. In the present analysis, SF
and MF occurred in 20.0 and 29.7% of cows in The term season of trimming x horn erosion
lactation 1 and in 23.5 and 24.7% of lactationswas the last term to be removed at probability
2 to 9, respectively. Approximately half the of .05 to .lo.
cows were aEfected by some degree of sole The term disease included the classes limb,
ulcer. limb plus severe, limb plus other, and severe
Nearly half the sole ulcer cases were SF. plus limb plus other. Because treatment for
Most reviews state that sole ulcer and lamhitislimb disorder was a component in all disease
apparently occur in several feet. However, the classes, it appears to be the most important
usual method of total lesion scores provides factor. Odds ratios estimated for disease ranged
little information about actual distribution offrom 1.7 to 7.8 depending on season of trim-
lesions found. Sole ulcer in one foot could be ming (interaction). Cows without disease had a
an early stage of MF, but because the median 1.5 times higher risk of SF if they were
number of days from calving to trimming trimmed in May to August. These cows may
among SF and MF were 63 and 66 in lactation have stepped on stones in the pasture or on the
1 and 74 and 84 in lactations 2 to 9, that
explanation seems unlikely. Furthermore, s e way to the pasture. Such traumatic sole ulcers
vere cases of SF were common. are likely to occur in one foot only. Williams et
al. (30) studied the effects of wet weather on
lameness and found significant but small ef-
Sole Ulcer in One Foot In Flrst Lactatlon
fects. Another possible explanation is that this
The fmal model of SF in the first lactation group of cows, which was trimmed early in
included the terms season of aimming, season lactation, was kept in stables during the entire
of calving, stage of lactation, FCM-BW, horn pregnancy and consequently had a higher risk

TABLE 1. Final logistic regression model of sole ulcer in one foot only (SF)in lactation 1. Sole ulcer of degrees 1to 2, 3,
and 4 to 5 occamd among 13.5, 102, and 4.8% of the 1550 cows.
Pacentage Odds 95%
Description of variable~l of n Illti0 CI
~ o n t hof trimming and disease*
Trimming M a y to Aug, no disease 19.8 15 1.1 to 2.0
'Iirimmiag Sep to Apr, disease 3.6 1.7 1.0 to 3.0
Trimming Sep to Apr, no dissase 75.7 1.o ...
Month of calving
May to Jun or Sep to Oct 33.3 1.4 1.1 to 1.8
Other months 67.7 1.o ...
Stage of lactation and pcM-BW3
Trimmiog 227 d in milk and
FCM 219.6 kg and B W 2490 kg (High FCM + High BW) 16.1 12.2 5.0 to 30
FCM 4 9 . 6 kg m BW <490 kg 55.4 8.7 3.6 to 21
Trimming Q 7 d in milk and
FCM 219.6 kg end B W 2490 kg (High EacM + J3igh BW) 6.0 1.o ...
FCM 4 9 . 6 kg or B W <490 kg 22.5 3.0 1 2 to 7.5
Heel erosion at f-j
Degrees 2 to 4 6.5 25 1.6 to 3.9
1 155 1.8 1.3 to 2.5
No heel erosion 78.0 1.o ...
'In addition, herd-year of calving is included in the model. Th+ combination himming M a y to Aug and disease was
omit&eddue to imprecision.
'Includes limb disorder alone (limb) or in combination with other distases (severe plus limb, limb plus other, severe
plus limb plus other). See text.
%CM = 4% at first test day after calving, B W = body weight after calving, U = confidence interval.

Journal of Dairy Science Vol. 74, No. 4, 1991

 EPIDEMIOLOGY OF SOLE UL€E!RS
of having claws exposed to manure, which
softens the claw horn. Using a different classifi-
cation of claw disorders, Thysen et al. (24)
studied the effect of the grazing areas (wet or
dry) and type of housing during pregnancy in
heifers but found no significant differences.
Feeding is also frequently mentioned as an
important factor for claw health. However, the
results of several investigations are inconclu-
sive (3, 23), although feeding high amounts of
crude protein (198 g vs. 161 g/kg DM) seems
to be a risk factor (10, 11).
Although the combination of trimming in
May to August and disease involved only 14
(.9%) Observations, the very strong relative ef-
fect of this combination (OR = 11.7, not
shown) indicates that disease potentiates the
effect of season of trimming or vice versa.
Thus, it may support the hypothesis that SF is
traumatic in origin. Disorders affecting the limb
can be expected to compromise claw horn pro-
duction and thereby increasing susceptibility to
sole ulcers. Cows with a limb disorder probably
shift their weight from the affected to
nonaffected limbs, thus increasing their burden.
Sore feet could also cause a cow to lie down
more often, thus increasing the risk of contract-
ing infectious skin disorders of the limb. "he
feeding in spring-summer might also increase
susceptibility to both SF and disease.
Calving in May-June or September-october
was associated with a 1.4-fold increased in the
odds of SF. These periods are when heifers are
tumed out and brought in from the pasture,
respectively. Also,heifers calving in September
to October will usually be brought into the cow
herd directly from the pasture. Such abrupt
changes in the environment may be important
risk factors (3, 29). In addition, the roughage
ration is more likely to be low in fiber and high
in protein content during these periods. The
latter observation is in accordance with trim-
ming in May to August being associated with a
higher risk of SF. The process of adapting to
different environments and rations is a promis-
ing area for future studies because these factors
have a large potential for manipulation. An-
other interesting view of this finding is that
cows calving in May to September had a lower
mi& production (9).
As expected, stage of lactation at trimming
was very strongly associated with the risk of
SF. Plots of the combined data (not shown)
1289
revealed that the OR increased almost exponen-
tially until approximately 4 mo after calving
[120 d in milk (DIM)], and after that a marked
decline was clear. A spontanwus cure of some
of the sole lesions probably was responsible for
the decrease in prevalence after approximately
90 to 120 DIM. A similar pattern is reported in
almost a l l studies.
Body weight and milk yield have been
postulated as risk factors for sole ulcers. Be-
cause sole ulcers are located at the point of the
sole where the pressure is highest, BW intui-
tively seems to be important. High milk yield is
stated to be an important risk factor for lamini-
tis (13, 15). Fatcorrected milk at the first test
day was used in the analysis because it is
expected to be relatively high for those cows
that are fed a relatively large amount of concen-
trate relative to roughage immediately after
calving. Such a feeding procedm increases the
risk of m e n acidosis and related disorders,
which are expected to predispose the cow to
laminitis.
Cows belonging both to the high FCM
group and the high BW group (high FCM plus
high BW) had the lowest risk of SF (OR = 2.9)
before 27 DIM. Later in lactation, the risk
increased to 12 for the high FCM plus high BW
group. Peterse (16) states that milk production
is reduced immediately at calving among cows
with sole lesions. However, observational
studies probably cannot clarify this cause and
effect sequence. The high FCM plus high BW
group could have been allocated more concen-
trate despite the applied flat rate feeding princi-
ple, because farm workers commonly give pref-
erence to high yielding cows. Because of the
higher social rank of heavy cows, they may
also have ingested more than their share of
concentrates.
Heel erosion in the current lactation was
associated with rn exponentially increasing risk
of SF and, consequently, was the only variable
that justified an analysis as an untransformed
continuous variable. However, the ordinality
assumption of the regression procedure was
probably not ~31stified, since the logit cumula-
tive probability curves clearly converged with
increasing degrees of heel erosion especially
above degree 2. For this reason and because of
the low number of observations above degree 2,
the present effect estimates probably are not
valid above degree 2 of horn degradation. As-
Journal of Dairy Science Vol. 74, No. 4, 1991
 1290 EN'EVOLDSEN ET AL.

sociations between sole ulcer and heel erosion
have been reported previously (2, 14). Claws
softened by sole ulcers may be more suscepti-
ble to heel erosion (6, 29) or the erosion may
reduce the weight-bearing surface, thus increas-
ing the pressure on the remaining sole (28).
Previous analyses of these data (27) have
shown that the overall prevalence of severe heel
erosion increased almost linearly from first
calving to the end of lactation 2, and the overall
sole ulcer prevalence fluctuated during the
same period. Such a pattern indicates that heel
erosion probably is not the most important risk
factor in individual cows. As described, howev-
er, the associations between diseases and sole
ulcer show that the same group of cows have
heel erosion, sole ulcers, and disease, i.c., these
conditions share common risk factors. Experi-
mental studies could be useful to clarify further
the relationship between sole ulcer and heel
erosion.
Sole Ulcer in More Than One
Foot in First Lactation
The final model of MF in the fiist lactation
included the terms season of trimming, season
of calving, stage of lactation, FCM-BW, horn
erosion, and disease. In addition, the interaction
terms season of trimming x season of calving,
season of trimming x horn erosion, season of
calving x disease, stage of lactation x disease,
and disease x FCM-BW were included in the
model. Sole ulcers in more than one foot of the
degrees 1 to 2, 3, and 4 to 5 occurred among
11.2, 17.3, and 12.9% of cows, respectively. To
facilitate interpretation of the effect estimates,
cows calving in November to April and all the
other cows were analyzed in two separate sta-
tistical models (Tables 2 and 3). In the first step
of the data analysis (before including interac-
tion terms), calving in May to October was
associated with a 1.3 times higher risk of sole

TABLE 2. Final logistic regression model of sole ulcer in more than one foot in lactation 1. Calvings were in
November to April. Sole ulcer of degrees 1 to 2, 3, and 4 to 5 occnmd among 7.7, 15.0, and 11.9% of the 866 COWS.
~ ~ ~~

Percentage Odds 95%

Description of variables' of n ratio CI
Month of tbmiqd and heel crosion
Trimmiq~M a y to Aug and
Heel erosion degrees 2 to 4 .9 16.8 3.9 to 71
Heel erosion degree 1 4.3 8.1 3.7 to 18
No heel erosion 17.6 3.7 2.3 to 6.0
Trimmiog Sep to Apr and
Heel erosion degrees 2 to 4 4.8 4.5 2.1 to 9.6
Heel erosion degree 1 12.1 3.6 2.7 to 6.0
No heel erosion 60.3 1.o ...
Discase' and K u - B W 3 and stage of lactation
Disease and
FCM 4 9 . 6 kg or BW <490 kg
Trimming 229 DIM 45 9.4 3.9 to 23
No disease and
FCM 219.6 kg and BW 2490 kg (High PCM
+ €€ishBW) and
Trimminga9dinmilk 6.9 1.3 .5 to 2.1
Trimming229dinmilk 13.4 6.4 3.3 to 12
FCM 4 9 . 6 kg or BW <490 kg and
Trimminga9dinmilk 21.6 1.o ...
TrimmingZ29dinmilk 51.5 4.6 2.6 to 30
lIn addition. herd-year of calving is included in the model. Three combinations of disease,XM-BW, and stage of
lactation are omitted.
21nclwies limb disorder alone (limb) or in combhtion with otha disease (severe plus limb, limb pills othm, severe
plus limb plus other). see text.
%CM = 4% at fjrst test day after calving. BW = body weight after calving, U = confidence interval.

J o d of Dairy Scimcc VoL 74, No. 4, 1991

 EFTDEMOLOGY OF SOLE ULCERS
ulcer (95% CI: 1.1 to 1.7). This effect estimate
was similar to the finding in the model of SP in
Table 1 and probably can be explained similar-
1Y*
The effect estimates for cows calving in
November to April are presented in Table 2.
Among cows without heel erosion, the cows
trimmed in May to August were 3.7 times more
likely to contract sole ulcer compared with
other cows. The corresponding effect on SF
(Table 1) was 1.5, but these estimates cannot be
compared directly. However, feeding and
stress, which can be expected to act systemical-
ly, probably are more important risk factors for
MF than for SF. Heel erosion occurred less
frequently among cows calving in May to Oc-
tober (69.9%) than in April to November
(77.9%). The effect of degree 1 heel erosion
differed in the two trimming periods, but the
very small number of cows with high degrees
of heel erosion make inferences difficult. In
contrast to the model of SF (Table l), the
ordinality assumption of the regression proce-
dure seemed to be reasonably satisfied, but the
numbers of heel erosion degrees 3 to 4 were
small. However, heel erosion evidently was
strongly associated with MF. The association
was stronger than with SF, supporting the hy-
pothesis that soft horn characteristic of claws
with sole ulcers promotes the formation of heel
erosion.
Table 2 summarizes the estimated effects of
belonging to one of the eight possible combma-
tions of the dichotomized variables stage of
lactation, FCM-BW, and disease. In this model,
disease was defined as belonging to either limb,
severe plus limb, severe plus other, limb plus
other, or severe plus limb plus other. The risk
of MF increased markedly near 29 DIM for
cows without disease. For cows without dis-
ease, the increased risk after 29 DIM was most
pronounced for cows belonging to the high
FCM plus high BW group, supporting the hy-
potheses that the stress of a relatively high mi&
production and the increased pressure on the
horn producing tissues caused by a high BW
increase the susceptibility to sole ulcer, The
estimated OR of high FCM plus high BW
range from 1.3 to 8.9, depending on stage of
lactation and disease. Because this factor exerts
its effect on a relatively large proportion of
cows, the total effect on the population can be
substantial.
1291
The disease factor, in contrast, affected few
cows, but had a very strong relative effect (OR
2 to 139). The logit cumulative probability
curves converged to a minor extent, making the
ordinality assumption less valid. However, dis-
ease clearly was strongly associated with MF in
early lactation. The effect of disease on sole
ulcer is fresuently mentioned in the literature
(6, 12, 15, 16), but as noted by Weaver (29),
the statistical evidence is sparse and seemingly
based on qualitative evaluations of clinical
cases without establishing proper comparison
groups. Metabolic and digestive disorders and
metritis usually are regarded as the most impor-
tant disease risk factors. In this analysis, they
had an effect only when combined with other
diseases. In contrast, limb disorders had an
effect by themselves. This could have been due
to a lack of statistical power or the possibility
that the animals with severe disease had died or
had been culled, whereas those animals
responding to treatment benefited from associ-
ated changes in dia and environment. This
hypothesis was supported by the finding that
severe must be associated with limb or other to
increase the risk of MF. Diseases in category
other may have been sequelae to severe cases
that were extremely severe. Herd mates may
also have had untreated (subclinical) long-last-
ing cases of the same diseases causing some
cases of MP, thus decreasing the relative effect
of the treated cases that had observed clinical
disease. The practicing veterinarians in the
herds had access to approximately 200 different
diagnostic codes. These were used differently
in various herds, which made distinguishing
between severe and nonsevere cases of disease
difficult. Misclassifications which decrease the
magnitude of the effect estimates, therefore
probably occurred. This was an argument for
pooling diagnoses.
The effect estimates for calving in May-
October are presented in Table 3. Among cows
without heel erosion, there was no increased
risk associated with trimming in May to Au-
gust, which contrasts to the estimate in Table 2.
Explanations could be that the horn quality of
this group was better or that they were on
pasture longer prior to calving. Housing condi-
tions also might have been less crowded during
May to August. The stronger association to
heel erosion in this period supports these hy-
potheses. The estimated effects of stage of lac-
J d of Dajxy Science Vol. 74, No. 4, 1991
1292 ENEVOLDSEN ET AL.

tation and FCM-BW were similar to the esti-
mates in Table 2.
Sole Ulcer In One Foot In
Lactatlons 2 to 9
The frnal model of SF in lactations 2 to 9
included the following terms: season of trim-
ming, stage of lactation, days between trim-
mings, heel erosion, sole ulcer previous trim-
ming, disease, stage of lactation x disease, days
between trimmings x disease, and sole ulcer
previous trimming x disease. Sole ulcer of
degrees 1 to 2, 3, and 4 to 5 occurred among
16.3, 8.6, and 6.4% of cows, respectively. To
facilitate interpretation of the effect estimates,
cows less than 67 DIM and all others were
analyzed in two separate statistical models. In
the first step of the data analysis (before includ-
ing interaction terms), 67 DIM or greater was
associated with a 2.0 times higher risk of sole
ulcer (95% CI: 1.4 to 2.9). Hots (not shown)
indicated that the effect of stage of lactation
clearly occurred later in lactations 2 to 9 com-
pared with lactation 1, and the effect estimates
also were smaller although an exact comparison
was not possible.
The model selected for cows less than 67
DIM (T.able 4) included only the variables heel
erosion and sole ulcer previous trimming. The
effect of heel erosion, which occurred more
frequently in lactations 2 to 9 compared with
lactation 1, was comparable to the effect esti-
mated for SF among cows in lactation 1. But as
for SF model, the ordinality assumption may
not be completely valid.
Table 4 provides separate estimates of the
effectsof different degrees of SF and MF at the
preceding trimming. Although Mp had an ef-
fect, a dose-response relationship was lacking,
maybe because the numbers were rather small.
Severe cases in the previous lactation might
have been culled more frequently, leading to a
selection bias or the cows may have been
offered special attention in the current lactation,
e.g., earlier trimming in lactation. In contrast,
SF exhibited a dose-response relationship with
SF at previous trimming. This finding supPoas
the hypothesis SF and h4F being two different
claw disorders. The variable sole ulcer at previ-
O U S trimming was included in the analysis due
to the high heritability of sole ulcers and re-
search repom stating that laminitis recurs in the
same animals in successive lactations (16).
Consequently, this variable may be very impor-
tant in making management decisions concem-
ing individual cows. This analysis confirmed
that sole ulcer is a highly repeatable disorder.
The estimated effects for cows 67 DIM and
greater are presented in Table 5. Although the

TABLE 3. Pinsl logistic regression model of sole ulcer in more than one foot (MFj in lactation 1. Calvin@ were in May to
October. Sole ulcer of degrees 1 to 2. 3, and 4 to 5 OCcllITdd among 6.4, 19.5, and 13.8% of the 897 cows.
perwtagt odds 95%
Dcscriution of variables' of n ratio a*
Month of trimming and heel erosion
Trimming May to Aug iuhd
Heel aosion degrees 2 to 4 15 22.3 5.3 to 93
Heel erosion degree 1 4.3 2.7 1.3 to 5.5
No hecl erosion 16.4 12 .8 to 1.9
Trimming Sep to Apr and
Heel erosion degrees 2 to 4 7.8 2.9 1.6 to 5.2
Heel erosion degree 1 165 1.7 1.1 to 2.5
No heel erosion 535 1.o ...
Stage of lactation
TrimminE; 229 d in milk 71.9 45 3.0 to 6.8
Trimming a 9 d in milk 28.1 1.o ...
-
4% FCM test d 1 (FCW and BW at cahrina
PCM 219.6 kg and BW 2490 kg 21.4 1.4 1.0 to 2.1
PCM 4 9 . 6 kg or BW 490 kg 78.6 1.o ...
1In addition. hcrd-ycar of calving is included in the model.
k
I = Confidcnct interval.
Journal of Dairy Science Vol. 74. No. 4, 1991
 EPIDEMIOLOGY OF SOJA ULCERS 1293
TABLE 4. Final logistic regression model of sole ulcer in single foot (Sp)in lactations 2 to 9. Sole ulcer of degrees 1 to 2,
3, and 4 to 5 o c c ~ e damong 11.9, 8.1, and 55% of the 471 COWS. Cows were trimmed less than 67 d after calving.
Pcrccntage Odds 95%
Description of variables' of n ratio cI2
Heel m i o n
Heel erosion degrees 2 to 4 17.8 2.6 1.3 to 5.1
Heel erosion degree 1 255 1.9 1.1 to 3.5
No heel erosion 56.7 1.o ...
Sole ulcer at previous trimming
Sole ulcer in mom than one digit 0
Degrees 4 to 5 2.6 2.9 .7 to 12
Degree 3 2.8 J .1 to 2.4
DegreesltoZ 2.6 3.9 1.0 to 16
Sole ulcer in one digit (Sp)
Degrees 4 to 5 2.6 11.1 2.6 to 49
hP 3 4.0 2.8 1.0 to 7.5
Degreeslto2 9.6 1.4 .7 to 3.1
No sole ulcer 75.8 1.o ...
lIn addition, herd-year of calving is included in the model.
%=IConfidence intmal.

ordinality assumption was slightly violated,
heel erosion was clearly associated with SF.
However, the lack of a dose-response effect
contradicted the hypothesis of heel erosion as a
direct cause of SF. More likely, certain claws
or cows were susceptible to both disorders or
the claws with sole ulcers were degraded more
easily as discussed above. The steady increase
in prevalence with age (population) is in agree-
ment with this finding with individual cows.
The combined disease classes limb, severe
plus other, severe plus limb, limb plus other,
and severe plus limb plus other were associated
with a 2.9 to 9.8 times higher risk of SF,which

TABLE 5. F d logistic regression model of sole u l w in single foot (SF)in lactations 2 to 9. COWStrimmed 67 d or later
after calving. Sole ulcer of degrees 1 to 2. 3. and 4 to 5 OCcMed among 21.9, 9.3, and 7.5% of the 375 cows.
Pnccntage Odds 95%
Description of variables' of n d 0 cI2
Heel erosion
Heel erosion degrees 2 to 4 205 1.4 .7 to 2.8
Heel erosion degree 1 29.6 25 1.4 to 4.6
No heel erosion 49.9 1.o ...
oiseast3 and trim interval4 and sole ulcer previous
Disease and trim interval A 5.3 9.8 2.8 to 33
No diswse and trim intmals A and
Sole ulcer previous degrees 1 to 5 75 3.6 1.1 to 12
No sole ulcer previous 45.1 12 5 to 2.9
No disease and trim inteavats B and
Sole ulcer previous degrees 1 to 5 11.1 1.o ...
No sole ulcca urcvims 28.3 1.1 5 to 2.8
'In addition, herd-year of cahriog is included in the model. Disease combined with trim intend B omitted due to
imprecisiOlL
% =I Confidence interval.
h l u d e s disease classes limb, severe plus other, severe plus limb, limb plus other, and severe plus limb plus other. See
text.
%rim interval is number of days between current and preceding trimmiag. A 56 to 188 d and 204 to 258 d. B 189 to
203 d and more than 258 d.

Jonmal of Dairy Science Vol. 74, No. 4, 1991

1294 ENEVOLDSEN ET AL..

was largely similar to the effects on MF in
lactation 1. The effect differed according to the
interval between p'w.Rding trimming (which
occurred in the previous lactation) and the cur-
rent one. Similarly, the effect of sole ulcer at
previous trimming differed among trimming in-
tervals. These complex relationships are M i -
cult to explain satisfactorily. At trimming, ab-
normal horn is removed but symptoms may
exist for some time, especially in cases of se
vere sole ulcers. However, with very long inter-
vals, the risk of new incidents is likely to
increase due to increased burdening of the
pododerm caused by excessive sole horn. B e
cause trimming is performed simultaneously
with the recording of claw health, trimming
will automatically interfere with the subsequent
measurements. The pattern of plots of the risk
cstimates for different trimming intervals
pointed to the presence of two different popula-
tions. In population 1, the risk decreased stead-
ily from approximately 2 to 7 mo. In popula-
tion 2, the risk decreased from approximately 7
mo and on. In addition, the pattern of sole ulcer
degrees 1 to 2 differed from the more severe
cases. If cows were treated differently accord-
ing to their status at second trimming in the
previous lactation or they were only trimmed
once, such patterns might be the result. The
findings at second trimming will be analyzed
separately in a later analysis to elucidate this
question. The trimming interval is a factor that
should be considered when interpreting record-
ings of claw health. This intuitively reasonable
hypothesis is supported by experimental data
showing that trimming immediately prior to the
second calving affects claw health positively
(16).
Sole Ulcer In More Than One
Foot In Lactations 2 Through 9
The estimated effects on MF in lactations 2
to 9 are presented in Table 6 and in Figures 1
and 2. Trimming in July to October was associ-
ated with a 2.2 times higher risk of MF com-
pared with other months. The seasonal effect
was similar in magnitude to lactation 1, but
occurred approximately 2 mo later. The expla-
nation may be that a higher proportion of sole
ulcers among heifers were laminitis cases. The
factors causing sole ulcers in heifers seemed to
act before calving or to act on a relatively more
susceptible newly calved animal. Excess pro-
tein supply and adaptational problems may pro-
vide some explanation for this pattern.
A m o n g cows calving in September to Octo-
ber, MF occurred 5.4 times more frequently if
the cows were less than 52 DIM, i.e., MF
occurzed earlier in lactation. However, the ordi-
nal@ assumption appeared slightly violated.

TABLE 6. Final logistic regression model of sole ulcer in more than one foot at fmt trinOming in lactations 2 to 9. Sole
ulcer of degrees 1 to 2, 3, and 4 to 5 occurred among 7.3 125, and 7.3% of the 859 cows.
Percentage Odds 95%
Description of variables' of n ratio a2
Month of trimminj
Trimming Jul to Oct 27.7 2.2 1.4 to 3.3
Trimming Nov to June 72.3 1.o ...
Month of calving and stage of lactation
Calving Sep to Oct (rimming 252 d in milk 10.6 7.2 3.1 to 17
Calving Sep to Oct trhmming 4 2 d in milk 9.9 5.4 2.3 to 12
Calving Nov to Aug trimming 252 d in milk 48.0 5.2 3.2 to 8.3
Calving Nov to Aug himming 4 2 d in miJk 315 1.o ...
Disease in classes limb, severe plus limb, severe plus other,
Limb plus ob=, and severe plus limb plus other 7.3 2.1 1 2 to 3.9
No disease (remaining classes, see text) 92.7 1.o ...
Trim interval: days between current and preceding
56 to 178 d and 189 to 251 d 73.1 2.7 1.7 to 4 2
179 to 188 d and more than 251 d 26.9 1.o ...
'In addition, herd-year of calving is included in the model.
%=I
Confidence intaval.

Journal of Dairy Science Vol. 74, No. 4, 1991

 EPIDEMIOLOGY OF SOLE UJXERS
The instability in feeding (e.g., turning in, a m -
mencement of feeding with sugar beets) during
this period could be one explanation of the
association. The work load in the herds usually
was very high h m the middle of March until
the middle of June and again from the middle
of August until the beginning of November. In
such periods, less attention obviously was paid
to individual animals, thus possibly increasing
the risk for an animal to have a low intake of
roughage for a longer period and thereby
changing the roughage to concentrate ratio sig-
nificantly.
The combined disease classes limb, severe
plus limb, severe plus other, limb plus other,
and severe plus limb plus other were associated
with a 2.1 times higher risk of MF compared
with the remaining health classes. This effect
was smaller compared with h4F in lactation 1.
The interval between trimmings exhibited the
1295
same patterns and had an effect on MF as
described in models of SF and poses the same
interpretational difficulties.
For cows without sole ulcer at previous
trimming, FCM-BW had no effect (Figure 1).
For cows belonging to the low FCM-high BW
group, the effect of sole ulcer at previous trim-
ming was approximately 3 (8.1/2.6) times
higher than that of cows not belonging to the
low FCM-high BW group. The OR of sole
ulcer previous trimming was 6.8 (8.U1.2) in the
low FCMnigh B W p u p versus 2.6 among the
remainder. However, the cause and effect se-
quence is unclear. The milk yield may have
been reduced among cows with poor claw
health. These may have had a longer calving
interval prior to the current lactation due to a
possible influence of lameness on repduction.
Fatness resulting from a long calving intewal
or other management factors is mentioned as a

Sole Ulcers in Dairy Cows

effects of FCM, BW & previous ulcers
101 I

0
8.7 I
d
d
8

R
a
?t.T;.I...........................................
t
I ...................... 19.0....
0

High FCM or t o w BW Low FCM 8 High BW

FCM at First Test & BW at Calving
Previous Trimming
-NO sole Ulcer Ulcer degrees 1-5
Wgure 1. Effects of milk yield, body weight at calving, arad occumnce of sole ulcer@) at the previous claw trimming
on ~JE odds ratios of sole ulcer in lactations 2 to 9. The percentage of dismBution of rhc obsQvations is presented ovec the
bars.

Journal of Dairy Science Vol. 74, No. 4. I991

1296 ENEVOLDSEN ET AL.

risk factor for sole ulcer (28). Due to a reduced farmers for individual cases of lameness.
intake of roughage early postpartum, fatness Therefore, the farmer decides what becomes an
may have caused a reduced FCM. For cows
without heel erosion, MF occurzed approxi-
mately three times more frequently in lactations
4 to 9 compared with lactations 2 and 3 (Figure
2). This finding is in agreement with the litera-
ture.Except for heel erosion degrees 2 to 4 in
parity 3, heel erosion had a similar effect in
lactations 2 to 9. A doseresponse effect was
obvious in lactation 3 only. This mixed pattern
does not support the hypothesis of heel erosion
as a direct cause of sole ulcer.
The effect of parity was markedly smaller
than reported in studies of clinical claw disor-
ders. An explanation could be the high culling
rate (-35%) in these herds (26). Another expla-
nation could be that most studies of the epide
miology of sole ulcers are based upon observa-
tions made by veterinarians called by the
incident. Inferences about the nature of a long-
lasting disease when the symptoms do not ac-
cur suddenly (like sole ulcers) are very diflicult
to make unless some measure of the severity of
that disease is available. Without such mea-
sures, the epidemiology of the factors that trig-
ger treatment and not the epidemiology of the
disease will be studied. In these herds the treat-
ment frequencies were very different in herds
with similar prevalences (25). Weaver (29) ar-
gues similarly. An explanation for older cows
being at higher risk to sole ulcers could be the
increase in claw size associated with both age
and sole ulcer (2, 14).
Initial analyses revealed that year of calving
and herd had systematic effects and that the
proportions of the combined degrees 1 to 2 of
sole ulcer increased during the study, indicating

Sole Ulcers in Dairy Cows

effects of parity & heel erosion

I L I P
..........................................
0
d
d ..........................................
8

R
a ...................
t
i
0

Lactation 2 Lactation 3 Lactations 4-9

Parity at Claw Trimming
Condition of Heels
No Eroslon Erosion degree 1 Erosion degrees 2-4

Pigure 2. Effects of parity and heel erosion on the odds ratios of sole ulcer. 'Ihe percentage of distribution of the
observations is presented over the bars.

Journal of Dairy Scimcc VoL 74, No. 4, 1991

 EPIDEMIOLOGY OF SOLE ULCERS
a possible shift in the recording procedure.
Consequently, herd-year of calving was forced
into all models to account for some of the
possible systematic Merences in the skills of
claw trimmers, genetic characteristics of the
herd, quality of floors and stalls, type and
amount of bedding, type of glazing areas (wet,
dry, stony), amount of microminerals in the
plants, growth and precalving preparation of
heifers, veterinary practice, possible systematic
changes in recording procedures, changes in the
feed supply (especially the highly variable s u p
ply of fodder beets and fresh grass), weather
conditions, and changes in farm workers. The
effect estimates were highly variable. Other
studies also have reported a strong effect of
year (4, 30). For herd health management and
research purposes, it therefore seems to be very
important to reveal which risk factors for sole
ulcer change from year to year. It also stresses
that care must be exerted when making infer-
ences about absolute levels of claw disorders
from 1-yr sweys.
The variable heel erosion previous trimming
was offered in models of SF and MF in lacta-
tions 2 to 9 but did not contribute significantly
to explain variability. As for heel erosion at
current trimming, the ordinaliv assumption
was not completely satisfied.
CONCLUSION
Some sign of sole ulcer occmed in approxi-
mately 50% of all lactations. The epidemio-
logic patterns differed markedly in first and
later lactations, and numerous biological plausi-
ble interactions frequently involving disease
were revealed in the analysis. Approximately
50% of sole ulcers occurred in one foot only.
Trimming or calving in summer to fall was
strongly associated with sole ulcer, which oc-
curred most frequently 3 to 4 mo after calving
but earlier in lactation 1, especially if prior
diseases were recorded (limb, metabolic, diges-
tive, or severe reproductive disorders). Low
milk yield alone and high milk yield combined
with high BW were both important risk factors
in lactation 1, whereas low milk yield com-
bmed with high B W was important in later
lactations. The results indicated that heel ero-
sion was caused by sole ulcers. Cows with sole
ulcers tended to have them in several lactations.
1297
ACKNOWLEDGMENTS
Computations supporting this research were
performed on the cornell Production Super-
computer Facility, which is supported in part
by the National Science Foundation, New York
State, and the IBM Corporation.
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