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Sole ulcer and sole hemorrhage


Nick Bell

Jon Huxley

Massey School of Veterinary Science logo

Synonym(s): Rusterholtz ulcer, Pododermatitis circumscripta


  • Cause: focal chronic sole corium injury and inflammation.
  • Signs: clinical lameness, or hoof tenderness with bilaterally shortened strides in cases with more than one limb affected. Occasionally an incidental finding (mild cases).
  • Diagnosis: exposed corium in the mid-sole region (hoof map zone 4); early or mild cases will present with haemorrhagic pigment or a soft, painful sole at this site. 
  • Treatment: trim, NSAID, block on other claw if that is healthy.
  • Prognosis: guarded long-term, especially if severe and / or bilateral.



  • Focal chronic injury and inflammation develops at a site palmar/plantar to the flexor tuberosity of PIII following repetitive trauma with sole contusion, which damages the horn producing germinal epithelium.
  • Most cows suffering acute sole contusion will recover with or without treatment. Those that fail to recover from the initial contusion will present with sole ulcers weeks to months later.
  • Despite the historical dominance as an etiological theory, there is little good quality research evidence to support rumen acidosis or laminitis in the etiology or pathogenesis.

Predisposing factors


  • Trauma to the corium adjacent to the flexor tuberosity is most likely the result of a combination of biomechanical events including: 
    • Failure of suspensory apparatus. Suspensory apparatus is weakened for several weeks before and after calving, leading to increased movement of PIII within the claw capsule .
    • Increased standing and walking times on hard surfaces such as concrete following calving. There are a number of complex and interrelated management and animal-related factors at play. A nadir in lying times occurs 6 weeks after calving.
    • The digital cushion may be inherently under-developed in young animals (primiparous heifers) and in animals without exercise on hard surfaces, eg concrete.
    • Body condition score Body condition score and lameness loss will reduce the digital cushion thickness, which may diminish its capacity for force dissipation during foot strike and limb loading.
    • Hoof overgrowth Hoof overgrowth, particularly poor foot angle, sole horn overgrowth and medio-lateral claw imbalance.


  • Primiparous heifers are generally at greater risk due to poorer development of the digital cushion and being a low dominance animal having to adapt to the milking herd increasing standing times.
  • Lack of cubicle training in heifers at first calving.
  • Insufficient exercise on hard surfaces (eg on stone tracks or concrete) before first calving, eg managed on clean, concreted feed area.
  • Uncomfortable cubicles (bed or dimension related) Housing dairy cows CowSignals white paper leading to reduced lying time.
  • Long penning times for milking or other routine husbandry activities, particularly in the 6-12 weeks after calving.
  • Lack of special fresh cow management protocols.
  • Overstocking cubicles, feed space, yard space or other resources.
  • Heat stress.
  • Lameness due to other reasons, eg Digital dermatitis Digital dermatitis, predisposing to longer standing times particularly in the fresh period.
  • Infrequent preventive hoof trimming in cows prone to overgrowth (toe, sole or heel horn) or incorrect trimming technique.


  • Changes to matrix metalloproteinases occur at calving leading to reduced strength of the laminae and the attachment of PIII.
  • Body condition score loss leads to the depletion of the digital cushion, and loss of force dissipating properties.
  • Claw over-growth and loss of optimal functional shape may increase weight-bearing on the contused sole.
  • Bony exostoses may predispose to more severe focal inflammation following contusion.
  • Chronic inflammation has similarities to other compartmental syndromes. Some cows cannot recover even with apparent adequate conditions for recovery.
  • No good evidence to support the direct involvement of rumen acidosis or Laminitis Laminitis in the etiology or pathogenesis of sole ulcers.


  • The lesion develops over weeks to months. 
  • A successfully treated lesion, without complications, will recover within 3-6 weeks.
  • First case likely to increase risk of future cases, ie disease may be self-perpetuating. 


  • Predominantly:
    • Cows with a previous history of hoof lameness.
    • Housed cows.
    • High yielding dairy cows within high yielding herds.
    • First life-time events are usually in the 2-5 months following calving.


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Further Reading


Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Randall L V, Green M. J, Huxley J. N. (2018). Use of statistical modelling to investigate the pathogenesis of claw horn disruption lesions in dairy cattle. Vet J 238, 41-48.
  • Newsome R.F, Green M J, Bell N J, Bollard N J et al (2017a) A prospective cohort study of digital cushion and corium thickness. Part 1: Associations with body condition, lesion incidence, and proximity to calving. J Dairy Sci 100, 4745–4758.
  • Newsome R.F, Green M J, Bell N J, Bollard N J et al (2017b) A prospective cohort study of digital cushion and corium thickness. Part 2: Does thinning of the digital cushion and corium lead to lameness and claw horn disruption lesions? J Dairy Sci 100.
  • Newsome R et al (2016) Linking Bone Development on the caudal aspect of the Distal Phalanx with Lameness during Life. J Dairy Sci 99 (6), 4512–4525.
  • Thomas H J et al (2015) Evaluation of treatments for claw horn lesions in dairy cows in a randomized controlled trial. J Dairy Sci 98 (7), 4477–4486.
  • Groenevelt M et al (2014) Measuring the response to therapeutic foot trimming in dairy cows with fortnightly lameness scoring. Vet J 201 (3), 283–288.
  • Horseman S V et al (2013) A survey of the on-farm treatment of sole ulcer and white line disease in dairy cattle. Vet J 197 (2), 461–467. 
  • Barker Z E et al (2009) Risk factors for increased rates of sole ulcers, white line disease, and digital dermatitis in dairy cattle from twenty-seven farms in England and WalesJ Dairy Sci 92 (5), 1971–1978.
  • Willshire J A & Bell N J (2009) An Economic Review of Cattle Lameness. Cattle Pract 17 (2), 136–141.
  • Amory J R et al (2008) Associations between sole ulcer, white line disease and digital dermatitis and the milk yield of 1824 dairy cows on 30 dairy cow farms in England and Wales from February 2003-November 2004. Prev Vet Med 83 (3–4), 381–391. 
  • van Amstel S R & Shearer J K (2006) Review of Pododermatitis Circumscripta (Ulceration of the Sole) in Dairy CowsJ Vet Intern Med 20, 805–811.
  • van Amstel S R (2003) Case report - clinical response to treament of pododermatitis circumscripta (ulceration of the sole) in dairy cows. Bovine Practitioner 37 (2), 143–150.
  • Webster A J (2002) Effects of housing practices on the development of foot lesions in dairy heifers in early lactation. Vet Rec 151 (1), 9–12.
  • Manske T, Hultgren J & Bergsten C (2002) The effect of claw trimming on the hoof health of Swedish dairy cattle. Prevent Vet Med 54 (2), 113–129.
  • Webster A J F (2001) Effects of housing and two forage diets on the development of claw horn lesions in dairy cows at first calving and in first lactation. Vet J 162 (1), 56.
  • Mochizuki M I (1996) Histopathological changes in digits of dairy cows affected with sole ulcers. J Vet Med Sci 58 (10), 1031.
  • Rusterholz A (1920) Das spezifische-traumatische klauensohlengeschwur des rindes. Schweizer Archiv fuer Tierheilkunde 62, 505–525.

Other sources of information

  • The Healthy Feet Project (2017) The Healthy Feet Website [online] Available at:
  • Eggers T et al (2000) Morphological aspects in wound healing of Rusterholz ulcer in the bovine hoof. Parma, Italy. pp 203.
  • Lischer C et al (2000) The significance of the suspensory mechanism of the third phalanx and its fat bodies in the pathogenesis of sole ulcers in cattle Part I: macroscopic findings. Parma, Italy. pp 222.
  • Greenough P R & Vermunt J J (1994) In search of an epidemiologic approach to investigating bovine lameness problems in cows. Proceedings of the 11th International Symposium on Disorders of the Ruminant Digit. Banff, Canada. pp 186-196.

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