A rotated coffin bone, which can result from several different causes, is a change in the position of the coffin bone. The sensitive laminae which normally hold the coffin bone firmly in place decay, allowing the toe of the coffin bone to drop. This then presses on the sole, which causes inflammation and changes to the laminae and bone of the toe. New horn no longer grows in this region; only a secretion is produced from the effected area. Eventually, as the sole is worn away from below and the horn on the inside of the sole decays, the tip of the coffin bone protrudes through the sole.

The usual orthopedic treatment to prevent the protrusion of the coffin bone and return it to its physiological position is to apply artificial pressure from below. This is attempted by, for example, a padded bar across the middle of the shoe.

However, this affects only a slight rearward shift of the pressure point, back from the tip of the coffin bone. The resultant alleviation of pressure naturally brings relief, but this is only temporary. After a while, inflammation sets in at the new pressure point, once again causing lameness. By changing the type of shoe, alleviating the pressure each time an acute inflammation occurs, a pain-free situation can be achieved several times without any actual healing having taken place. However, at some point, changing the type of shoe will no longer help, because there is no healthy part of the coffin bone left to which the pressure can be diverted.

In contrast to this, healing can occur when the hoof, through correct trimming, is returned to its optimal natural form, in which the mechanical action of the hoof will resuscitate the laminae.