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To analyze horse-related accidents caused by hoof kicks.Prospective study to evaluate hoof kick-related accidents.Multicenter study, including 9 trauma centers in Hamburg, Germany.Patients who were treated as the result of a hoof kick between January 1, 2010, and May 1, 2010, were included in the study.Horse and rider qualifications, riders' use of protective equipment, location and activity at time of accident, mechanism of injury, injuries sustained, and treatment required for these injuries.Twenty-four equestrians received hoof kicks. The average age was 22.6 years (range, 7-34 years). All accidents (100%) occurred while the equestrians were handing or grooming the horse. Two riders (8.3%) wore a helmet at time of accident. Sixteen riders (66.7%) suffered orbital, midface, or mandible fractures; 8 riders (33.3%) had injuries on other parts of the body.Hoof kick injuries account for a significant proportion of equine injuries and occur when riders are dismounted, most frequently when grooming without wearing protective equipment. Head and facial injuries occur most frequently and suggest that mandatory helmet and facial grill use should be considered during all horse-related activities.