The Horseshoe is an item obtainable in Silent Hill 2. After inserting three tablets into the gallows of the Toluca Prison courtyard, a scream will be heard, drawing James Sunderland's attention back to the prison. On the way back, the horseshoe can be found hanging from the courtyard door handle. When combined with a wax doll and a lighter, it forms a handle that is used to open the hatch in the west wing, located on the first floor of the prison.
- The crescent shape of the horseshoe represents the symbol of a goddess worshipped by many ancient civilizations and was regarded as a protective talisman used to ward of witches and demons when nailed to a door. In more recent folklore, the horseshoe is synonymous with luck, but only if the "U" shape is facing upwards. Otherwise, the luck will supposedly "pour out". This isn't necessarily bad, but eventually indicates that the luck won't last forever.