I have a young mare, 4 years old, that I raised. Started her under saddle last year and rode lightly. Turned her out for the winter. I started riding her again and she had a very slight lameness in her left front. Took her to a vet at an equine hospital. The vet blocked her heel and she was sound. He took x-rays and stated she had trauma induced navicular in her left front. The x-rays do not look that bad, but the vet stated they were horrible and suggested injections and nerving her in two weeks. I thought that was a bit of a rush. I took the x-rays to two other vets (one is a friend) and just said will you look at these and tell me what you think sort of thing. They saw some mild changes, but didn’t see anything alarming. She came sound immediately with the injections and special shoeing. She rode for 8 to 9 weeks before going lame again. She responds to one gram of bute and will be sound for a couple of days. She is on a supplement, Duralatin, and Adequan. Her left leg is swollen in the upper area (right below the knee). Not sure what to do next. I cannot seem to get a direct quote on the cost of an MRI. I have read about Tildren, IRAP, and other therapies. Should I get a second opinion? What have you done? Thank you very much!
I would definitely investigate an MRI or ultrasound of her foot (if you have a skilled practitioner nearby) to look into a soft tissue injury/inflammation (some type of tear, navicular bursa inflammation or adhesion, etc). Ultrasound is much less expensive but you cannot see every structure in the foot as you can with an MRI. However, with a good practitioner it is often more than sufficient.
Advising neurectomy off of x-rays alone is alarming. Even if this was a primarily bony issue, I’d want to make sure there wasn’t also a soft tissue injury that would be worsened and trod around on.
I’m not sure where you are located, but the MRI (including stay and every other extra little thing that comes with the MRI) was $3300 in MA for both fronts for my horse’s navicular. Tildren was $1200.
Saying to nerve the horse without trying other routes first is very premature of the vet. If you can do the MRI, it’s recommended for navicular horses as “they” are finding many navicular horses have other soft tissue damage as well, namely deep digital flexor tendon damage where it comes into contact with the navicular bone, or impar ligament damage. We discovered avulsion fractures of both front navicular bones and impar ligament desmitis via the MRI. The fractures were undetectable via regular rads, though the bone degeneration was very clear.
Her left leg is swollen in the upper area (right below the knee). Not sure what to do next. I cannot seem to get a direct quote on the cost of an MRI. I have read about Tildren, IRAP, and other therapies. Should I get a second opinion? What have you done? Thank you very much![/QUOTE]
You say her left front is swollen below the knee, is this new swelling? If the swelling below her knee is new then I would start the whole lameness exam over again as the recurring lameness may or may not be associated with the mild navicular changes. I would go to a reputable clinic, clinical assessment and repeat the blocks. If your horse still blocks sound to the low heal block then and MRI may be the best way to go.
Personally I would not feel comfortable considering de-nerving any horse without an MRI as I would want to access the condition of the deep digital flexor tendon. If you were to de-nerve a horse with significant damage to the deep digital flexor tendon there is a risk of catastrophic injury.
I would haul to reputable clinic let them evaluate the horse before you volunteer the history. Have your digital X’rays on hand.
These are just my thoughts. Good luck!
If the swelling below her knee is new then I would start the whole lameness exam over again. I would go to a reputable clinic. If your horse still blocks sound to the low heal block then and MRI may be recommended.
I’d be investigating the swelling below the knee. There is a decent chance that the current lameness has to do with that and not the navicular at all.
Did she respond to the hoof tester?
Sounds like there might be 2 problems at once here. Certainly would NOT nerve this horse at this point. As others have said, that is premature. You need to get a competent vet to find out what the deal is on the high swelling before you do anything else. That they can do w/ ultrasound. To get a better idea what is going on w/ the whole leg, you would need an MRI, which is spendy but better that than ending up w/ a permanently crippled horse…
I would either send her straight in for the MRI ($1200-$1800 for one leg in a standing MRI) or I would have a better vet come out for another lameness exam, and ultrasound the new swelling below the knee. Maybe the lameness is coming from the suspensory now, and not the foot at all.
[QUOTE=fourmares;7012198]
I’d be investigating the swelling below the knee. There is a decent chance that the current lameness has to do with that and not the navicular at all.[/QUOTE]
Agreed. My mare had a series of lameness that was coincidental. She had an abscess on her front left that blew out her heel and had hit herself on her cannon from behind (we think) within a few weeks if each other. Sometimes it just dumb luck.
Thanks to everyone for taking the time to reply!!! This reinforces what I have been thinking.
If you end up trying Tildren, it is much cheaper to do a regional perfusion instead of normal IV injections. We have done the regional perfusions several times on our old guy.
MRI prices vary a lot depending on if you get a standing MRI. Where are you located?
http://rockleyfarm.blogspot.co.uk/
This woman is rehabbing horses with navicular type lameness. Her blog is fantastic. I learned a ton. The first thing you should evaluate is if your horse is having a heel first or toe first landing when she walks. If it is toe first then you have a place to start. Good luck and you should become an expert in navicular because you can bet that most vets are NOT!
Before going to an MRI, I’d want to know what was going on with the swelling.
In any case I would be hesitant to nerve at this stage of affairs without an MRI.
My trainer has a horse who was diagnosed w/ navicular at 4 and he was told to nerve the horse right away and it would probably only have a year because it was so bad. He got other opinions and ended up instead taking the horse barefoot. Horse is now 10 or 11, just massive bodied, and schooling GP. While I respect vets and get their opinions, sometimes listening to your gut is the way to go.
MRI including full work up (blocking, lameness exam, ultrasound, overnight stay, radiographs) for me with GA was about $2500.
What about your horses feet? Is this horse barefoot and has bee barefoot all her life? Or did you begin to have her shod after you started riding her? Or did you change farriers recently?
I bought a 3 yr old Morgan gelding who had gone thru a period of hoof neglect while he was growing up. He was a bit toed in but travels nice a straight. After I had begun riding him we got to the point where I decided to put front shoes on him. Inside of three months he came up lame in one front when circling to one side. He was vetted then I took him to a prominent No. VA clinic for another more extensive vetting. The told me that my then 4 year old Morgan after less than 6 months of riding had “navicular syndrome”.
I took a good look at his feet, looked at the video I had taken of him before purchasing him and realized that the farrier had corrected his pidgeon toed front feet. While he was barefoot he was able to wear his feet back to his “normal”. When shod the correction done by the farrier had full effect and lamed him. The farrier was doing a nice balanced trim but it was wrong for this horse.
What I’m suggesting is that many horses with “heel pain” or a navicular diagnosis have a trimming or shoeing problem.
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