Experience With DDFT Injuries / Navicular Bursitis

[Hunter11]

My 6 year-old warmblood was diagnosed in September 2023 with a DDFT strain and navicular avlusion fracture via MRI after coming up lame in the front right (we do not know how he did it but I will note he is a stall kicker). He was a 3/5 lame on the front right and 0/5 lame on front left. He was sound going straight and lameness was only noted in turns. The following was concluded on his discharge report:

• Focal distal medial navicular avulsion fracture
• Navicular and coffin bone bruising
• Navicular bursitis
• Moderate medical teep digital flexor tendinopathy corresponding to the fragmentation site

The MRI report stated:

• Moderate proliferative navicular bursitis
• Extensive mild to moderate fluid and distal medial margin fragmentation, navicular bone
• Focal mild to moderate deep digital flexor tendinopathy with possible adhesion formation
• Mild synovitis and mild to moderate arthrosis, distal interphalangeal joint
• Mild collateral cartilage ossification, distal phalanx

The MRI report seemed to note the most relevant clinical finding was the bursitis. The vet felt the prognosis to return to work (low level hunter) was fair. Fast forward after a month of stall rest, 3 months small turnout, IRAP and PRP, 3 months large turnout (and therapeutic shoeing), the horse was doing fantastic and returned to work after he returned to the vet for a re-check after a month and a half and the vet was super happy with his soundness. However, just last month he seemed to re-injure it literally overnight and was way worse - I’d say a 4.5/5 lame on that front right on straightaways this time. I couldn’t afford another MRI and insurance excluded the leg so we blocked it to be sure it was the same injury (it blocked 100% immediately) and x-rayed but x-rays were clean - as they were back in September.

We are starting the rehab process over again, except tripling to quadrupling it: 3-4 months stall rest (on a mild sedative to mitigate any stall kicking) and then small turnout until spring. The vet however said the prognosis for return to work is poor and said not to bother with additional therapeutic treatments like IRAP, PRP or shockwave again.

In 2018, I put down my 7 year old TB 3 months after a traumatic colic surgery with a 360* torsion, peritonitis, etc. I had him for two years. Two years ago I retired my 15 year-old TB cross after only three years of ownership due to neurologic decline from Lyme’s disease after he started falling under saddle (broke my knee cap, required surgery to pin back together). I did ALL of the testing and ALL of the treatments to get him better with one of the top neurologic specialists in the country at New Bolton, but ultimately he was unsafe to continue riding. He is currently a pasture pet and I am happy to fund his retirement because I am beyond grateful for the two short years we had together. This guy is my final horse, as I can no longer afford the heartbreak, finances, and just overall hit after hit with poor luck with horses. I need to do everything possible to get him sound. If/when he gets over this hump, I’d like to put him on 24/7 turnout since he is a stall kicker around feeding time and is overall happier being out.

I guess I am looking for similar experiences, recommendations, treatments, success stories, etc. I’ve asked if injecting the bursa or something like previcox would help since bute seems to help the horse significantly, and am waiting to hear back but I feel like I’m grasping at straws at this point. Thanks in advance for any input you can provide.

I’ll note that I am actually pregnant with our first due in October - so if I have anything right now, it’s time. My last priority is getting this horse back to work anytime soon and my biggest priority is his longevity, future soundness, and happiness.

[ATXmom]

Ugh, I’m so sorry. Is there another vet you could use for a second opinion? Has your vet done any injections to alleviate the inflammation? I know that a bone bruise can take a considerable time to heal, perhaps it wasn’t fully healed when he went back to work?

I feel for you as my daughter’s horse was out 6 months with a bone bruise, came back 2 months and then re-injured himself, so he’s back at rehab now. I really think that stall rest is terribly detrimental to both their bodies and minds, and when they come back from it, their bodies are much weaker than you think, causing the potential for additional injury. JMHO

Jingles for some answers and some relief for your sweet boy.

[Hunter11]

Thank you so much. He has not done injections, I actually just heard back from him - he feels it would relieve the pain but at the risk of allowing the horse to exacerbate more serious injuries (inpar ligament and DDFT) but said it could be an option if all else fails. He also says he has never seen just bursitis cause this degree of lameness, or change lameness so acutely.

As for a second opinion, I’ve thought about it. I figured I will let the horse rehab for the year and give him the chance to heal on it’s own since I know the best medicine, particularly for DDFT injuries is typically time, time, and more time. If he is still off come next spring, I think I would possibly seek a second opinion then.

Jingles for your daughter’s horse as well! It is so frustrating, so I absolutely feel for you and her. I agree re: stall rest and had seriously considered just turning him out for a year but the vet strongly advised against it. I am doing my best to ensure long handgrazes daily but I know it’s no substitute for turnout. Ugh.

[ATXmom]

I’ve done A. LOT. of reading and from what I’m understanding, the inflammation and synovitis are at least as damaging as the initial injury. I think if I were in your shoes, I would strongly ask for an injection of triamcinolone or ask him about arthramid or noltrex to alleviate the synovitis.

[ASBJumper]

So… back in 2007/8, my (then) mare sustained a mild DDFT tear inside the hoof capsule as a 4 yr old. Like yours, only lame on turns and graded 3/5. I was never told to put her on stall rest. Small/restricted turnout, and walk hacks in a straight line for 20 min 3x/week - the whole point was not to damage the tendon further but to also stretch it out/work it gently as it healed. I was told this was very important to preventing re-injury. She was fully sound after about 4-5 months of this rehab program never had an issue with that leg again.

Not sure why you were told to stall rest this horse. The tendon needed to be gently stretched as it healed, otherwise re-injury was very likely.

I am not a vet, but at this point I would advise limited turnout and handwalks to work that leg gently. NOT stall rest. JMHO…

[IPEsq]

Was the fracture displaced? Did it heal? Where did you put the IRAP and PRP? In the coffin joint, navicular bursa? In the DDFT? If you don’t know the current degree of soft tissue or bone involvement, I would not go with steroid injections. Might try more biologics or something else, but it depends what the target would be. It would be hard to know exactly without another MRI.

I will say that I have an avulsion fracture in one knuckle. Hurt like hell. For some reason, the collateral ligament didn’t tear or become wholly detached. It just ripped a chunk of P1 off, which I did not get removed since they didn’t need to reconstruct the soft tissue. What helped me the most was MagnaWave. I was treating my horse regularly (who was grumpy on stall rest and kicked at me which is how I broke the finger), and holding those coils for 45 mins to an hour did more than anything else in knocking inflammation and pain down. Knuckle is very slightly enlarged but fully functional (can lift heavy things, good grip). Dietary collagen also seems to help my various joint problems.

Long story short…MangaWave or Pulse type PEMF therapy is actually strong enough to treat issues in the hoof capsule. They have specific paddles for hoof treatment and one therapist I know (I don’t have these components) has a block like an xray block type thing the horse can stand on that you put the hoof paddles in so they don’t damage the coils. That is potentially something you could add without going the MRI and injections route. But even then, it really is a big guess at prognosis without some sort of follow up MRI (whether that’s now or after symptoms improve before you try putting the horse back to work).

[OutsidersOpinion]

First off as others have said, I would not do strict stall rest. All studies are showing that it is detrimental to long term healing.

I would also recommend finding a vet to inject the bursa/coffin joint with prp/renovo/irap. I wouldnt personally wait until next spring as you want to aid in healing, not trying to fix how it healed incorrectly.

Time off for sure will be your friend, but i would also try to help aid in healing in any way you can financially. Accupuncture, magnawave, shockwave, etc will help in small but significant ways over time.

[wildlifer]

My horse had a DDFT tear amd navicular damage. I basically retired him at that point, he owed me nothing. We did use supportive shoeing, otherwise he was allowed normal turnout (in which he is pretty mellow). Because by the time we discovered the injury, it had already been a while (he doesn’t tell anyone when he is sore).

It took about 1.5 years before he really looked normal again. He looked so good, in fact, I did return him to riding - no more competing or jumping, but he enjoyed heaps of trails & pleasure riding at home.

He’s 28 now, so he just chills out as king of the farm, but it’s probably been 10 years since that injury & he is happy & sound (with polyurethane shoes to reduce concussion) in retirement.