Heel Pain, not responsive to Traditional Navicular Treatment. What to Do Next?

[painthunter]

I have a 16 year old Paint gelding that I have had for almost 3 years. I did a PPE on him with no rads as we’ve known and trusted all who have leased him for years and he’s been sound as the Day is long until this January. Horse is on daily Equioxx and has always had a low level hunter job (mainly long stirrup/some low adult hunter).

He took a bad step on some hard ground in a lesson. He kept going fine but once we let him walk and went back to the trot he was head-bobbing lame on the LF. There was some heat and minor swelling along the suspensory. He was immediately wrapped, locked up and the vet called. Ultrasound specialist called in. She saw nothing. Decided he must have just tweaked something, for a week of stall rest and a week of lay up turn out before back to regular turnout and light work.

Horse was still 2/5 lame in the LF. Blocked to foot. Opted to inject coffin joint. Brought back slowly and was sound. Came out stiff sometimes, but worked out of it. This bring us to the end of April. We went and horse showed. It was a 2 day show on good footing, but he was straight up lame in the under saddle Sunday and has not been sound since. Has blocked to the back 2/3 of the LF. Rads show mild navicular changes to both feet (which could have always been there, I have nothing to compare to).

Vet and farrier immediately agreed to put him in a 3 degree aluminum wedge with leather rim pad and start Isoxuprine. Horse hated the wedge and his legs stayed swollen. Those were pulled and he went back in his normal shoes (4 steel).

Blocked again 2 weeks later (horse 3/5 lame now). Still LF, heel. Decided to inject navicular bursa. That was a week ago. Tried to ride him this weekend and he’s still lame.

Have reached out to insurance to see if they’ll approve an MRI. He really needs to go do a standing one as he had a poor reaction to anesthesia this fall when he had corneal ulcer surgery…

so my questions

1. Any feedback on ultrasound of soft tissue structures in the hoof? Vet recommended this as a possible way to go if MRI is declined.

2. Any experience with standing MRI and image quality? We’d go to VA Tech. NC state is literally right down the road, but my guy took hours to wake up from anesthesia in September.

Many thanks to anyone who read my novel. I am making myself nuts worrying about my guy!!

[mroades]

You need the MRI. You might see something with an ultrasound, but it can’t image down into where the ddft attaches etc.

[purplnurpl]

Aluminum is a horrible choice of metal. Concussiom goes right through to the horse’s foot. It’s a soft metal. Think about hitting a base ball with an aluminum bat. Dooooooing. Ouch!
3° is a really big change. And wedges are a catch 22, they cause more heel pressure.

Ultrasound won’t show much in the foot. Most foot stuff is DDFT at the navicular or collateral ligaments.

We don’t think enough about collateral ligaments. Especially when the hoof is torqued. (Like when a horse rips off a shoe).

I’d just give him the summer off, personally.
Don’t change shoeing if he’s been fine his whole life.

Every horse has navicular changes. All bone changes over time. I highly doubt there is navicular issue.

[BoyleHeightsKid]

Pictures of feet would be helpful

[AppaloosaDressage]

I have a mare that’s presenting same after she sprung a shoe. We are all scratching our heads thinking MRI is next. Good luck to you

[Palm_Beach]

A soft tissue injury may take up to a year or even more to heal. It’s only been a little over a month since the lameness presented.

[painthunter]

Insurance just confirmed we can proceed with an MRI.

Our plan was to make a plan and give him a substantial amount of time off if we couldn’t get an MRI as it was cost prohibitive for me. Hopefully we’ll get some answers.

Thanks all for the answers!

[joiedevie99]

That doesn’t sound like navicular at all. It sounds like a sudden onset type thing - which makes me think of a soft tissue injury in the hoof. I hope the MRI gets you the answer you need, and that its able to be treated once you have a diagnosis. Keep in mind that there may be a chronic element to it - as the original injury may go back to when you injected the coffin joint (Steroids diffuse around the joint and may have made a soft tissue injury near the joint feel much better for a time). It helps to write out a good history to give to the vet who will be reading the MRI.

Assuming you can get in to the MRI in the next week or so, I would just take him in as is and let them pull his shoes. If he has to wait, I’d take off whatever navicular set-up they’ve got him in.

[painthunter]

Yup, he’s out of the navicular set-up and didn’t stay in it for long. He was clearly miserable.

Horse is being referred for MRI today. Hopefully they get him in soon. Hopefully there’s a treatable answer. If not, he has more than earned a happy retirement. He’s started many little girls (and nervous adults…) riding careers.

[purplnurpl]

@AppaloosaDressage

I have a mare that’s presenting same after she sprung a shoe. We are all scratching our heads thinking MRI is next. Good luck to you

Horses 100% sprain their collateral ligaments when they pull off shoes.
If the MR doesn’t cost much, then go for it.
But I still hate knocking them out, laying tbem down and stringing them up by their feet.

I’d again, just give it a few months. Maybe guve some NSAIDs daily, like Previcox.

[Jungle_Monkey]

I opted for a standing MRI because I was not willing to risk the anaesthetic and we got a definitive diagnosis from it. Tear on DDFT at P2 and navicular bone, distal sesamoid lesion and collateral ligament lesion.

Images were fine.

[purplnurpl]

@painthunter

Yup, he’s out of the navicular set-up and didn’t stay in it for long. He was clearly miserable.

Horse is being referred for MRI today. Hopefully they get him in soon. Hopefully there’s a treatable answer. If not, he has more than earned a happy retirement. He’s started many little girls (and nervous adults…) riding careers.

He’ll be fine. Don’t retire him! At his age you can also nerve his heel. But I doubt you’ll have to do anything crazy.

Throw in some PRP, give time off and then get rollin again.

I have rehabbed some crazy shit. One was a 40% to the DDFT at the navicular!! That horse jumps and gallops around with no issues now.
I’ve never had reoccurance in any of my rehabbed horses.

this includes:
Collateral ligaments
Hind supensories
Front suspensories
Sesmoidal ligaments
DDFTs
Digital Flexors
SI ligaments
Management if shitty feet and chronic heel pain
Check ligament tear
Check ligament rupture and resulting desmotomy

My education is in biomechanics. It’s def been a godsend for the horses!

feel free to shoot me a note.
Kristen M. Wertz on fb

I’d really like to know What the MR shows!

[painthunter]

Definitely do NOT want to retire him. We will try our best to rehab him (throw whatever we can at him). Will definitely message you!

MRI is Thursday - will report back

[andawaywego]

MRI should tell you alot, but just adding for posterity, our horse had a mystery lameness start up let year. He was literally sound one day, dead lame the next. We all assumed it was a sole bruise, he was a little sensitive to hoof testers, but after a week or two still lame, so start vet treatment. In the end, he was diagnosed with navicular changes (we had an X-ray from a few years ago and now and it was “significantly progressed”. Horse was treated with navicular bursa injections, Osphos and normal steel shoes with pads. We were told to hive him a solid 10 days before riding to let the injections do their job. Day 10, he was still off, better but noticeably still taking some off steps. Day 11 perfectly sound, and continued to be so for about a year when it reared it’s ugly head again. It seems that our horse stomps at flies which aggravates his foot issues so this came up again same time of year this year. Just had a coffin injection and Osphos, rode him on day 4 and he was 100% sound.

So, not all horses need shoeing changes, and in fact or horse hated the sole pressure of the pads and we had to rip them out. Also, a week after injections may not been quite enough time.

But anyway, hope you get answers soon!

[mlb722]

@purplnurpl

He’ll be fine. Don’t retire him! At his age you can also nerve his heel. But I doubt you’ll have to do anything crazy.

Throw in some PRP, give time off and then get rollin again.

I have rehabbed some crazy shit. One was a 40% to the DDFT at the navicular!! That horse jumps and gallops around with no issues now.
I’ve never had reoccurance in any of my rehabbed horses.

this includes:
Collateral ligaments
Hind supensories
Front suspensories
Sesmoidal ligaments
DDFTs
Digital Flexors
SI ligaments
Management if shitty feet and chronic heel pain
Check ligament tear
Check ligament rupture and resulting desmotomy

My education is in biomechanics. It’s def been a godsend for the horses!

feel free to shoot me a note.
Kristen M. Wertz on fb

I’d really like to know What the MR shows!

Off topic, but any wise words for a SDFT forelimb injury rehab? No “holes” but siginifigant strain. Currently on very small turnout, ice 3x a day and surpass. I think we’re about 2 weeks in. Doing shockwave.

[BlueDrifter]

Years ago I did an MRI and stem cell, but it was still a 9 month recovery – after which she was fine.

Now I have a similar thing with a new horse. I am going to look at shoeing first. And if that doesn’t help, then the MRI question comes up.

Regardless of what the MRI finds, the rehab and recovery seems to be the same protocol. So it makes me think twice about having it done. Anesthesia was hard on my 7 year old mare, not sure I want to do that again (standing wasn’t an option at the time). However it was pointed out that shockwave is effective and you need the MRI to pinpoint where to shockwave, so I may consider it after all.

(but I am really hoping it is the shoeing…)

[Palm_Beach]

@purplnurpl

Horses 100% sprain their collateral ligaments when they pull off shoes.
.

No, they don’t.

[Palm_Beach]

@painthunter

Yup, he’s out of the navicular set-up and didn’t stay in it for long. He was clearly miserable.

Why were both his legs swollen? Front? Back? Wedged shoes result in a quicker heel strike and the horse does need to transition into them. But wedges reduce tension on the navicular structures and deep flexor tendon.

Post #16 - "Regardless of what the MRI finds, the rehab and recovery seems to be the same protocol. " This is so true. You can’t expect one thing to work immediately - if there is an injury, it needs to heal, which takes time, and you need to protect the injured structure via shoeing and a reduction in activity. Some shoes work better for some horses and it can be a period of trial and error to find the right set up for a particular horse.

[Peggy]

@BlueDrifter

Years ago I did an MRI and stem cell, but it was still a 9 month recovery – after which she was fine.

Now I have a similar thing with a new horse. I am going to look at shoeing first. And if that doesn’t help, then the MRI question comes up.

Regardless of what the MRI finds, the rehab and recovery seems to be the same protocol. So it makes me think twice about having it done. Anesthesia was hard on my 7 year old mare, not sure I want to do that again (standing wasn’t an option at the time). However it was pointed out that shockwave is effective and you need the MRI to pinpoint where to shockwave, so I may consider it after all.

(but I am really hoping it is the shoeing…)

My understanding on collateral ligament injuries (per Mark Martinelli) is that some of them will heal on their own with enough time, and some won’t and will ultimately need intervention. The good news is that he also said that the prognosis was the same whether you did the intervention immediately or waited several months to see if it got better. This was as of about 8-9 years ago.

[BlueDrifter]

Peggy – my vet had a collateral ligament pull with her horse too, she gave it a year off. No change. Finally did MRI and shockwave and a quick healing. Supports Martinelli’s comments!