Navicular diagnosis only after abaxial block?

[lmatters]

My vet recently narrowed my 8 year old Andalusian x mustang’s shorter than normal strides to Navicular Syndrome.
He blocked the right front heel which didn’t make much of a difference, but blocking higher up with an abaxial block made a significant difference. Radiographs show significant navicular changes both sides, huge sidebones which probably don’t cause any problems, some high ringbone. His recommendations are shoes with full pads, possible injection of navicular bursa, and possibley tildren.

Armacito has never been exuberant in his movement during our 3 years together, but would intermittedly seem off. Farriers have always praised his hooves (never had shoes), a well respected vet/acupuncturist in KY said he was just extremely stiff in his pole and shoulders, vets that did not do lameness evaluations did not seem too worried, and my previous trainer suggested to keep a steady riding schedule, as he does seem to gain more movement when in exercise (dressage). It has been hard to pinpoint Armacito’s lameness, as it would improve after riding some days, but some days just standing in the cross ties for 15 minutes causes him to take tiny baby stride for the first couple steps then return to normal for him-- yet he has a bad habit of pawing in the cross ties, which looks more like striking the ground, Spanish walk style until I ask him to stop. I had always suspected it to be a shoulder issue, as getting up after laying down takes a good few steps of hobbling before returning back to normal as well.

Everything I research about navicular problems seems be centered around heel soreness, but his heels are fine and hoof testing does not amount anything. Has anyone had similar horse woes or insight? Thinking about next steps, considering an MRI…ugh! Thanks so much!

Lauren

[Scribbler]

Well, if blocking basically below the ankles solved the problem then you know it isn’t the shoulders.

If you have questions as to how your vet deduced his diagnosis you should ask him directly to explain.

As far as location it’s important to remember that the navicular bone is up inside between first and second coffin bones and while it can have heel pain as a symptom it’s not the heel bulbs per se that are inflamed.

If you read up on navicular syndrome you will see that there are numerous ways for the navicular bone to be compromised but that x degree of damage doesn’t equal x degree of pain in every horse, so it is a bit elusive.

There sounds like enough bony changes in his feet and ankles to be causing problems.

As far as the vet recommending shoes, he’s given you a standard recipe here and I would pursue treatment options with a good farrier rather than just request what the vet said. Vets in general aren’t trained farriers.

If his feet are as perfect as you say I don’t know what you do, but it’s possible there is room for improvement on balance and angles that will help.

[Fharoah]

Is the ringbone in the coffin joint or the pastern? I think I might try blocking that joint. The navicular changes may or may not be significant. I’d wonder about injecting the coffin joint first.

[JLR1]

Someone I know went through a similar situation with on and off front lameness. X-rays done of the horse showed early signs of bony changes of the navicular bone. The horse was treated with Osphos, joint injections and corrective shoeing but was never completely sound. It wasn’t until an MRI was done that the the whole picture became clear…and unfortunately not a favorable prognosis. Since your horse has significant navicular changes I would definitely want an MRI to make sure the deep digital flexor tendon or any other supporting tendons or ligament within the hoof haven’t been effected. It was something like $1000 per hoof, but in the end worth it to have a clear diagnosis.

[Mathilda]

I would recommend you locate a vet or technician experienced in thermography. A thermal scan is typically extremely affordable, evaluates the entire horse, and can be performed at your barn. It can fairly definitively indicate navicular. However it will also show any areas on your horse which are experiencing inflammation or atrophy, which will be visible as areas of increased/decreased heat (the pictures are awesome by the way). Areas of heat in the body is so closely correlated to injury that in many situations thermography can reveal issues before there’s even clinical symptoms appear.

[Scribbler]

@Mathilda

I would recommend you locate a vet or technician experienced in thermography. A thermal scan is typically extremely affordable, evaluates the entire horse, and can be performed at your barn. It can fairly definitively indicate navicular. However it will also show any areas on your horse which are experiencing inflammation or atrophy, which will be visible as areas of increased/decreased heat (the pictures are awesome by the way). Areas of heat in the body is so closely correlated to injury that in many situations thermography can reveal issues before there’s even clinical symptoms appear.

Isn’t thermography more scanning about the surface level? I have a hard time believing it would give you a more accurate picture of the inner structure of the hoof than an x-ray or MRI. Both of those also can reveal emerging problems before symptoms appear, or even apparent problems that never develop into problems.

[Mathilda]

@Scribbler

Isn’t thermography more scanning about the surface level? I have a hard time believing it would give you a more accurate picture of the inner structure of the hoof than an x-ray or MRI. Both of those also can reveal emerging problems before symptoms appear, or even apparent problems that never develop into problems.

You’re correct, it can only image surface temperature. It’s “thermal imaging”, as the name suggests it’ll give you an image of the heat of the body, which varies a surprising amount. No, it will not give you an image of the internal structure of the horse.

As I said previously, it’s extremely cheap and very accurate at releaving most problem areas. Obviously an MRI is going to be more accurate, but a full body MRI will typically cost ten times as much as a thermography evaluation, and may require life-threatening anesthesia. And no, and x-ray or MRI cannot generally reveal a problem before it occurs. Once you see a change on X-rsy or MRI, whst you have is a physical change-- the problem is there. It might be small, but there’s observable damage. Thermography on the other hand can reveal areas of inflammation. In many instances that inflammation is the body trying to HOLD OFF the damage-- the damage isn’t done yet. X-ray or MRI simply can’t give you that information in many cases.

The real benefit of thermography is that, for a price usually equal to or less than an ultrasound, you can get a picture of any areas of inflammation on the body, excluding extremely deep structures. If your vet is having trouble identifying where an issue is originating, thermography can often be much more precise and provide more information than blocking. It especially excells with leg and back issues, but can reveal much much more.

I think you’d be very impressed with the science if you took the time to gain a little education about it.

[lmatters]

@Scribbler

As far as location it’s important to remember that the navicular bone is up inside between first and second coffin bones and while it can have heel pain as a symptom it’s not the heel bulbs per se that are inflamed.

Absolutely, I just am trying to better understand the prognosis between an insignificant PD nerve block and soundness after the abaxial. I have not found many articles on navicular syndrome with that combination.

[lmatters]

@JLR1

It wasn’t until an MRI was done that the the whole picture became clear…and unfortunately not a favorable prognosis. Since your horse has significant navicular changes I would definitely want an MRI to make sure the deep digital flexor tendon or any other supporting tendons or ligament within the hoof haven’t been effected.

What was the prognosis after the MRI? (Mentally preparing myself, ha) Thank you for all of that! I think that is the next step…

[lmatters]

@Mathilda

I would recommend you locate a vet or technician experienced in thermography. A thermal scan is typically extremely affordable, evaluates the entire horse, and can be performed at your barn. It can fairly definitively indicate navicular.

I will definitely check on that, think I have a contact that could help with thermography! Honestly, all the information I can have the better, regardless of an MRI.

[Scribbler]

@Mathilda

You’re correct, it can only image surface temperature. It’s “thermal imaging”, as the name suggests it’ll give you an image of the heat of the body, which varies a surprising amount. No, it will not give you an image of the internal structure of the horse.

As I said previously, it’s extremely cheap and very accurate at releaving most problem areas. Obviously an MRI is going to be more accurate, but a full body MRI will typically cost ten times as much as a thermography evaluation, and may require life-threatening anesthesia. And no, and x-ray or MRI cannot generally reveal a problem before it occurs. Once you see a change on X-rsy or MRI, whst you have is a physical change-- the problem is there. It might be small, but there’s observable damage. Thermography on the other hand can reveal areas of inflammation. In many instances that inflammation is the body trying to HOLD OFF the damage-- the damage isn’t done yet. X-ray or MRI simply can’t give you that information in many cases.

The real benefit of thermography is that, for a price usually equal to or less than an ultrasound, you can get a picture of any areas of inflammation on the body, excluding extremely deep structures. If your vet is having trouble identifying where an issue is originating, thermography can often be much more precise and provide more information than blocking. It especially excells with leg and back issues, but can reveal much much more.

I think you’d be very impressed with the science if you took the time to gain a little education about it.

I am somewhat familiar with thermography. I agree it could be useful for a preliminary full body scan if you were trying to narrow down a site of injury. I thought the OP had already discovered the main problem was below the ankle in the hoof capsule and the question is now how much damage and how to treat, so need more detail hence the MRI.

[JLR1]

@lmatters

What was the prognosis after the MRI? (Mentally preparing myself, ha) Thank you for all of that! I think that is the next step…

The horse had several issues going on within both hoof capsules and the decision was made to retire him. He is 12 and the owner has since learned the horse has had chronic lameness problems for most of his life that were masked with Bute. I’m not sure if “nerving” was an option, but the owner was not interested in doing that. I hope your horse has a better outcome.

[JLR1]

@lmatters

I will definitely check on that, think I have a contact that could help with thermography! Honestly, all the information I can have the better, regardless of an MRI.

Thermography is a really useful tool when looking for a “hot spot”. You have already identified the hot spot of sore feet and I don’t think thermography will add any additional useful information at this time.