Navicular in a young horse - Updated #13

[MsM]

My 7 year old was just diagnosed with navicular syndrome. I first noticed lameness yesterday. The vet was scheduled to be out today anyway so I added my horse.
Physical exam didn’t show anything. Horse was slightly off at the walk, significantly lame at the trot. On longe, worse tracking right. Did a block but couldn’t get the outside completely blocked. Still lame. Much improved with the next block up so we moved on to radiographs. Angles were lovely, feet looked excellent until you looked at the navicular. “Significant” lesions in the bone.

This horse has been barefoot with excellent feet his whole life. The vet was a bit surprised as he had none of the predisposing factors, but said sometimes it “just happens”. So he got a treatment with Osphos. He will have new trimming and probably shoes. I am debating whether to spring for an MRI and another opinion at the Big Clinic, but it doesn’t seem like that will change much in treatment plan.

Opinions? Encouraging stories? Wine?:sigh:

[mroades]

I would do an mri, otherwise you are guessing. Especially if it didn’t block all the way

[Sansena]

I’m also confused, when you say yesterday was the first time you noticed lameness, and the vet saw him on the same or next day.

Usually navicular presents with stumbly trot, short strided at the walk and a more noticeable reluctance to break over.

I’ve known horses with navicular bones that looked like Swiss cheese and were sound, and horses with one tiny keyhole and were dead lame.

I think you’re smart to add shoes. I also agree an MRI is important as well. There might be something else going on causing the lameness and you found the navicular degeneration coincidentally.

[findeight]

Third the MRI recommendation as it did not block just to the hoof…definitely indicates something else may be wrong higher up. Maybe compensatory, maybe something comletely unrelated.

Navicular can be managed although it can get costly and can limit what they can do. Have had several but they all blocked completely sound above the hoof. How is thus horse bred? There may be a genetic component according to my vets if there’s no conformational predisposition for it to develop.

Bummer. It won’t go away and can progress. Horses…:no:

[DoodlesMom]

My guy was 5 when he was diagnosed. Never been lame a day in his life, but tripped and fell twice under saddle in a few month period. Had a vet out who said he was fine, it was just baby stuff and training issues.

One day he came in super lame. Different vet happened to be coming out for another horse, so we have him take a look. He suspected navicular, along with a collateral ligament tear. X-rays and MRI confirmed both.

It’s been a year now. He’s sound (knock on wood), and now barefoot. Initial treatment was stall rest and shockwave for his ligament, Osphos, joint injections, bar shoes, and pads/wedges. He is the WORST when it comes to shoes, so after 8 or so months of my farrier replacing his shoe ever week or two, he’s barefoot for a while. We keep a close eye on his angles (his right foot is a little clubby), but for now he’s good.

The vet is pretty optimistic about his long-term soundness, as long as we stay proactive. I mean, he’s not going to be able to go to Rolex or anything, but he’s an appendix and we weren’t aiming that high anyway lol. We do lower level dressage, and I have no delusions. He’s got a home with me forever, so my goal is just to keep him as sound and pain-free as possible, for as long as I can!

ETA: My old lease horse also had navicular. 23 yr old foundation QH, built like a tank. He was a former speed horse, but had been nerved before his last owner got him. He was sound for a long time, but we always were super careful with terrain and checking his feet because of the nerving. He had steadily been going downhill - getting more sensitive and on/off lame. I read somewhere that it’s possible the nerves were regenerating, but we aren’t sure. He died unexpectedly before anything could be done, diagnostic or treatment-wise.

[PNWjumper]

I’ve posted here many times about the fact that I don’t “believe” in navicular. Or more specifically, I don’t believe that most diagnoses of “navicular syndrome” are really related to the navicular bone in non-predisposed breeds. I think that often lameness of unknown sources happens to coincide with ugly navicular shots and the relationship is drawn whether it exists or not.

To Sansena’s point, one of the best horses I’ve owned was a halter-bred QH who carried me through the big grand prixes. His navicular shots were the worst any of my vets had ever seen. He required attentive shoeing for sure, but that horse competed at the highest levels until he colicked badly and died in his 20s.

Having said that, yes, it absolutely happens. And yes, horses can absolutely be lame from significant or insignificant changes in the navicular. But without x-rays from an earlier time to compare to, those x-rays could be his normal. And the fact that he didn’t block out would leave me suspicious of more going on than heel pain.

I also wouldn’t do Osphos just on a guess. Obviously it worked out okay for you in the short term, but there are many detrimental side effects that are starting to come out now (there was a recent thread here about just that). I’ve also posted about the fact that my innocent Osphos shot resulted in kidney failure for my FEI horse. In this case, specifically, I wouldn’t do Osphos when the lameness didn’t block to the foot.

[MsM]

A bit of clarification: On the first block, the vet did not get the lateral portion numb. Rather than repeat that block, he did the next one which did work on both sides and resulted in significant improvement.
Horse is scheduled for an MRI on the 20th.

[CL_Moonriver]

I would get a second opinion. Keep in mind that modern thought is that x-rays are not diagnostic of navicular syndrome. Many perfectly sound horses show navicular remodeling on x-rays. Also, keep in mind that modern thought is that “navicular syndrome” is better called “caudal heel pain syndrome” because it’s not a single problem. Any number of things can cause heel pain.

That said, seven is at the low end of the age range for navicular syndrome to be diagnosed. But it is typically diagnosed between the ages of 7 and 15.

I wish you and your horse all the best.

@MsM

Opinions? Encouraging stories? Wine?:sigh:

I don’t know if this is encouraging or not, but a few days ago I had a horse that started pointing and I became very worried about navicular syndrome. It turned out to be an abscess in the heel area.

So again, all I can do right now is agree with what everyone else has said. Second opinion from someone who specializes in lameness issues.

[CL_Moonriver]

I second what PMWJumper said. So called "navicular syndrome is better called “caudal heel pain syndrome” because the cause is not always related to the navicular bone. Furthermore, as has been pointed out, x-rays are no longer considered diagnostic of navicular syndrome because many perfectly sound horses show significant navicular remodeling.

So again, second opinion needed from a vet who specializes in lameness.

[Abbie.S]

To add to the confusion around what “navicular syndrome” actually means… there is a lot of evidence to suggest that it is actually the irritation, strain or other damage to the DDFT and other related/surrounding soft tissues in hoof that are the root cause of the lameness and pain associated with “navicular”. Which is why Osphos and other bone/joint specific remedies are effective in “treating” some horses but not others. It would also explain why some horses show significant remodeling and are perfectly sound and others have minimal changes and are dead lame.

I empathize - I put down my 9yo mare two years ago this month due to a combination of bilaterally fusing hocks and bilateral navicular syndrome up front. Not the story you want to hear, I’m sure, but the reality is veterinary medicine is still not conclusive or anywhere near in agreement about the why and how as it relates to this issue.

[StormyDay]

One of my horses was diagnosed at 8. His xrays looked really bad.
I can go into the steps we did, but long story short is he hasn’t had symptoms in years. I really think that he didn’t have navicular and it was something else, and he just happened to have bad xrays. either that or I found the cure for navicular
I don’t look at navicular as the offputting death sentence it used to be viewed as. even the worst cases I have seen have been controlled enough that the horse is sound for riding. None of the horses I have had experience with needed to go to nerving.

[painthunter]

I posted this similar story back in May regarding my (older) horse. My normal vet – who I very much like and respect – truly wanted it to be navicular when my normally very sound 16 year old Paint pulled up lame in his left front. We blocked. And blocked. And blocked some more. His x-rays showed significant remodeling of the navicular in the left, some in the right. We changed his shoes. Still lame and his legs swelled up so bad. Blocked again. We injected his navicular bursa. He was still lame. I finally said I wanted an MRI once we had insurance blessing. What we found was a core lesion to his DDFT that started right at the navicular bone (and a ton of adhesions in his navicular bursa).

2 rounds of stem cell therapy later, shoeing changes and 8 months later, my guy is currently sound. We are hoping to try and canter him later this week. He has had follow-up ultrasounds every 6 weeks since and has had so much improvement even the orthopedic folks at the vet school are shocked. Only time will tell if he ever returns to jumping… Best of luck with your MRI!!

[MsM]

Went for MRI. Horse was nearly sound and actually showed some discomfort in the other front. So ended up doing both.
Main issue seems to be a small lesion on right DDF. There is also some inflammation around navicular and collateral ligaments and some imbalances to be addressed. The navicular bone itself was not bad.

So now he is on rest for two months. Small paddock turnout, and, because I know he is too playful in turnout, we will used reserpine. Vet is preparing trimming and shoeing needs for the farrier. After two months we will do very slow rehab for two more months.

At least it is winter.

[Zu_Zu]

So now a diagnosis and treatment plan … good !

((hugs)) laced with strength and extra patience for his worried owner ~

HAPPY HOLIDAYS !

[MsM]

Update: Horse is shod with natural balance shoes with 2 degree pad with frog support. He is on reserpine and BO reinforced and made his paddock smaller with hotwire (now lovingly referred to as the “velociraptor paddock”). Horse appears sound, though we haven’t done more than look at him at the walk.

Still struggling with whether to do more treatment.

Clinic vet said we “could” do shockwave but felt it wasn’t essential. Local vet does not have shockwave. Reached out to Big Vet who texted that he would do PRP and shockwave. (He has not really elaborated and I cant get him on the phone)

So now I am torn. See very mixed things about PRP and wonder how that would work when the lesion is deep within the hoof. And haven’t seen much on shockwave providing better long-term results. Anybody have experiences? Any downsides (besides the strained credit card) to this?

[painthunter]

I don’t know how deep in the hoof your DDFT lesion is. My guys started right at the navicular bone and was a large core lesion. The only treatment my vet school recommended was stem cell therapy. PRP and shock wave were not on the table because of how deep it was. We talked about everything as he was still insured at the time.

My horse was diagnosed and started treatment in May. He has had multiple follow up ultrasounds (for what they are worth, I can’t really afford or justify another MRI as this horse reacts poorly to anesthesia and should not be laid down for it) has shown significant healing. He’s currently sound walk/trot and just started to canter where he is also sound…

[MsM]

I hate it when vets do not agree! There is a small lesion near the insertion at the coffin bone. So about as deep into the hoof as you can get! Local Vet doesn’t see how PRP could reach that area. Have only spoken to Big Vet briefly on the phone. I sent him the MRI pictures, reports, etc but don’t know how well he has studied them yet. He is coming out next week. I am leaning towards doing shockwave. He would have to do more to convince me about PRP unless it also would help the other inflammation in the hoof.

So hard to do the “right thing” and not over or under treat!

Also wish the weather would settle down as horse hates being in and the reserpine seems to be doing little for him when he is inside. Just getting out into his tiny paddock makes him so much calmer!

[Libby2563]

@MsM

I hate it when vets do not agree! There is a small lesion near the insertion at the coffin bone. So about as deep into the hoof as you can get! Local Vet doesn’t see how PRP could reach that area. Have only spoken to Big Vet briefly on the phone. I sent him the MRI pictures, reports, etc but don’t know how well he has studied them yet. He is coming out next week. I am leaning towards doing shockwave. He would have to do more to convince me about PRP unless it also would help the other inflammation in the hoof.

If it’s that deep, I’d be skeptical of shockwave too. I’m actually skeptical in general because I haven’t seen many studies that clearly support its efficacy and even its proponents can’t explain exactly how it might work. You might want to go to pubmed.com and search for “shockwave horse” and “ESWT horse” to learn what you can about it. You can also search for studies specific to DDFT treatment.

It does suck when the vets don’t agree… I totally sympathize, as I had numerous well-respected vets examine my last difficult lameness case and there was quite a range of opinions. In the end, I was actually the one who came up with and suggested the eventual diagnosis (DSLD), not any of the big-name vets. One of them actually told me, “I wouldn’t worry about DSLD,” and performed a surgery that it turns out had no hope of success. So it really does pay to educate yourself.

[eruss]

@MsM

Update: Horse is shod with natural balance shoes with 2 degree pad with frog support

It’d be interesting to see x-rays of last shoeing and next shoeing. NB shoes reduce force to the deep flexor tendon but increase load on the heels. 2 degree pad also decreases pressure on deep flexor tendon and increases load on the heels.

Generally what happens is the back of the foot collapses throughout the shoeing cycle. When the shoes/pads are taken off the foot is at a worse angle than when you originally started.

Quick fixes are generally long term problems.

[summerfield]

I just put down my 9 year old for this. His X-rays were not great, but did not predict the degree of lameness he had. I also did an MRI, and there were no soft-tissue injuries.

The two things that made my horse remotely sound were actually on the extremes. One, I tried barefoot rehab (my horse had been barefoot all his life, too, but that doesn’t mean a good trim job.) Google Rockley Farm. When I tried to follow their protocol, my horse was actually rideable for a brief period.

The other thing thing that worked, when he was past being ridden, was having a really, really good farrier work on him. I learned a lot about hoof balance from this experience, and most farriers, IMO, do an okay job that works for most horses. I got someone really good to do what was basically a custom shoeing - reverse shoes with a wedge that he hot shod- my horse was pretty comfortable. Not enough to be ridden, but I could see the difference.

Ultimately, I would say enjoy him. I miss my guy terribly. I wish he could have kept going, but he wasn’t really comfortable and I couldn’t face nerving him or buting him every day at 9.