Success on nerving your horse? (neurectomy)

[beau159]

Oh, I feel like I don’t know what else to try for my daughter’s horse and lightly considering getting him a neurectomy later this year. I thought I’d reach out to the brilliant minds of COTH to see if I am missing anything else I can try for his navicular or if there are any success stories after a neurectomy.

Horse is an angel for my daughter. She will be 7 years old this summer. She’s a very timid child and he is just perfect for her. He listens so well and is a do-gooder. So my entire goal is to keep him sound enough for her. She’s currently just walking and trotting on him, maybe once or twice a week. I don’t know if she’ll be brave enough to start loping on him this year or not. Either way, it’s very light work.

Of course, I have to include a picture of the sweet boy.

He will be 17 years old this year. AQHA. We bought him when he was 10 years old. He had a hard life before that (cowboys … and not good ones). He’s had some mild bony changes in his front feet since we bought him but he surprisingly was never that bothered by it clinically; just mild. His hocks were fusing when we bought him and that bothered him more, but was easily managed with hock injections. He did almost die (not joking) when he was 13 years old when he got a hock joint infection from impaling his hock on something, but he shockingly made a full recovery and I was even able to make a couple barrel runs on him again after almost 2 years.

But… it’s those darn front feet. I’m not sure if the hock injury expedited problems on his front feet (just due to keeping weight off his hind leg) or maybe it had nothing to do with it.

This year, I’ve really noticed he has that “navicular stance” where he is camped out. I hop on him once in a while, maybe once every couple weeks, just to really keep him soft for my daughter and I can just feel that he is ouchy on those front feet.

In 2021, I tried Osphos injection. Didn’t help at all.
Also in 2021, I tried having him on pentosan most of the year. Didn’t help at all.
Last year (2022), I tried regular steroid injections into the coffin joint. Didn’t help at all.
I pretty much keep him on daily Equioxx during the summer months but I just feel like it wasn’t doing much at all in 2022 as he was still symptomatic.
Once upon a time (before the hock infection incident) I did have shoes/pads on his front feet but I really am not sure how much it actually helped at that time. So he’s been barefoot since the incident anyway.
I always put his SoftRide boots on his front feet anytime that he is going to be standing tied to the trailer for a length of time, and anytime I haul.

Part of me is leaning toward just doing the neurectomy in order to make him more comfortable. But I also know those don’t last forever (and could last as short as 6 months) and it only covers up the pain. I’m just trying to figure out how I can make him last for her!!!

My goal for this spring, when our mountains of snow melt, is to treat him with my PEMF system every day for two week while also back on the Equioxx, and see if that makes a dent in how his front feet feel. Since he is my daughter’s horse, I admit he takes a back seat to my 2 main horses and I made time for them to get the PEMF treatments but I just would always run out of time for him. And I just need to figure out to get him the time too. (Who needs sleep anyway…)

I’m not opposed to putting shoes/pads on him, as my other main horse has special shoeing needs, but I might give the PEMF a chance first. Part of me has a hard time putting shoes on a horse in very light work, but I also am thinking long-term and what is long-term going to be best for him.

I have to haul about 6 hours to get to someone who can do the neurectomy, which isn’t a problem for me. My one concern with the nerving is that if the navicular gets worse, he won’t feel it, and won’t show me that he’s getting worse. Has anyone had that happen?

My horses are turned out 24/7 on pasture year round. So he’s never locked up and always can move around as he pleases. Which I hope is helpful to him.

[Small_Change]

Probably the biggest thing to remember about a neurectomy is that although the horse might look sound afterwards, he’s not. You touched on it in your post - it doesn’t fix the problem, just makes it so he can’t feel it. If you are okay with careful management, and will not let the horse out of your care, it could be a viable option.

A horse who boarded with us was nerved for navicular pain, and went on to live many years in comfort after the procedure. When he was still with us, he wasn’t in much work, and I don’t know what he went on to do, but the bilateral neurectomy of both front feet certainly offered him relief. The surgeon did talk about removing a relatively large piece of nerve to prevent bridging of scar tissue and reinervation. He felt that the biggest concern would be either neuromas forming on the severed ends of the nerve, or injury to the horse that could potentially go undetected. Recovery from the procedure was very straight forward, and I suspect that the biggest issue is overall management going forward from the neurectomy.

I lost track of the horse, but know he was still around about 10 years after his neurectomy. I don’t know what his condition was like at that point, but do know he likely wouldn’t have made it that long without being nerved.

[beau159]

@Small_Change

Probably the biggest thing to remember about a neurectomy is that although the horse might look sound afterwards, he’s not. You touched on it in your post - it doesn’t fix the problem, just makes it so he can’t feel it. If you are okay with careful management, and will not let the horse out of your care, it could be a viable option.

Exactly. It’s only masking his pain but not changing the disease process.

I wouldn’t have any plans for him to go anywhere… ever. My kids are young so as long as I can keep him going, he will always have a job to pack around one of them. And if the day comes where I can no longer keep him comfortable, then he’ll be put down. But I hope that day is a long way off!!!

@Small_Change

A horse who boarded with us was nerved for navicular pain, and went on to live many years in comfort after the procedure. When he was still with us, he wasn’t in much work, and I don’t know what he went on to do, but the bilateral neurectomy of both front feet certainly offered him relief. The surgeon did talk about removing a relatively large piece of nerve to prevent bridging of scar tissue and reinervation. He felt that the biggest concern would be either neuromas forming on the severed ends of the nerve, or injury to the horse that could potentially go undetected. Recovery from the procedure was very straight forward, and I suspect that the biggest issue is overall management going forward from the neurectomy.

I lost track of the horse, but know he was still around about 10 years after his neurectomy. I don’t know what his condition was like at that point, but do know he likely wouldn’t have made it that long without being nerved.

What I have bolded is my biggest question on the neurectomy. I like to think I take excellent care of my horses but there’s the chance that something could be advancing more that he would not be able to feel, and therefore not able to show symptoms. Or … when the nerves regenerate (because they will at some point), will he be in more pain then?

[Highflyer1]

I’ve seen a few that were fine and as far as I know remained fine-- and one where the nerve regrew after several years and he was suddenly 4/5 lame. The vet who x-rayed him said his x-rays were the worst she’d ever seen and he was euthanized not too long after because he was so uncomfortable. So yes, for him the degeneration continued to the point where there was no cartilage left and the joint was badly damaged. He appeared to be pretty sound right up until he wasn’t-- I actually thought he had a bad abscess at first.

[IndysMom]

I realize that you don’t want to do shoes. However, they might help. We kept my very navicular horse sound for several years using a tenessee navicular bar shoe with pads. He did start out on bute and isox, but we weaned off those eventually.

[mroades]

Make sure you MRI and block the feet first. You need to rule out soft tissue damage and your nerving is only going to be as good as your block

[luvmyhackney]

I would do a bit more diagnostics before going to nerving. Definitely MRI with feet blocked.

Try shoes and pads, plus see if any other pain meds might work a bit better. Even a good pair of hoof boots.

Nerving seems so wrong to me, especially just to keep a horse in work even for one of my kids.

[Xanthoria]

@beau159

I pretty much keep him on daily Equioxx during the summer months but I just feel like it wasn’t doing much at all in 2022 as he was still symptomatic.

A horse whose pain is not controlled by daily painkillers is in a lot of pain. IIWM, I’d be retiring him with a view to euthanasia if you can’t get the pain under control - not patching him up more so you can ride. But: your post doesn’t mention what your vet says?

PEMF just seems like trying to put out a house fire with a teaspoon.

For what it’s worth, my vet won’t do a neurectomy - it’s a very morally suspect thing to do. Very painful if the nerves grow back, but if they don’t your horse can never be turned out again because they don’t know where their feet are. That’s not a kind way to treat a horse, nor a horse I’d ride, by the way.

[SLW]

Back in ‘79 I was a working student at a farm and a former ASHA level hunter mare boarded there. She had been nerved after years of showing.

She was lovely to ride, a sweet mare. However, she was kept in a stall with paddock or indoor arena turnout. Some of that was due to her age, 20 years old, and some of that was because the pasture was vast and filled with 20 horses.

Anyway, I just mention how that mare was kept on the off chance your pasture is vast.

[lenapesadie]

@Xanthoria

For what it’s worth, my vet won’t do a neurectomy - it’s a very morally suspect thing to do.

Ditto. I dunno if they think it’s morally questionable just that their office (5 vets) won’t do it.

OP - FWIW my horse with chronic navicular changes plus sinking founder has been made comfortable with shoes and pads plus trims done “by x ray”.

Do you have recent x rays of the front feet? It would seem logical to try different trims / shoes before nerving him.

[beau159]

@IndysMom

I realize that you don’t want to do shoes. However, they might help. We kept my very navicular horse sound for several years using a tenessee navicular bar shoe with pads. He did start out on bute and isox, but we weaned off those eventually.

Per the OP, I did have him in shoes before (with special pads) and I’m unsure of how much they helped at that time. However, it was before his hock incident so it has been a while. Most likely, I will end up putting shoes this spring when the snow melts (after I go get his xrays updated first so my farrier can work off that.) It’s something to try.

@mroades

Make sure you MRI and block the feet first. You need to rule out soft tissue damage and your nerving is only going to be as good as your block

The closest MRI to me is about a 7 hour drive in the opposite direction of the surgeon who I would have do the procedure the other 6 hours away. Again, I’m really only lightly considering it and of course would do what my vets direct me to do prior to the procedure.

@luvmyhackney

I would do a bit more diagnostics before going to nerving. Definitely MRI with feet blocked.

Try shoes and pads, plus see if any other pain meds might work a bit better. Even a good pair of hoof boots.

Nerving seems so wrong to me, especially just to keep a horse in work even for one of my kids.

(see MRI comment above)

What other pain meds are there? I certainly don’t want to give him bute on a regular basis due to the GI effects, and we’ve already done the Equioxx route.

@Xanthoria

A horse whose pain is not controlled by daily painkillers is in a lot of pain. IIWM, I’d be retiring him with a view to euthanasia if you can’t get the pain under control - not patching him up more so you can ride. But: your post doesn’t mention what your vet says?

PEMF just seems like trying to put out a house fire with a teaspoon.

For what it’s worth, my vet won’t do a neurectomy - it’s a very morally suspect thing to do. Very painful if the nerves grow back, but if they don’t your horse can never be turned out again because they don’t know where their feet are. That’s not a kind way to treat a horse, nor a horse I’d ride, by the way.

My usual vet is actually the one who suggested the neurectomy. She is very, very good and she knows my horse’s history. She herself isn’t set up to do surgery, so that’s why I would travel elsewhere to have the procedure done.

Your description of a neurectomy is not what I have been told. The horse’s entire foot is NOT numb (only the heel) and they can still feel where their feet are and they absolutely can be turned out.

PEMF has done wonders for my other horse (also with heel pain). Maybe it won’t help this one, but I’ll still going to give it a try.

Horse is absolutely NOT ready for euthanasia. I’m gathering from the tone of your post that you somehow think I am riding a poor horse into the ground who is limping around 3-legged lame. If you want to see for yourself how he moves, here you go.

Dexter Trotting

If you are morally against a neurectomy yourself, that’s fine. But my vets consider it an option and it is indeed an option. I came on here to ask questions and have a discussion about it, not be shunned for it.

@lenapesadie

Ditto. I dunno if they think it’s morally questionable just that their office (5 vets) won’t do it.

OP - FWIW my horse with chronic navicular changes plus sinking founder has been made comfortable with shoes and pads plus trims done “by x ray”.

Do you have recent x rays of the front feet? It would seem logical to try different trims / shoes before nerving him.

I plan to repeat his front feet x-rays in the spring. I usually do them yearly. The xrays themselves really have not changed much at all, since we bought him. Which I guess is good that the bone itself is not further deteriorating, but of course the xrays do not show what is going on with the soft tissue around it.

I am lucky to have an amazing farrier and yes, I always show him the xrays when I get new ones. I’ve also had a discussion with him about what to do. Last time we did the shoes/pads, we just did frog support (no wedge) because per his xrays, he really should not be in a wedge because his angles are good. But … might end up having to do a 1 or 2 degree if it comes down to it.

And yes, even though I was not super clear in my OP, I would absolutely try shoes/pads first before going the neurectomy route, of course.

[Xanthoria]

People don’t suggest neurectomies for sound horses. Or even ones that are slightly lame. It’s an absolute last resort that a lot of vets will not do. And you said daily painkillers don’t fix his symptoms of pain. You even said he’s having trouble standing normally. That usually means things aren’t looking good, and you and your vet have tried all the usual stuff.

But you’re showing a video of a horse jogging around in an arena as proof that he is… not very lame?

Bilateral lameness doesn’t usually look like “three legged lame” head bobbing - it can often look like a very short strided horse holding a lot of tension in their body. If you nerve block one leg, they suddenly get very head bobbing lame on the other leg.

[endlessclimb]

I understand that truly kid-safe horses are worth a million dollars, and can’t be found easily. I am not against a neurectomy with the horse in light work (I’m talking walk-jog ONLY) if nothing else will work. A couple things though -

If bute works better than Equioxx, you’re after quality not quantity. The GI issues bute can cause can be mitigated in a myriad of ways, so switch to the bute if it works better to reduce his pain.

Shoes. I hope you have a good farrier that has experience with this, because they really can help.

Lastly, he is clearly very sore in the video you posted. Short strided at both walk and trot, setting fronts down as fast as he can and an obvious toe-first landing.

I wish you the best of luck, he seems like a good boy.

[No1]

Before I did anything at all, I would block the horse. It’s very simple, relatively cheap, and will give you valuable information going forward. If you have never blocked the horse before, you are assuming that it’s his feet, based on X-rays. That’s logical, but possibly not true. Before signing the horse up for surgery or an MRI, do the easy thing and block him. As someone said before, if he doesn’t block, nerving him won’t help anyway.

If he blocks to a PD, which he should, if he’s sore because of the navicular changes, it may be possible that you need to do several things at once to make the horse more comfortable. You’ve done a few things, but it sounds like they were all spread out? I would put shoes on, start the horse on Isox, and give the horse Osphos all at once. I’m sure your vet told you, but it takes several weeks for Osphos to take effect. Give him that time to adapt to all of the changes. Sometimes, once a horse has built up a level of discomfort, it takes a few things and a little time for them to come back.

If the horse blocks and you decide to nerve him, he definitely needs an MRI before hand. One of the dangers of neurectomy is that the horse can’t feel other structures in the back of his foot. If he has damage to the ddft in the foot, for example, and can’t feel it after the neurectomy, he could easily over do it in turn out and end up with a very serious injury. Most people I know who recommend and perform neurectomies, will not do it until the horse has been blocked and had an MRI.

[lenapesadie]

My horse has been through about 5 shoe set ups now in the quest for the best match.

What really turned the page was having the vet and farrier here at the same time, trim X-ray trim. If there’s any extra toe it puts more stress (pain) on his feet. The farrier has a nifty looking compass tool he used to measure the optimal hoof length during that appt and now we refer back to that measurement at each farrier appointment.

FWIW, my vets feel Bute is a more effective pain management drug than Equioxx. My boy was on a heavy dose of Bute after his last laminitis attack and we were able to keep his tummy happy with Outlast and alfalfa hay. Horse is off all pain meds now. Horse was retired when I acquired him due to the chronic front feet lameness. It’s been a $$$ journey but the vet feels he’s sounder now than he has been in a decade (same vet clinic has treated the horse for the two owners before me). All that to say that just because a lameness has been a chronic condition for years doesn’t necessarily mean it can’t be improved with the right approach.

[MsM]

The two “nerved” horses I knew were quite a while ago - long before MRI was available.

The vet did a block to see if the horse was a candidate. Apparently, the nerve can be severed at different points, but he felt the only ethical one was shown by a low block. That meant the horse only lost sensation in a portion of the back of his foot so he could still place his feet accurately. One horse was “sound” for maybe 3 years before the pain returned and he was euthanized. The other I lost track of after 5 years when he was still doing easy trail rides. Both had regular vet visits and radiographs but otherwise were manage pretty normally with turnout.

If the pain is not able to be controlled reasonably well with NSAIDs continuing on like that is not a reasonable option. If the horse can be made comfortable with neurectomy and careful followup vet care, that sounds like a much more humane choice. Sure the disease will progress without the horse showing signs unless it affects structures not blocked. But the horse is comfortable and has a good QOL at least until the block no longer works. Perhaps one of the vets on here can inform us if there are catastrophic endings for these horses as some fear.

[ASB_Stars]

I used a chemical neurotomy on my horse to see if it was appropriate. When I bought him, I did have him radiographed, and not only did he have some navicular changes, he also had hock and stifle changes. Don’t ask why I bought him anyway.

I competed him successfully in some shoes designed by Bill Moyer, who was at NBC at that time. When I stopped working him in his late teens, we pulled his shoes and turned him out. At that point, he started to shorten up, and his heels contracted. He was putting a lot on strain on his back end, and his hocks weren’t happy, either.

After consulting with my Vet, we decided to try the chemical neurotomy. My blacksmith, who was her husband, poo-pooed the idea.

It was more than successful. Because he had no pain in front, he opened up his stride, and his contracted heels opened up. His hocks improved, and the horse was just all around doing better. We went with it for about six months, at which time he was doing really, really well. We were able to stop doing the chemical neurotomy, and he maintained for several more years until he had other issues which caused me to have him euthanized.

The thing that I like best about doing things this way is that you can evaluate as you go, and it is not irreversible.

[Small_Change]

I just had another thought, and it may be a stupid one, but worth considering? Will the horse still be kid appropriate after his pain is taken away, if you went with a neurectomy and it worked? Sometimes horses are “quiet” when they’re actually too sore to be silly.

I’d hate to go through with this for a horse only to find out he’s not suitable for his job afterwards. I know lots of creaky, quiet lesson ponies who came ALIVE after starting on medication for arthritis or what have you, and were no longer suitable for up-down lessons.

[StormyDay]

I’ve known nerved horses and if I had one that was at that last resort, I’d do it.
It’s not the procedure it once was. They have gotten much better at preventing complications. Yeah, it’s possible the nerves regrow quickly, but it’s also possible they never regrow and you have a happy horse.
Arthritis is a weird disease. The best thing to help is movement… but movement hurts. While you are covering up the pain, in this case that pain isn’t ‘helpful’ pain. The pain isn’t telling your horse to stop because moving could injure them (like a tendon injury). Your horses’ arthritis is unlikely to progress any faster whether you do the surgery or not. And as long as you are ok with him just being in light work, maybe WTC and some poles, nothing fast, nothing hard, then it may be a good fit.
I will say through, there’s a group on Facebook call hoof care and rehabilitation. I would go there and post photos of his hooves. Sometimes even good farriers make mistakes, and bad angles can make a horse with a mild navicular case look crippled.

[kaya842]

@ASB_Stars Can you please explain more about the chemical neurectomy? How often did you have it done/ how long does it last? What is the procedure like? Cost, if you don’t mind sharing? I think this could be immensely helpful for my coffin bone infection horse (who is improving albeit slowly which we attribute to her not using her hooves correctly).