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Diagnosis
Conditions or ailments that are the cause of a problem that you see - your observation.

Your vet may diagnose

Navicular Syndrome

Synonyms: Navicular Disease, Caudal Heel Syndrome, Chronic Heel Pain, Navicular Cyst, Palmar Foot Pain, Podotrochleosis, Podotrochlitis

Summary

"Navicular syndrome" is actually composed of several related conditions that affect the navicular bone and related nearby structures.

Generally, pain and lameness result from the interference with blood supply, trauma, pressure and/or friction on the navicular bone, navicular bursa, navicular tendons and/or the deep flexor tendon within the hoof. With the advent of better imaging (primarily MRI), we are learning that this syndrome is a much more complicated group of injuries than previously recognized.

Navicular Syndrome (lameness associated with the structures of this part of the foot) is the most common cause of chronic forefoot lameness in horses. It is a well known cause of poor performance and a short choppy gait in American Quarter Horses and Thoroughbreds, but is seen in horses of most breeds and disciplines. It is ALWAYS a possible diagnosis for horses that are not performing to expectations, and the signs can be subtle.

This diagnosis is arrived at by your vet via a careful history and lameness exam that likely involved nerve blocks and radiographs, at minimum. Your vet should help you understand the anatomy and mechanics of this problem so that you understand principles of long-term management, shoeing recommendations, and your horse's prognosis. Should you proceed with treatment, you will need to work closely with your vet and farrier to manage this syndrome.

Treatments of this condition are varied and include bisphosphonate drugs (like clodronate or tiludronate), rest or reduction in work level, shoeing changes, injection of coffin joint and/or navicular bursa, NSAIDS, and combinations of these.

The most important thing to understand about this syndrome is that the pain may be coming from specific conditions and structures within this region of the foot. The most appropriate treatment(s) depends on the specific condition being treated, and that information can only be gotten through MRI.

In many cases, however, MRI will not be performed because of cost or availability, and so treatments may be tried without the benefit of this specific information. Ongoing management approaches will depend on the success (or lack thereof) of these treatments.

my vet's role

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OTHER DIAGNOSES CONSIDERED

Other conditions or ailments that might also need to be ruled out by a vet.

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Diagnostics Used

These are tests that might be helpful to make this diagnosis or further characterize the condition.

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Treatments May Include

These treatments might be used to help resolve or improve this condition.

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PROGNOSIS AND RELEVANT FACTORS

Prognosis depends on the duration and severity of the condition and the precise diagnosis, specifically, how much radiographic change there is in the navicular bone, and whether other structures are involved such as the deep digital flexor tendon. The precise approach to treatment, and the prognosis will depend on all of this information.

The horse's underlying conformation is important. Horses with heavy bodies and very small feet will in many cases be harder to manage than horses with better conformation and larger feet. Mechanical problems of the lower limb, like long toe/low heel or NPAS (negative palmar angle syndrome) need to be managed along with other factors.

Prognosis is fair to good for pleasure horses, depending on accuracy of diagnosis and a careful treatment and management plan. Return to prior level of performance is questionable.

my role

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I might observe

You might make these observations when a horse has this condition.

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Rare
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Questions To Ask Your Vet:
  • Have you diagnosed the precise injury causing the horse's heel pain?
  • What are the long-term prospects for me horse?
  • What additional information could MRI provide and how might treatment differ if MRI was used?
Prevention

Many factors make horses susceptible to this syndrome. Breeders should select for horses of adequate bone and foot structure and horses without a history of lameness problems. Buyers should have a purchase exam conducted to identify horses with this condition or with conformation predisposing to problems in this region. Good regular hoof care and maintenance also helps prevent injury to the area.

further reading & resources

Author: Doug Thal DVM Dipl. ABVP