Very Common
Related Observations
This treatment might be used for a horse exhibiting these signs.
Treatment
A way to improve or resolve a condition or diagnosis. This might include resolving the underlying cause or treating the signs of disease (symptomatic treatment).
Cost: $1,000 to $2,500
These cost ranges are approximate and may vary from region to region.
Additional charges may also apply.
YOUR VET MAY Recommend
Neurectomy, Palmar Digital
Cost: $1,000 to $2,500
These cost ranges are approximate and may vary from region to region.
Additional charges may also apply.
Summary
The palmar digital nerve runs down the inside and outside rear of the pastern of both the front and hind limb. When we diagnose chronic heel pain/ navicular syndrome, we block (numb) this nerve (usually in the front lower limb) to prove that pain is coming from the heel and sole region of the hoof. If this nerve is removed, sensation to the heel and sole structures of the foot is lost. In horses with chronic heel pain, a final "salvage" procedure is surgical removal of a segment of the nerves to numb the area long-term.
Palmar Digital Neurectomy is surgical removal of the palmar digital nerves at the level of the pastern. This is used for horses that have untreatable pain in the rear half of the hoof, usually from navicular syndrome. It can also be used for other conditions causing chronic, untreatable or permanent pain in that part of the hoof. When the nerves are removed, horses can no longer feel the pain from the disease process in the rear of the hoof.
The procedure is often done standing although I do it on the surgery table. In the procedure, as long a segment as possible of the nerve is removed from the inside (medial) and outside (lateral) palmar digital nerves.
YOUR VET'S ROLE
Your vet helps you determine the suitability of the procedure for your horse, as a last resort. They help you determine the surgeon to do the job, and the care of the horse going forward. In addition, they can help you determine the athletic activities that the horse will be able to perform safely after neurectomy. They will have recommendations on specific farriery to reduce degeneration of the navicular apparatus in the future.
YOUR ROLE
You will now have the responsibility to look out for those feet. The horse has lost sensation so it will be up to you to be sure that there is not a stone lodged in the frog sulcus or a nail in the hoof. Pick up the feet frequently and daily. Assess for heat and pulse. Learn what normal feels like so you will differentiate abnormal digital pulse, heat or swelling. Pick out the feet daily, trying to keep the hoof free of thrush. Ensure that the horse stays on a consistent trimming/shoeing interval and that the farriery helps prevent excessive torque and strain on the structures of the palmar foot.
Palmar Digital Neurectomy is surgical removal of the palmar digital nerves at the level of the pastern. This is used for horses that have untreatable pain in the rear half of the hoof, usually from navicular syndrome. It can also be used for other conditions causing chronic, untreatable or permanent pain in that part of the hoof. When the nerves are removed, horses can no longer feel the pain from the disease process in the rear of the hoof.
The procedure is often done standing although I do it on the surgery table. In the procedure, as long a segment as possible of the nerve is removed from the inside (medial) and outside (lateral) palmar digital nerves.
YOUR VET'S ROLE
Your vet helps you determine the suitability of the procedure for your horse, as a last resort. They help you determine the surgeon to do the job, and the care of the horse going forward. In addition, they can help you determine the athletic activities that the horse will be able to perform safely after neurectomy. They will have recommendations on specific farriery to reduce degeneration of the navicular apparatus in the future.
YOUR ROLE
You will now have the responsibility to look out for those feet. The horse has lost sensation so it will be up to you to be sure that there is not a stone lodged in the frog sulcus or a nail in the hoof. Pick up the feet frequently and daily. Assess for heat and pulse. Learn what normal feels like so you will differentiate abnormal digital pulse, heat or swelling. Pick out the feet daily, trying to keep the hoof free of thrush. Ensure that the horse stays on a consistent trimming/shoeing interval and that the farriery helps prevent excessive torque and strain on the structures of the palmar foot.
my vet's role
Related Diagnoses
This treatment might be used to treat these conditions or ailments.
Very Common
Less Common
Know Related Treatments
Your vet considers other treatments that might be used along with or instead of this treatment.
Very Common
Less Common
Rare
CONSIDER POTENTIAL SIDE EFFECTS & COMPLICATIONS
PAINFUL NEUROMAS are cut nerve endings that are inflamed and can be bound up in the scar tissue as the wound heals. These appear sometimes as a small painful bump under the skin near the surgical scar. They may respond to injection of steroid around them and sometimes require removal (re-amputation).THE NAVICULAR DEGENERATION GOES ON. This procedure does nothing to treat the degeneration of the navicular bone and associated structures. Pain is protective in that it prevents the horse from overloading and continuing to damage the structures as rapidly.
NERVE REGROWTH- After neurectomy, cut nerves attempt to re-join, and over months to years may be successful, or new nerves may branch out from the cut end, resulting eventually in skin sensitivity over the heel bulbs and recurrence of lameness.
HORSES CANNOT FEEL OTHER INJURIES TO THE HOOF- If a horse that has had a neurectomy steps on a nail, they will probably not feel it. So the injury may become life-threatening, with the horse never even showing lameness. They will likewise not feel some sole bruises and abscesses. So as a caretaker, you must assess the soles and hooves frequently.
THE NAVICULAR DEGENERATION GOES ON- Horses may overload and further damage the diseased structures because they no longer favor the limb. On the other hand, disuse from chronic pain causes disuse atrophy of structures of the hoof. So there are positive and negative effects from the use.
CONSIDER REASONS NOT TO USE THIS TREATMENT
This is a salvage procedure. It is used when other means of management and treatment have not been successful. It SHOULD NOT be used when other means of treatment have NOT been tried. It is not used if diagnostic anesthesia of the palmar digital nerves at the level of the low pastern (Palmar digital nerve block aka PD)has not been performed or does not alleviate lameness. It is not considered a good solution when there is significant arthritis of the coffin (distal interphalangeal joint)your role
Related Skills
These are skills you might need if your horse is getting this treatment.
Less Common
Is it working? Timeframe for effect.
Horses that have had neurectomy lose sensation over their sole and heel after the nerve has been removed. Hoof tester application over what was a painful frog should be negative. The skin of the heel bulbs should be numb. If the pain was originating from that area then the horse is expected to be sound. That should persist as long as the nerves are severed. If lameness returns, either the nerves have re-grown, or pain is now coming from outside the numbed area. Questions To Ask Your Vet:
- Are there other treatments we have not used yet that should be tried before we resort to neurectomy?
- What will I likely be able to do with my horse once its had neurectomy?
further reading & resources
Helpful Terms and Topics
Written, reviewed or shared by experts in equine health