Advice from anyone who has experience with severe navicular syndrome please!

[[118739]]

*Long post sorry*
I bought a TB last spring who has sadly been diagnosed with navicular after going lame this summer. X rays showed severe deterioration of the navicular, and MRIs showed the cartilage is wrecked and the tendon had begun to rip. She's now halfway through a 3 month stint of box rest and has had a few injections that should help - with the intention of being retired to the field eventually, she's 8yo.

At least that was my intention but now I'm doubting it. When I picked her up after her MRIs and we were given a plan I guess I misunderstood (wilfully maybe, I was pretty emotional) that after this 3 months box rest it would just be a case of slowly returning her to turn out eventually graduating from short periods in small pens to 24/7 in the field. After a check up (where vet said she had greatly improved in the last 6 weeks so that was positive) it became clear this is going to be a much longer rehab with the ever present risk that if she has an explosion during hand grazing/walking, or even completes rehab and gets out to the field only to do a load of rasping around - all the work would be undone and we'd be back to square one.

Basically I'm worried that I'm putting her and myself through a good year to two years of hard work (including 3 months sat in the stable which can't be fun (as much as she likes to be pampered/stabled in general) and she could go out and be immediately broken again - then is what I've put her through to get there really fair? Is it worth trying all this for a retirement she might not get? I will undoubtedly have to pick a point in the future to PTS even if this does work for a few of years - I'm aware she's unlikely to get the chance to die of old age/natural causes.

At the moment my plan is:
1. continue with the treatment and bleed the insurance for all its worth (including farriery) BUT if at any point she regresses during rehab I'd consider that the end point and not try to start again (in which case - bute her up for a few days of pain free turn out and PTS after that? I don't know its difficult to plan an exit route).
2. If we make it through rehab and she's field sound then just keep an eye. Once insurance has run out hope that she has a long stint of soundness before the issue begins to resurface and I call it quits (possibly fork out for a few extra injections if she really looks like they've helped but they're not cheap).

What have/would others do? Is my plan reasonable? If she looked like she was unhappy with life it would make the decision so much easier but she's so laid back and just ENJOYS everything - I'm able to check in on her without her seeing /knowing anyone is about and she's always content never head down and depressed looking so its hard to even consider putting her down right now. She looks from the outside so healthy... until I ask her to turn a corner that is!

My vet has said that she's one of the more severe cases of navicular damage he's seen - but also that she improved a LOT in 6 weeks and is worth trying to help, he's also put 30-40 mins walking under saddle into our rehab programme later on which was initially very unlikely, so he clearly thinks there's a chance she will improve with farriery.

 

[scruffyponies]

Very sorry for you and your mare.

I had an older horse with navicular a few years ago. He was able to stay in work with Cytek shoes, which is a PITA, as you need a specialised farrier. Normally I don't shoe, and I don't really like the principle of Cyteks, but for him they worked.
Best of luck.

 

[Polos Mum]

It's really hard to second guess the future. Horses don't plan for the future and they can't link pain / hassle now to longer term benefits. If insurance / funding is OK now then key is the wellbeing of your horse today (and then tomorrow and then the next day). If she is coping well with box rest, start of rehab great - but be prepared for that to change.
When I had a really sick dog I found a score sheet with about 50 questions on it really useful. I did it every week and knew that when I regularly got less than 20 /50 then I would make the decision. Maybe think about how you can objectively measure her quality of life, regularly because it's hard to see if it's drifting and you see her every day.

I am a firm believer of better a month too soon than a day too late.
You rightly know you will have to make the decision - hard part is what has to happen to make it.

If there is a reasonable risk of catastrophic failure of her tendon from a silly 5 mins in a turn out pen - then you have to think really carefully about how closely you / YO can monitor her and how quickly vets / knackerman can be on site if that happens.

 

[Sprig]

If she was mine I would pts now. She will not know the difference and you could be saving you and her from a good deal of pain and heartache.

 

[brightmount]

Your case takes me back to 2004 when the horse in my Avatar had identical symptoms, diagnosed by MRI. I’ll start by encouraging you by saying although we considered PTS at the time, she went on to live another 12 years before we lost her to laminitis as an end result of Cushings

You’ll probably discover a standard approach for navicular is going barefoot, which is what I did with mine and the point at which she turned the corner. But do get a specialist on board if you go down that route, whether it’s a podiatrist or remedial farrier, as there’s more to it than just trimming and chucking the horse in a field. You’ve got to rehabilitate the foot with balance and the correct stimulation, according to what your horse can cope with as it progresses. When I stumbled on this approach in 2004 it was quite new but is now very mainstream.

Box rest didn’t do her any favours. However if you have a DDFT tear I can understand why you’ve had to do it, although after 3 months hopefully your horse has healed enough for some controlled rehab now. Hand walking in boots and sole mates pads is a great place to start and you should notice how comfortable she is with pads, which at the same time provide the right stimulation for the early days.

I’m sure lots of other forum users will have navicular success stories from the barefoot route.

 

[[118739]]

It's really hard to second guess the future. Horses don't plan for the future and they can't link pain / hassle now to longer term benefits. If insurance / funding is OK now then key is the wellbeing of your horse today (and then tomorrow and then the next day). If she is coping well with box rest, start of rehab great - but be prepared for that to change.
When I had a really sick dog I found a score sheet with about 50 questions on it really useful. I did it every week and knew that when I regularly got less than 20 /50 then I would make the decision. Maybe think about how you can objectively measure her quality of life, regularly because it's hard to see if it's drifting and you see her every day.

I am a firm believer of better a month too soon than a day too late.
You rightly know you will have to make the decision - hard part is what has to happen to make it.

If there is a reasonable risk of catastrophic failure of her tendon from a silly 5 mins in a turn out pen - then you have to think really carefully about how closely you / YO can monitor her and how quickly vets / knackerman can be on site if that happens.

I agree with your first point and the day too soon rather than too late. At the moment there is significant improvement in her lameness - above what the vet expected I think so I guess while she is improving we continue and at the first sign of levelling off below the desired outcome or even backwards steps that would be the end as in plan 1...

On the last point it isn't really the risk of her totally ripping the tendon in two - more that she could come back in lame which is an indication that the work has been undone/damage has been restarted. He was talking in more of a "you'd have to do this all again" but in reality that would be a definite end point regardless of the option to try again, for me anyway. Either way she's kept at home and I am wfh so monitoring isn't an issue.

 

[[118739]]

If she was mine I would pts now. She will not know the difference and you could be saving you and her from a good deal of pain and heartache.

But if she could go out and live another 1,2+ years in a field pretending she's a cow I would know the difference? Sorry I'm not disagreeing its just this is exactly my sticking point - I don't know for certain that this will work, but I don't know that it wont either. I'd feel a lot happier knowing I tried everything that was reasonable first I guess, but like you say that means nothing to her.

 

[dorsetladette]

If she was mine I would pts now. She will not know the difference and you could be saving you and her from a good deal of pain and heartache.

This would be my thought too.

If when she does go out you are holding your breath every time she trots up the field or or has a charge round when her mates are turned out, then that is no quality of life for you or her.

Was also going to say about being able to afford her on grass livery and affording another to enjoy riding, but just seen your comment about her being at home so scratch that.

 

[[118739]]

Your case takes me back to 2004 when the horse in my Avatar had identical symptoms, diagnosed by MRI. I’ll start by encouraging you by saying although we considered PTS at the time, she went on to live another 12 years before we lost her to laminitis as an end result of Cushings

You’ll probably discover a standard approach for navicular is going barefoot, which is what I did with mine and the point at which she turned the corner. But do get a specialist on board if you go down that route, whether it’s a podiatrist or remedial farrier, as there’s more to it than just trimming and chucking the horse in a field. You’ve got to rehabilitate the foot with balance and the correct stimulation, according to what your horse can cope with as it progresses. When I stumbled on this approach in 2004 it was quite new but is now very mainstream.

Box rest didn’t do her any favours. However if you have a DDFT tear I can understand why you’ve had to do it, although after 3 months hopefully your horse has healed enough for some controlled rehab now. Hand walking in boots and sole mates pads is a great place to start and you should notice how comfortable she is with pads, which at the same time provide the right stimulation for the early days.

I’m sure lots of other forum users will have navicular success stories from the barefoot route.

My understanding of the plan is that initially she will be in shoes with bars and wedges to raise the heel and from there trimmed in a way gradually each time that eventually the shoes will come off. Your story does give me hope that I can do something but at the same time I don't want to keep trying to achieve someone else's story! God its so difficult.

 

[TPO]

I've lost two with navic and one with something else that was similar to your situation as in every day checking for "something".

Big long stories that I've bored regulars on here with numerous times. To get to the point I'd pts.

Horse knows no difference or what is coming. Having a "fragile" field ornament is a huge stress, weight and pressure. I didnt realise how much so until after my retired one went and although I was really sad I simultaneously felt a huge weight lift.

With hindsight I can see how many hours and how much worry I went through with him (he was never in the situation that he needed pts for his welfare) and honestly it would have made no difference to him if he had gone 6yrs earlier when the issue first appeared or when he did go (ironically not because of the thing that had been causing the chronic issue).

It's easy to say and harder to do but I would pts any young horse who doesnt have a good prognosis for long term soundness and/or wouldnt cope with long term box rest.

Horrible position to be in

 

[laura_nash]

I will undoubtedly have to pick a point in the future to PTS even if this does work for a few of years - I'm aware she's unlikely to get the chance to die of old age/natural causes..

I understand that your mare's case is quite extreme, but if you do manage to rehab her to the point where she is field sound I'm not sure why you assume she will get worse again and only manage a few years? Its now understood (I thought) that "navicular syndrome" is not degenerative and can even be reversed. If your vet is still working on the old fashioned paradigm of a "degenerative disease" I very much encourage you to do your own research.

 

[doodle]

A while ago a friend had a dire diagnosis for her 6yo mare. Tendon had ripped and bone in bad shape. Vet said either 6 months total box rest or PTS now. Box rest wouldnt work for this horse, she wasn’t horrifically lame so she moved yards to somewhere she could live out 24/7 with no coming and going to minimise hairing around. That was 7 or 8 years ago and looking at her in the field there is nothing wrong. Of course she never came back into a huge amount of work but she has been ridden lightly again.

So if it was my horse I wouldn’t give up yet. You have done some of the hard work so I would be inclined to carry on and see what happens. But be prepared for her to go downhill and deal with accordingly.

 

[[118739]]

I understand that your mare's case is quite extreme, but if you do manage to rehab her to the point where she is field sound I'm not sure why you assume she will get worse again and only manage a few years? Its now understood (I thought) that "navicular syndrome" is not degenerative and can even be reversed. If your vet is still working on the old fashioned paradigm of a "degenerative disease" I very much encourage you to do your own research.

I am only assuming I guess that eventually the wear and tear will catch up with her. There is no correcting the loss of cartilage between the navicular and the tendon and so if the tendon is under pressure to cope with a lot it will eventually rub again. She has a quiet life and isn't generally tearing around but you can't guarantee that so it really depends on her I suppose..

 

[laura_nash]

My understanding of the plan is that initially she will be in shoes with bars and wedges to raise the heel and from there trimmed in a way gradually each time that eventually the shoes will come off. Your story does give me hope that I can do something but at the same time I don't want to keep trying to achieve someone else's story! God its so difficult.

I would want to query with the vet / farrier if they have any success stories from this route (and not just for 6 months but over the longer term). I know there is the odd horse out there that has been rehabbed sucessfully in bars and wedges, but AFAIK the success % is extremely low. Generally, the bars and wedges cover up the problem for a while as it continues to worsen.

Some reading:
http://rockleyfarm.blogspot.com/2010/06/bar-shoes-and-such.html

Same blog on my previous point:
http://rockleyfarm.blogspot.com/2010/02/reversing-navicular-bone-damage.html

 

[[118739]]

A while ago a friend had a dire diagnosis for her 6yo mare. Tendon had ripped and bone in bad shape. Vet said either 6 months total box rest or PTS now. Box rest wouldnt work for this horse, she wasn’t horrifically lame so she moved yards to somewhere she could live out 24/7 with no coming and going to minimise hairing around. That was 7 or 8 years ago and looking at her in the field there is nothing wrong. Of course she never came back into a huge amount of work but she has been ridden lightly again.

So if it was my horse I wouldn’t give up yet. You have done some of the hard work so I would be inclined to carry on and see what happens. But be prepared for her to go downhill and deal with accordingly.

This is my current compromise I guess - I have made the decision that any step back in her rehab would be a cut off point I just wasn't sure if I was being fair. That mare does boost morale a little bit thanks! The mixed responses on this thread really reflect what's going on in my brain to be honest!

 

[[118739]]

I would want to query with the vet / farrier if they have any success stories from this route (and not just for 6 months but over the longer term). I know there is the odd horse out there that has been rehabbed sucessfully in bars and wedges, but AFAIK the success % is extremely low. Generally, the bars and wedges cover up the problem for a while as it continues to worsen.

Some reading:
http://rockleyfarm.blogspot.com/2010/06/bar-shoes-and-such.html

Same blog on my previous point:
http://rockleyfarm.blogspot.com/2010/02/reversing-navicular-bone-damage.html

I'll have a look - I don't have a reputable dedicated barefoot trimmer round here that I know of and most of the barefooters are trimmed by my farrier - so its something I'll discuss further with him. I'll also have another chat with my vet about how/why he thinks it will be successful but we will be getting 2nd MRI at 6 month mark so around January to see how the leg structures are. I don't see why he'd suggest an MRI to see how things are going if there isn't much chance of it working... but definitely something to look into further to get some perspective. I am inclined to trust this vet as he is a specialist in this area but I have been reading around too.

 

[AShetlandBitMeOnce]

My 6yo was diagnosed with severe Navicular yet only ever 2-3/10ths lame. My vet said to me when he called it was a terrible case and he was suprised the horse wasn't crippled. I tried everything I feasibly could with him, boxrest, walking in hand, injections, specialised farriery, barefoot etc. Having spent 6 hours in the field looking for £180 (1 shoe) worth of farriery, and looking over to my horse I realised he would never be truly happy again. The hard ground was causing him pain, super soft ground would cause him pain and so would the ruts in the middle. He appeared field sound to anyone else who looked over but if you watched him he was being so careful with where he walked and didn't hooley any more, to me who knew him I knew the spark was gone. So I made the call and had him PTS.

I am sorry you are dealing with this OP, but if I were you I would PTS at this point. 3 months of box rest is an awfully long time for a very uncertain future.

 

[paddi22]

I had one (but doesn't sound as severe as yours, had no tendon issue) and prognosis was bad. I took shoes off and he's a different horse after a few months and was back in ridden work. I just took shoes off, he was footy at first but with boots and correct surfaces he seemed to cope. I boot him up for stony hacks but on grass etc hes perfect. It was amazing how his angles changed once the shoes came off. I wish I'd tried barefoot years ago. we had two years of remedial wedges and stuff and he just got worse.

personally if it was my horse and is looking like the most viable option then you've nothing to lose. I'd take the shoes off, box rest for a week or two to let her get used to it, and then try the small pens etc for a limited time and then put out to grass livery for a while. if she's gonna soon around the field and pull a tendon, then she's gonna do it eventually. you might as well give her a last shot and see how she holds up. But def take the shoes off. I 100% believe the remedial farrier work made my worse.

 

[PoppyAnderson]

I'd forget box rest, remedial shoeing, vets etc and send to rockley farm. Have a read on their website of all the navicular related posts. Here's a couple to start you off.

http://rockleyfarm.blogspot.com/2009/10/navicular-horses.html?m=1

http://rockleyfarm.blogspot.com/2013/07/surprise-surprisenot-really.html?m=1

https://forums.horseandhound.co.uk/threads/rockley-farm-and-navicular.615141/

 

[ElizabethAngela]

I had a horse develop navicular, tried barefoot, shoeing, steroid injections. Exhausted most of the possibilities. I had him PTS and got his forelegs back to do a PM on, I still have the photos somewhere. The pathology of the distal sesamoid (navicular bone) was quite something, it was rough like a piece of pumice stone, and the deep digital flexor tendon was like frayed baler twine from running across the rough surface. No chance that anything could have been done to mitigate the damage that existed. I wish I'd had the balls to put the horse down sooner. On the week he was PTS he was on 5 sachets of Bute a day to allow him to be sound enough to go in the field without being totally miserable.

 

[[118739]]

Has anyone been to rockley farm? I'm looking into it (as of a couple of hours ago) but I'm a) not keen on pinning any hopes on it without some IRL independent reviews (not just the success stories they have listed on their website) b) slightly concerned that I'm struggling to find a single case where it hasn't worked - I'm googling and I just can't find anyone that says "tried it but didn't work for me for xyz reason" which is a bit of a red flag? maybe I'm too cynical. What are they doing that no other barefoot practitioner/farrier/vet can achieve?

Why is all of the science on this stuff crap! I can't find a consensus on anything at this point it is frying my brain. One thing is for certain the responses here (much appreciated thank you) are just as mixed as the many scenarios I put through my brain when I think about this for too long. I'm not going to pts just yet still need to do more thinking and weighing up options, and research..

she's got the sort of brain that any sensible horse person would give their left arm for which is hy I bought her, I'm so annoyed she hasn't got the limbs to match up to it

 

[Gloi]

Has anyone been to rockley farm? I'm looking into it (as of a couple of hours ago) but I'm a) not keen on pinning any hopes on it without some IRL independent reviews (not just the success stories they have listed on their website) b) slightly concerned that I'm struggling to find a single case where it hasn't worked - I'm googling and I just can't find anyone that says "tried it but didn't work for me for xyz reason" which is a bit of a red flag? maybe I'm too cynical. What are they doing that no other barefoot practitioner/farrier/vet can achieve?

Why is all of the science on this stuff crap! I can't find a consensus on anything at this point it is frying my brain. One thing is for certain the responses here (much appreciated thank you) are just as mixed as the many scenarios I put through my brain when I think about this for too long. I'm not going to pts just yet still need to do more thinking and weighing up options, and research..

she's got the sort of brain that any sensible horse person would give their left arm for which is hy I bought her, I'm so annoyed she hasn't got the limbs to match up to it

It wouldn't hurt to ring her up and ask her opinion.

 

[Chinchilla]

When I had a really sick dog I found a score sheet with about 50 questions on it really useful. I did it every week and knew that when I regularly got less than 20 /50 then I would make the decision. Maybe think about how you can objectively measure her quality of life, regularly because it's hard to see if it's drifting and you see her every day.

do you have a link to this please? Or even a name/title for it? Thanks

 

[Tiddlypom]

What are they doing that no other barefoot practitioner/farrier/vet can achieve?

I believe that there are other good barefoot rehab places, though for the life of me I can’t remember the name of the place I was recommended. Not very helpful of me, sorry. I was warned off Rockley, which I had presumed to be the gold standard and had wondered about sending one of mine there.

 

[[118739]]

I believe that there are other good barefoot rehab places, though for the life of me I can’t remember the name of the place I was recommended. Not very helpful of me, sorry. I was warned off Rockley, which I had presumed to be the gold standard and had wondered about sending one of mine there.

Can you tell me why you were warned off? I’m going to keep it in my pocket for now as another back up option. But I’d need a lot more info (not just from them) before using it.

 

[ycbm]

I think the lack of cartilage is the really big issue here. I have not heard of that diagnosis before, only soft tissue injury.

I would be tempted to take the shoes off and chuck the horse out for the winter keeping watch on his soundness and demeanour, and then if he is sound in spring try a barefoot rehab, and if not sound, PTS.

Though I see no shame in PTS now, his prognosis is pretty poor with no cartilage left.
.

 

[Tiddlypom]

Can you tell me why you were warned off? I’m going to keep it in my pocket for now as another back up option. But I’d need a lot more info (not just from them) before using it.

Nothing dreadful. The locals (so I was told) regard them as a bit of a con, as they allegedly do very little work with the horses in their care when they have them. I suppose that they are relying on the variety of surfaces that they turn them out on/getting them off grass to do the work.

I am 95% sure that this place is where I was told would be better than Rockley - the location fits. I did not go onto make enquiries with them, though.

http://hoof-help.co.uk/index.html

 

[Polos Mum]

do you have a link to this please? Or even a name/title for it? Thanks

If you google dog quality of life score there are loads - this was one that came up that was similar to that I looked at
https://vetsocialwork.utk.edu/wp-content/uploads/2016/03/Quality-of-Life.pdf

 

[[118739]]

I think the lack of cartilage is the really big issue here. I have not heard of that diagnosis before, only soft tissue injury.

I would be tempted to take the shoes off and chuck the horse out for the winter keeping watch on his soundness and demeanour, and then if he is sound in spring try a barefoot rehab, and if not sound, PTS.

Though I see no shame in PTS now, his prognosis is pretty poor with no cartilage left.
.

Excuse me for sounding dense - I only have the experience/diagnosis of this horse to go off, but why would there ever be a soft tissue injury in a horse with navicular without damage to the cartilage? It is my understanding from the vet/looking at her x rays & him looking at the MRI that it is the damage done by cysts in the bone to the cartilage that causes a rough surface which damages the tendon. If the cartilage were still intact over the navicular bone she would never have gone lame (despite the cysts in the bone itself) because nothing would have damaged the tendon. Or is navicular being used more broadly to cover other issues than what I’ve described?

 

[misst]

Having been there and done this with an 8yo TB as well, I would PTS. After 6 months on off rest he was not really any better. A chat with the wonderful Sue Dyson at the AHT (sadly closing) gave us the shocking diagnosis of this almost certainly being a non recoverable injury. I think we had just had our heads in the sand until then. We brought him home and PTS a week later.
If I had known then what I know now I would not have put him through all that.
Another vote for better a day to soon than a moment too late.
Hugs. xx