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

[[118739]]

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

I like that idea - although on that scale at the moment she’s very high on “quality of life” but still in the stable so I guess the quality of life needs a context too. She wouldn’t have a good quality of life in a stable long term so it’s a situational scale. It’s handy though!

 

[ycbm]

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?

Navicular is a cover all term for lameness originating in the back half of the foot. In the old days before MRI it was diagnosed by the state of the navicular bone on x ray, but vets were always puzzled why so many horses could have poor x rays and be sound. When MRI came in it became obvious that the lameness was only rarely due to the bone, but due to ddft and/or collateral ligament and/or impar ligament damage.

Experiments by a guy called Dr. Rooney of cadaver legs in a rig showed that it was a toe first landing which damaged the ddft and the ddft that damaged the bone, not the other way around.

You are very unlucky with your diagnosis.

 

[[118739]]

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

Sorry you had such a time of it, it’s so awful with these young horses. Did yours not improve at all from original diagnosis?

My dilemma is slightly different I suppose in that she’s made a significant improvement in 6 weeks and the rehab is to try and ensure she CAN withstand turn out eventually. I’m just on the fence as to whether it will work. But the fact that she’s improved so much in 6 weeks makes it hard to make a decision either way.

 

[[118739]]

Navicular is a cover all term for lameness originating in the back half of the foot. In the old days before MRI it was diagnosed by the state of the navicular bone on x ray, but vets were always puzzled why so many horses could have poor x rays and be sound. When MRI came in it became obvious that the lameness was only rarely due to the bone, but due to ddft and/or collateral ligament and/or impar ligament damage.

Experiments by a guy called Dr. Rooney of cadaver legs in a rig showed that it was a toe first landing which damaged the ddft and the ddft that damaged the bone, not the other way around.

You are very unlucky with your diagnosis.

Ah I see - this is very clearly cysts within the bone that have worn through the cartilage. You can see that they’ve travelled through the bone over time.

 

[Polos Mum]

I like that idea - although on that scale at the moment she’s very high on “quality of life” but still in the stable so I guess the quality of life needs a context too. She wouldn’t have a good quality of life in a stable long term so it’s a situational scale. It’s handy though!

I think we all have our own frames of reference. You can build your own using the good bits from those online. It helped me be objective about an animal I was struggling to see fading slowly over time.

 

[[118739]]

I think we all have our own frames of reference. You can build your own using the good bits from those online. It helped me be objective about an animal I was struggling to see fading slowly over time.

Yeah definitely it’s a good basis especially for anyone struggling to be objective.

 

[misst]

Sorry you had such a time of it, it’s so awful with these young horses. Did yours not improve at all from original diagnosis?

My dilemma is slightly different I suppose in that she’s made a significant improvement in 6 weeks and the rehab is to try and ensure she CAN withstand turn out eventually. I’m just on the fence as to whether it will work. But the fact that she’s improved so much in 6 weeks makes it hard to make a decision either way.

He did seem to improve but then went backwards which is why we ended up at the AHT. It was a few years ago but I think for him the outcome would have been the same. I hope yours continues to improve though
What I would say is despite all our care and how well I thought he was doing I have photos of that time and with hindsight I see a horse becoming more depressed. At the time I had no idea as I saw him 3 times a day every day.

 

[[118739]]

He did seem to improve but then went backwards which is why we ended up at the AHT. It was a few years ago but I think for him the outcome would have been the same. I hope yours continues to improve though
What I would say is despite all our care and how well I thought he was doing I have photos of that time and with hindsight I see a horse becoming more depressed. At the time I had no idea as I saw him 3 times a day every day.

I’m sorry it didn’t work out - usually I have a gut feeling on these things but I’ve thought about it so much it’s not swaying me either way... I’ll bear your experience in mind thanks for sharing.

 

[paddi22]

you mentioned the horse had made progress over the last few weeks, so if I was in your position I'd be swayed slightly to keep trying. was the box rest only for the tendon risk? is the horse currently in pain or on pain meds?

 

[[118739]]

you mentioned the horse had made progress over the last few weeks, so if I was in your position I'd be swayed slightly to keep trying. was the box rest only for the tendon risk? is the horse currently in pain or on pain meds?

So she’s had an injection of lip filler into the space between the navicular bone & the tendon to ‘cushion’ if from the rough bone surface this can be topped up in a year to boost and should last 2 years in the hoof. Then went into box rest. The improvement is because the tendon has begun to heal during the box rest. The challenge is to prevent the navicular bone from damaging it again once box rest is over. There is no reversing the damage to the cartilage now but the idea is that we can prevent the tendon rubbing on the bone through the remedial farriery and building up strength to support (which will eventually be weaned to barefoot from what I understand).

She was on bute for 1 week after the lip filler injection as they injected through the tendon and none since. Not in pain and now not very noticeably lame in walk - an untrained eye wouldn’t notice until you asked her to turn a circle.

 

[PinkvSantaboots]

I wouldn't box rest a horse that is only ever going to be field sound, I would turn her out now and just see how it goes.

 

[Regandal]

This is a great podcast featuring Robert Bowker. A poster on here linked to it a few weeks ago, it’s very good.
The more information you have, the better.

 

[tallyho!]

I rehabbed my horse who was a PTS job with his navicular.

That was 10 years ago and I rehabbed him barefoot and he is in his 20's now.

Up to you. You have access to so much research, so much is on a screen nowadays. It's difficult either way but at least if one avenue works you have a horse. The other, you don't.

 

[Tiddlypom]

So she’s had an injection of lip filler into the space between the navicular bone & the tendon to ‘cushion’ if from the rough bone surface this can be topped up in a year to boost and should last 2 years in the hoof

So she’s had a gel injection? That could be very therapeutic, though my experience is with hock and coffin joint gel injections.

 

[sbloom]

I only know about general heal pain, arthritis of the coffin joint etc rather than this type of navicular. I would look to barefoot, or possibly the techniques these guys use https://www.facebook.com/hoofscanandhoofcarecentre (Australia but stuff to be learned) and https://www.facebook.com/markjfarrier who IS in the UK and takes on the odd case in the wider East Midlands area. I was always a barefoot advocate but these two are doing fascinating work. I have been to Rockley and met Nic, the turnout does the work for the first month but after that there's a lot of riding and leading, so you're paying full livery. I have come across one or two that came back poorer than they went, in terms of fat coverage, but there are very few failures, Nic only takes on cases that she thinks she can help and that have full vet support and in almost all cases MRI so she knows exactly what she's dealing with.

 

[[118739]]

Hello everyone - thanks for your input it has helped to lay out the options, it has also helped me look into and discount other inappropriate options for our specific situation.

I had an honest chat with another vet at my home practice and he mirrored many of the comment here - that the shoeing will only be a temporary fix, eventually the tendon will shorten with the wedges and we'll be back in square one. Realistically though given the level of damage to the cartilage there isn't a fix and its more of a case of when not if. After a long chat he gently nudged me towards getting the shoes given that the cost will be covered and turning her out - then keeping a close eye on her until its time to call it a day.

So my intention is to keep her in until the shoes are on so that she can rest the tendon and maximise healing time. Begin to turn her out in small grass pens of increasing size until she can go back out into the field without having too much of a bomb around. She'll be in at night regardless as she's too flimsy to be out 24/7.

I know I'm just delaying the inevitable but at least this way she does get some period of retirement at turnout - rather than a long period stuck in the stable when its unlikely to make much difference long term. Will call the referral vet to discuss this today but I know my home vet has been very honest and frank and we concluded this was a sensible approach.