Navicular bone cyst - any straws to clutch at

[Polos Mum]

Lovely 7 y/o has been in for lameness work up today and vet has just called to say bone cyst in navicular - gutted.

They've made some suggestions - starting at bar shoes (he's nicely barefoot currently), maybe steroids, with more drastic being neurectomy which sounds not great.

Anyone share any success stories to give me a glimmer of hope?

 

[ycbm]

Sorry to hear that

Are you insured? If so, I would push for an MRI because a lot of horses have navicular bone cysts but aren't lame with it, and I'd want to know it wasn't some other soft tissue injury causing the lameness.

That said, the treatment is probably the same.

I have seen one barefoot horse with navicular syndrome from soft tissue damage due to insufficient movement over a winter, and he was sorted by a barefoot rehab track livery in a few weeks.


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[Polos Mum]

Thanks - he is insured, 6 weeks box rest on bute as initial step.

He was lame 8 weeks ago, 3 weeks box rest (2 with bute) back fully sound, another week in the field just to be sure - then genuinely gently back into work for 4 weeks then lame again. Absolutely nothing to see anywhere, no swelling and sensible second opinion agreed with that.

He has slightly low heels and I'd booked a recommended barefoot trimmer to get his view (current farrier is lovely but we've always needed boots so feet not 100% functional), ground has been ridiculously hard.

I'd love for him to have niggled a ligament - will think on MRI when I see how much bill is for todays entertainments and how he is in 6 weeks.

 

[ycbm]

I don't understand why a bone cyst would respond to box rest, but a soft tissue injury would, and I think is more likely to be fixable than a cyst.

Given the extra information, I would want an MRI, I don't think the diagnosis that you have fits the symptoms as well as other issues do.

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[Polos Mum]

It was the nerve block that located the pain in the back of the heel, then xrays showed the cyst. I've asked for a copy of those, but not seen yet.

Soft tissue would have to be in the same area for it to be responding to nerve block.

The vet said it's the inflammation / irritation around the cyst that causes the pain, aggravated by it growing and / or the hard ground / being in work.
He said bute for anti inflammatory and rest to try and settle it to being 'clinically silent' .

Also recommended Osphos injection that is supposed to change how bone is remodelling

 

[ycbm]

That all makes sense. I hope it works, it's a lot easier than fixing a soft tissue injury inside the foot.

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[Polos Mum]

Many thanks - I'll speak to them on Monday

 

[angel7]

Sorry mine had a bone cyst at the base of the coffin joint. Obvious black whole on xray. Inoperable. Tildren given to no effect.
Lameness was on off on off for months, box rest appeared to help but lame again as soon as work restarted. She was lame bilaterally from compensating.
Bar shoes improved lameness by removing weight bearing from the exact point of pain (centre of frog) but she kept loosing these and was crippled without. Discussed neurectomy for comfort but would have had to be cut at the knee and lose feeling to whole lower leg due to position of cyst. You might get away with just cutting nerves to the heel area if localised.
I PTS 4yo after 6 months trying she was miserable and bute and metacam didn't work.
Cysts can be nasty and not much literature on them.

 

[ITPersonnage]

I "think" one of YO horses had one of these and it was operated on (to my amazement) and did come right eventually. If you like I can check and ask for details. This was about three years ago and they cut away a section of the front part of the hoof to remove. But it grew back and he's been in full work for the last 9 months. ETS - just re-read, maybe I jumped the gun a bit, you say on the navicular so maybe that would be inaccessible, sorry.

 

[Polos Mum]

Thanks ITP - the cyst is inside the bone - the navicular bone sadly. Vet says it is inoperable.

Hopefully vet and YCBM is right and the lameness is caused by the soft tissue swelling around the cyst as it grows and in combination with hard ground and stepping up work.
If we can get the cyst to be 'clinically silent' then maybe the irritation calms down and he can be field sound or best case light hack.

Bar shoes with padding are biggest quandary right now - I think I'll have to sedate to shoe - lots of stress and expense for field sound and I'm really not a fan given what I've read about barefoot.

 

[ITPersonnage]

. Sorry that sounds pants

 

[Polos Mum]

Interesting x rays for anyone else with this horrible situation. The difference between left and right is marked.

I'm worrying we might not be able to get him field sound with those. Surprised how quickly this has all happened, we were doing successful jumping clinics just pre lockdown.

 

[ihatework]

It’s a marked difference and I assume there is a clear difference in soundness L to R?

I suppose the difficulty is ascertaining the clinical relevance of the cyst if you don’t have any earlier xrays to compare to.

I think in your shoes I would try a bone remodelling agent. Osphos or Tildren, they aren’t without risk for sure, but those xrays are compelling enough for me to try. And the beauty is that you can follow up reasonably cheaply on X-ray.

I wouldn’t rush to shoe yet. I’d try and do stuff systematically and I’d keep that in the toolbox for later if needed.

 

[Polos Mum]

Thanks IHW, you're exactly right, no pre lameness xrays. He's almost sound (unless you look too closely) on circle on left rein, hopping on right so marked difference.

Osphos has been given, box rest on bute for 4 weeks then vet will re-assess.

I had a recommended barefoot trimmer booked anyway for this week as I wasn't 100% happy his feet were as functional as they should have been anyway so I'll see what his view is - it would be a last resort as I think I'd have to sedate and sedation to shoe to keep him field sound would be a step too far for me personally.

 

[[118739]]

Hello - I hope you don’t mind but do you have an update on this situation? My 8yo has just been diagnosed with basically the same thing. Waiting on MRI results today but it was clear from the x ray that the navicular was in rough shape from a cyst and likely causing irritation/damaging the tendon. I really want to hope I’ll at least be able to get her field sound and she can come home to be a lawnmower, she’ love to be a light hack but vet did a lot of gently implying that it’s not looking good. I am also shocked at how quickly this all came on.

 

[Polos Mum]

Hi - sorry not great news. The vet came back after the 4 weeks of box rest and bute - the lameness was better ish. OK on the good rein in the school - not great on either on the yard.
I had a v long conversation about whether he was sound enough to turn out. The vet said there would be people riding with his level of lameness and not noticing.

I haven't had an MRI because it wouldn't make any difference to the next steps.

He's been turned out 24 / 7 for 6 months, I'll trot him up every month to check the lameness hasn't got any worse - the vet will come back in Jan-21 or sooner if he deteriorates.
He is at home - i spy on him in the field very closely each time I walk past a window so I am as happy as I can be I can closely monitor his pain. He roles, he plays with his mates and trotting on the soft grass playing looks pretty dam sound. i am giving him a chance - the vet did say they'd be supportive of PTS now if that's what I felt, if he goes down even 2% from where he is now I'll make that decision.

De-nerving was mentioned repeatedly - worth reading the recent thread on here on that topic.

Sorry to hear about your horse and sorry I can't give more positive news.

 

[Pearlsasinger]

A neighbour's horse was diagnosed with a bone cyst within the foot - not sure, if I ever knew, exactly where - no operation was ever carried out but the horse is still retired in the field many years later, I believe on bute. I might have done things differently.

 

[Polos Mum]

A neighbour's horse was diagnosed with a bone cyst within the foot - not sure, if I ever knew, exactly where - no operation was ever carried out but the horse is still retired in the field many years later, I believe on bute. I might have done things differently.

I'd welcome your thoughts on alternatives. As far as the vets have made me aware there is no operation to take out something the size of a marble from right inside the middle of the bone as delicate as in the foot. Or have I missed something ?

 

[Pinkvboots]

Fwiw I think your doing the right thing I wouldn't have gone down the bar shoe route, my horse has navicular not a cyst like yours but he had osphos and the bursa was medicated I turned him away and took shoes off, he wasn't sound straight away it took nearly 4 months, so I don't think the osphos does work straight away so I suppose I am trying to give you some positive views on it

 

[[118739]]

Hi - sorry not great news. The vet came back after the 4 weeks of box rest and bute - the lameness was better ish. OK on the good rein in the school - not great on either on the yard.
I had a v long conversation about whether he was sound enough to turn out. The vet said there would be people riding with his level of lameness and not noticing.

I haven't had an MRI because it wouldn't make any difference to the next steps.

He's been turned out 24 / 7 for 6 months, I'll trot him up every month to check the lameness hasn't got any worse - the vet will come back in Jan-21 or sooner if he deteriorates.
He is at home - i spy on him in the field very closely each time I walk past a window so I am as happy as I can be I can closely monitor his pain. He roles, he plays with his mates and trotting on the soft grass playing looks pretty dam sound. i am giving him a chance - the vet did say they'd be supportive of PTS now if that's what I felt, if he goes down even 2% from where he is now I'll make that decision.

De-nerving was mentioned repeatedly - worth reading the recent thread on here on that topic.

Sorry to hear about your horse and sorry I can't give more positive news.

Thanks for coming back to reply - I know the loss of use must be v disappointing but honestly at the moment we are powering through with the goal of getting her paddock sound so your story does offer me some comfort. We’ve had a few treatments offered today so will try them until the insurance money runs out providing they are sensible in terms of expected outcomes. I appreciate the update. Denerving hasn’t been brought up but it’s not something I would consider so I’m glad it hasn’t been offered.. maybe in a more emotionally tense moment I’d be tempted.

Good luck and hope yours can enjoy a comfortable retirement ?