Navicular Syndrome & Caudal Heel Pain

   Chronic heel pain and Navicular Syndrome cases are a specialty of Parker Farrier Service. This includes conformations of long toe & under run heels, contracted heels, broken back or upright HPAs (Hoof Pastern Axis). There are many phases associated with Navicular problems and all cases do not present as a syndrome. Navicular problems characterize a progressive disease affecting the Navicular Bursa, Navicular Bone, and the Deep Digital Flexor Tendon. This disease is sometimes referred to as Caudal Heel Pain for the frequent heel-bound lameness associated with it. Navicular Syndrome has long been regarded as the disease "of the well bred horse” because it knows no boundaries and onset can seemingly occur during the height of a horse's health and career. It is a complex condition and I have dedicated myself to studying causes and treatment techniques in order to give your horse the thorough analysis and promising treatment he deserves.

    Navicular problems can take on different appearances, but the common link is the occurrence of abnormal heel concussion. About 70% of horses with Navicular issues will grow excessively long toes with low or under run heels. These heels are also referred to as crushed or contracted. Horses with this conformation simply cannot dissipate concussion with such a slopping and unnatural pastern. This usually accounts for severe strain among the DDFT Tendon and the associated Navicular structures. It is imperative that the Farrier understand proper and corrective techniques for these cases. Conversely, horses with a very upright pastern seen as a short toe with an upright heel conformation will absorb too much concussion and stress the Navicular bone and Coffin Joint. Many of these horses avoid placing weight on the heel area and they remain upright and in pain. These horses require balanced, corrective trimming and shoeing. Navicular problems require that the Farrier work performed is tailored to the precise conformational problems associated with the heel.

   Navicular Syndrome mimics a severely degenerative form of osteoarthritis. It has been linked to vascular and blood flow changes, chronic cases of inflammation, and repetitive biomechanical force during activity. This is why providing shock absorption and concussion reduction is critical to these cases. I do not advise any shoeing protocol that does not intensely relay on the relief from shock, vibration, and ground reactive forces. I feel that this is one step that many avoid or rank of lower importance, but is crucial to the treatment of your Horse. The reasoning behind this is much of the pain is caused by inflammation of the surrounding soft tissues. Getting to the route of the problem is critical. Inflammation of these tissues respond well to balance, proper angular trimming of the toe and heels, and therapeutic shoeing. The shoeing that I perform is tailored to the level of progression and areas affected as seen in the X-rays and/or MRI (when available).

   Knowing what symptoms to look for can help treat early Navicular changes. A horse suffering with heel pain caused by Navicular changes will show many external indicators. You may find your horse will be hesitant working on medium to hard surfaces or you may see resistance when trotting in tight circles. You may also notice your horse standing with his hooves in front of him in an attempt to shift weight off the affected hooves. This is called a “Saw Horse” stance. For further progressed cases,  a shortened, choppy stride accompanied by a toe first landing is expected and sometimes presents with faster heel growth or "upright heels". This is further evidence of the horse trying to avoid putting weight on his heels due to an inflamed Navicular Bone, Bursa, or associated soft tissues in the heel area. A close examination of the sole may show bruising on the toe area and the toe of the shoe will be worn excessively. Again, these are signs of the horse attempting to stay off his heels. An experienced Farrier can see this when we ask you to trot your Horse and as we remove the old shoes and begin our trim. It should be noted that the old shoes tell us a lot about wear and weight distribution whereas the hoof illustrates changes as well as predispositions to patterns of growth. Staying ahead of possible angular deviations is very helpful in preventing further progression!!

   A horse’s hoof conformation is a prime factor predisposing them to developing Navicular changes or worsening an existing syndrome. The hoof must be trimmed and maintained in a way to achieve balance around the “Center of Articulation” or COA of the lower limb. A hoof trimmed in this manner provides optimum balance and support while minimizing leverage caused by the toe and compression of the Navicular region. This is an advanced technique which cannot be successfully accomplished without a skilled Farrier. The trim must safely remove as much distortion in the toe and heel area as possible. A therapeutic shoeing package applied to a hoof that has not been trimmed properly will have less than satisfactory results. As an example, we can forge modify a shoe to relieve strain off the deep digital flexor tendon, but we would have to first perform a corrective trim taking into account the affected heel and toe angles.

   I often evaluate a hoof using a hoof tester to locate pain in the heel region and around the middle of the frog, this can let my client know of any reaction. Next, I ask to consult with a Veterinarian when possible as only they can make a true diagnosis. Navicular Bursa injections will help to show where pain is originating from and X-rays are then suggested for solidifying a clinical diagnosis. During the beginning stages of the disease, X-rays are best compared to a set of “reference or baseline” X-rays which were taken prior, particularly when the horse was sound. This is a better way to observe what “changes” have occurred.  However, during most stages of progression, the changes are obvious. Furthermore, an MRI is exceptional tool as it can pinpoint inflammation and as an example, help identify if the cause of pain is originating from soft tissues such as the Impar and/or Collateral Navicular Ligaments. This information helps us decide on a shoeing package specific to the needs of the horse. Of course, we understand an MRI is very helpful, but not always available. It should also be noted that other techniques such as joint manipulation and elevating the heel on a wedge block to assess discomfort level are considered out-dated. 

   Corrective shoeing can make a World of a difference for your Horse. For advanced cases or Sport Horses, hydrotherapy and training on the Horse Gym Treadmill are wonderful medically supported approaches! But please consult with your Veterinarian. Alternative holistic medical approaches can also offer combined treatment in the way of chiropractic, massage, and acupuncture. Alternative medicine should be used in conjunction with your Veterinarian's recommendations and a correct shoeing package.

   Caudal Heel Pain takes on many forms and requires many different shoeing modifications to properly assess and alleviate pain & inflammation. This is true in less traditional cases with low and sloping heels or cases with upright heels. Different problems require different solutions as seen below: