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Phillip D Jones, DVM, MS Diplomate American College of Veterinary Surgeons NAVICULAR SYNDROME AND HEEL PAIN IN THE PERFORMANCE HORSE.

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Presentation on theme: "Phillip D Jones, DVM, MS Diplomate American College of Veterinary Surgeons NAVICULAR SYNDROME AND HEEL PAIN IN THE PERFORMANCE HORSE."— Presentation transcript:

1 Phillip D Jones, DVM, MS Diplomate American College of Veterinary Surgeons NAVICULAR SYNDROME AND HEEL PAIN IN THE PERFORMANCE HORSE

2 OUTLINE Causes for caudal heel pain Diagnostics and therapies Shoeing recommendations

3 CAUDAL HEEL PAIN Navicular syndrome Degenerative process that changes the bone-initiation and progression of the disease is a result of excessive and prolonged forces of compression on the bone Important factors- signalment, conformation, and use

4 NAVICULAR SYNDROME Mild to moderate intermittent lameness Insidious onset Perceived as shoulder lameness Poor confirmation Bilateral lameness Lameness switches to contralateral limb after unilateral PD block

5 NAVICULAR SYNDROME Important PE findings -contracted heels -atrophied frog -small foot compared with body size

6 NAVICULAR SYNDROME Medical therapy -shoeing changes -anti-inflammatory medications -rest Surgical therapy- PD neurectomy (criteria! & complications!)

7 DIAGNOSTICS Localization Palmar Digital Nerve block -Mepivacaine: 1 -1.5ml /nerve

8 DIAGNOSTICS

9 NAVICULAR SYNDROME Changes within the navicular bone -edema -vascular stasis -enlargement of the nutrient foraminae -cyst-like medullary areas -subchondral bone changes -changes in the flexor surface -fragmentation of the distal border

10 ADD NORMAL NB

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17 Dyson- Radiographic Interpretation of the Navicular Bone. EVE 2008

18 SHOEING Correct or preserve dorsopalmar and lateromedial foot balance Hoof pastern angle should be straight Foot trimmed to maintain heel mass and shorten toe to facilitate breakover Elevation of heel may relieve pressure from DDFT on palmar aspect of navicular bone Egg bar shoe: greater surface area disperses forces. -Of 55 horses with navicular disease 53% had permanent pain relief of lameness after egg bar shoes in 12-40 month follow up.

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21 SHOEING Key points: Correct and maintain dorsopalmar and lateromedial balance Ease breakover Maintain heel mass Protect palmar aspect of the hoof from concussion

22 MEDICAL THERAPIES Intra-articular injection Intra-bursal injection Tilduronic acid (Tildren) NSAID’s Isoxuprine -2.2% oral bioavailability

23 TREATMENT

24 CAUDAL HEEL PAIN Desmititis of the collateral ligaments. Tendonitis of the DDFT at 3 possible locations: -insertion -palmar to the navicular bone -proximal to the navicular bone Desmitis of the impar ligament. Desmitis of the distal annular ligament. Synovitis in the distal interphaleangeal joint. Synovitis in the navicular bursa. Cystic lesion in the second phalanx

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26 TREATMENT

27 SHOCKWAVE Extracorporeal shock wave -generates a pulse wave within the body Encourages growth mediators and other cytokines integral to the healing process Offers temporary pain relief

28 FRACTURE Dyson- Radiographic Interpretation of the Navicular Bone. EVE 2008

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31 BIPARTITE NAVICULAR BONE Develops as 2 separate centers of ossification that never unite Unilateral or bilateral Broad well defined lucent line between the 2 pieces Horse may be clinically normal, or have episodic lameness in full athletic function No history of acute lameness as in fracture

32 BIPARTITE Dyson- Radiographic Interpretation of the Navicular Bone. EVE 2008

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