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Navicular Syndrome and Heel pain in the performance horse

Navicular Syndrome and Heel pain in the performance horse. Phillip D Jones, DVM, MS Diplomate American College of Veterinary Surgeons. Outline. Causes for caudal heel pain Diagnostics and therapies Shoeing recommendations. Caudal heel pain. N avicular syndrome

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Navicular Syndrome and Heel pain in the performance horse

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  1. Navicular Syndrome and Heel pain in the performance horse Phillip D Jones, DVM, MS Diplomate American College of Veterinary Surgeons

  2. Outline • Causes for caudal heel pain • Diagnostics and therapies • Shoeing recommendations

  3. Caudal heel pain • Navicularsyndrome • 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. Navicularsyndrome • 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. Navicularsyndrome • Changes within the navicular bone -edema -vascular stasis -enlargement of the nutrient foraminae -cyst-likemedullary areas -subchondral bone changes -changes in the flexor surface -fragmentation of the distal border

  10. Add normal NB

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

  12. 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.

  13. shoeing • Key points: • Correct and maintain dorsopalmar and lateromedial balance • Ease breakover • Maintain heel mass • Protect palmar aspect of the hoof from concussion

  14. Medical therapies • Intra-articular injection • Intra-bursal injection • Tilduronicacid (Tildren) • NSAID’s • Isoxuprine-2.2% oral bioavailability

  15. Treatment

  16. 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

  17. Treatment

  18. 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

  19. Fracture Dyson- Radiographic Interpretation of the Navicular Bone. EVE 2008

  20. 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

  21. Bipartite Dyson- Radiographic Interpretation of the Navicular Bone. EVE 2008

  22. ?

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