Page 483 - Adams and Stashak's Lameness in Horses, 7th Edition

Lameness of the Distal Limb 449

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A B
Figure 4.13. A lateral STIR MR image (A) and cross‐sectional MR image (B) of the horse in Figure 4.11 demonstrating abnormal signal
within the navicular bone (A; arrow) and surface damage to the DDFT (B; arrow).

individually tailored treatment regimen is thought to made regarding further exercise and continued treat-
promote a more positive outcome in many equine cases. 3 ment at the first shoeing change based on the response
A variety of treatment options are available for horses to treatment.
with navicular disease/syndrome with the goal of manag-
ing the disease. One of the most important treatments
is corrective trimming and shoeing. 96,115,120 Other nonsur- Corrective Trimming and Shoeing
gical treatments include rest and controlled exercise, Corrective trimming and shoeing are the basis for
nonsteroidal anti‐inflammatory drugs (NSAIDs), bispho- managing the majority of horses with navicular syn-
sphonates such as tiludronate and clodronate, intrasyno- drome/disease. 4,25,96,120 Many horses respond favorably to
vial medications, and medications aimed at preventing shoeing alone without requiring further medical or surgi-
secondary OA of the DIP joint. Surgical treatments cal therapy. Improvement in clinical signs within 3
include palmar/plantar digital neurectomy, inferior check months of initiation of treatment has been reported with
ligament desmotomy, and endoscopy of the navicular 86% of the horses remaining free of lameness for 1
bursa. A brief overview of these treatments is discussed year. 120,121 The goals of trimming and shoeing are to (1)
below. See Chapters 8 and 11 for more information. restore normal foot balance; (2) correct foot problems
such as shearing of the quarters and heels, underrun
heels, and heel contraction; (3) reduce biomechanical
Rest and Controlled Exercise
forces on the navicular region; (4) ease break‐over at the
In the past, prolonged rest has not been recommended toe; (5) support the heels and prevent heel descent during
for most horses with navicular disease because the lame- loading; and (6) protect the injured areas of the foot. 25,115
ness often returns shortly after the horse resumes exer- Multiple types of shoes have been used for horses
cise. However, significant soft tissue injuries within the with heel pain, and one single type of shoe cannot be
73
foot such as DDFT or CSL lesions may warrant a more used in every horse. For instance, a horse with the low‐
extended rest and rehabilitation period, similar to that heel, long‐toe conformation may benefit from an ele-
recommended for horses with tendinitis elsewhere in the vated heel shoe, whereas a horse with a narrow upright
limb. However, many of the lesions within the DDFT foot may actually benefit from heel removal and place-
appear to be degenerative and not inflammatory and do ment of a flat natural balance or egg‐bar shoe. When the
not generally respond to rest alone. Nevertheless, a short heels are long, they tend to grow forward, decreasing
period of rest is usually recommended for most horses heel support and contributing to dorsopalmar hoof
with navicular disease/syndrome to help reduce the soft imbalance (Figure 4.14). In general, foot preparation
25
tissue inflammation and allow the horse to acclimate to or trimming is more important than the type of shoe
115
corrective trimming and shoeing. This is substantiated used in most horses with navicular disease/syndrome.
by MRI findings that concurrent soft tissue and bone A well‐made shoe placed on an improperly trimmed
pathology most likely contribute to the pain in many foot serves little purpose. The heels should be trimmed
horses with palmar foot pain. 39–41,43,44,78 Although the to the widest aspect of the frog and the toes shortened as
rest period may vary for individual cases, the author much as possible to shift weight‐bearing to the back of
usually recommends no work until at least the first the foot. 4,25 See Chapters 8 and 11 for more information
shoeing change in most horses. A decision is usually on foot trimming and shoeing.