Diagnosis and treatment of the navicular syndrome in horses

Navicular syndrome can be treated in a variety of ways. This is related to the fact that it has a variety of causes. Prognostically, most horses will improve with treatment. One can expect about 50 per cent of the horses to become useably sound for 1 year, no matter what treatment is used. The disease is progressive, and affected horses eventually will need to be retired because of lameness. The author's therapeutic approach is to utilize shoeing as the primary therapy. Shoeing is performed to correct structural problems and to ensure that shoeing is physiologically sound. Nonsteroidal anti-inflammatory drugs are not used unless radical changes have been made in the shoeing. In cases of confirmed distal interphalangeal joint synovitis, either sodium hyaluronate or polysulfated glycosaminoglycans will be used in conjunction with shoeing. In cases where decreased circulation is documented, isoxsuprine hydrochloride will be administered if shoeing alone has not improved the horse within 6 weeks. If therapy does not improve the horse within 6 to 12 weeks, palmar digital neurectomy is recommended.     

Equine Behavior Problems—Around Farriery: Foot Pain in 11 Horses

Although foot pain may clearly be the cause when a horse with foot pathology does not tolerate farriery, it may be overlooked or underappreciated as the cause of this behavioral problem when the pathology is mild and/or chronic. In this study, the records of 11 adult horses whose behavior for farriery initially warranted sedation for trimming and shoeing were reviewed. All 11 horses had a history of chronic lameness that was mild to moderate, but foot pain was the presenting complaint in only seven horses - all with chronic laminitis. The other four horses had abnormal foot conformation (long-toe, low-heel, or “club foot), but the lameness had not been attributed to the foot. All 11 horses showed improvement in gait with corrective trimming and shoeing. In each case, sedation for farriery could be discontinued after one to six visits, concurrent with the improvements in gait and foot pathology. On the basis of the survey results from 17 professional farriers, an ethogram of farriery-related undesirable horse behavior was developed.     

Injection of corticosteroids, hyaluronate, and amikacin into the navicular bursa in horses with signs of navicular area pain unresponsive to other treatments: 25 cases (1999-2002)

OBJECTIVE: To determine history, clinical and radiographic abnormalities, and outcome in horses with signs of navicular area pain unresponsive to corrective shoeing and systemic nonsteroidal anti-inflammatory drug administration that were treated with an injection of corticosteroids, sodium hyaluronate, and amikacin into the navicular bursa. DESIGN: Retrospective study. ANIMALS: 25 horses. PROCEDURE: Data collected from the medical records included signalment, history, horse use, severity and duration of lameness, shoeing regimen, results of diagnostic anesthesia, radiographic abnormalities, and outcome. RESULTS: 17 horses had bilateral forelimb lameness, 7 had unilateral forelimb lameness, and 1 had unilateral hind limb lameness. Mean duration of lameness was 9.2 months. All horses had been treated with corrective shoeing and nonsteroidal anti-inflammatory drugs for at least 6 months; 18 had previously been treated by injection of corticosteroids and sodium hyaluronate into the distal interphalangeal joint. Fourteen horses had mismatched front feet, and 21 horses had signs of pain in response to application of pressure over the central aspect of the frog. Palmar digital nerve anesthesia resulted in substantial improvement in or resolution of the lameness in all horses. Twenty horses (80%) were sound and returned to intended activities 2 weeks after navicular bursa treatment; mean duration of soundness was 4.6 months. Two horses that received numerous navicular bursa injections had a rupture of the deep digital flexor tendon at the level of the pastern region. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that navicular bursa treatment may provide temporary improvement in horses with signs of chronic navicular area pain that fail to respond to other treatments.     

Outcome of medical treatment for horses with foot pain: 56 cases

Reasons for performing study: Currently, there are limited data regarding the long‐term outcome of horses with foot pain treated with corrective shoeing, rest and rehabilitation, and intrasynovial anti‐inflammatory medication to target lesions detected with MRI. Objective: To report the long‐term (≥12 months) outcome of horses with foot lesions following medical therapy. Hypotheses: 1) There is no association between clinical parameters considered and a poor response to therapy. 2) Horses with a deep digital flexor tendinopathy are less likely to respond to medical therapy than horses without a deep digital flexor tendinopathy. Methods: The medical records of horses with foot pain subjected to MRI examination and medical therapy (2005–2007) were evaluated retrospectively. Data collected included history, signalment, occupation, duration and severity of lameness at the time of MRI, radiological and MRI abnormalities. Number of treatments, complications and long‐term response to treatment were obtained by detailed telephone questionnaires. Association between clinical and MRI findings and long‐term lameness were investigated. Results: Frequent abnormal structures included the navicular bone, the deep digital flexor tendon, the navicular bursa and the distal interphalangeal joint. Thirty‐four of 56 horses (60.7%) failed to return to previous level of exercise due to persistent or recurrent lameness or owners' decision to decrease the horse's athletic level; however, 11 horses (32.3%) were being used for light riding. Prognosis for horses with concurrent deep digital flexor tendon, navicular bone and navicular bursa lesions was worse than horses with individual lesions. Deep digital flexor tendinopathy was strongly associated with persistent or recurrent lameness. Conclusions: Horses with multiple foot lesions managed with conservative therapy have a guarded prognosis for long‐term soundness. Deep digital flexor tendinopathies negatively influence prognosis.     

Lameness due to pain associated with the distal interphalangeal joint: 45 cases

This paper describes the clinical and radiographic features, and response to treatment, of 45 horses which showed lameness that was improved by intra-articular anaesthesia of the distal interphalangeal (DIP) joint. Although many horses had poor conformation of the foot of the lame limb, the majority showed no localising clinical signs suggestive of involvement of the DIP joint. Lameness was usually unilateral. No horse with bilateral lameness responded to treatment. Palmar digital nerve blocks frequently improved or alleviated lameness, although in some horses palmar (abaxial sesamoid) nerve blocks were required to eliminate lameness. This difference in response did not affect response to treatment. Intra-articular anaesthesia of the DIP joint usually resulted in resolution of lameness within 5 mins; a partial improvement in lameness or a slow response were poor prognostic indicators. None of the horses had radiographic abnormalities compatible with navicular disease. Radiographic changes of the distal interphalangeal joint per se were generally detectable only in lateromedial views and were identified in less than one third of the horses. Success rates were low following treatment of cases with radiographic abnormalities. In those with no radiographic abnormalities the response to corrective trimming and shoeing and intra-articular administration of sodium hyaluronate, once or repeatedly, was variable and no parameters could be used to predict the likely outcome. Treatment was successful in approximately 30 per cent of cases. Subsequent treatment of horses which remained lame, by intra-articular administration of polysulphated glycosaminoglycans, was not helpful; only a small proportion became sound following prolonged (nine months) rest.(ABSTRACT TRUNCATED AT 250 WORDS)     

Short-term effect of therapeutic shoeing on severity of lameness in horses with chronic laminitis

OBJECTIVE: To evaluate the short-term effects of 4 therapeutic shoeing systems on lameness and voluntary limb-load distribution in horses with chronic laminitis. ANIMALS: 10 horses with chronic laminitis. PROCEDURES: A clinical trial was conducted that used a concurrent control, crossover design to evaluate the relative effectiveness of a standard flat shoe, fullered egg-bar shoe, heart-bar shoe, and modified equine digital support system to alleviate chronic lameness in horses. Therapeutic success was assessed during a 7-day period by use of subjective (Obel grade and clinical score) and objective (force-plate data) evaluations. RESULTS: Comparison of pretreatment and intertreatment control data indicated that disease status of the horses did not change during the course of the study. None of the therapeutic shoeing treatments used resulted in a significant change in severity of lameness. CONCLUSIONS AND CLINICAL RELEVANCE: Results were interpreted to imply that substantial clinical improvement should not be expected during the first 7 days after therapeutic shoeing for the specific shoes tested in this study. On the basis of our results, we hypothesize that when used as the lone indicator of therapeutic success, severity of lameness may not be a valid indicator.     

The ossification of cartilages of the distal phalanx in the horse: An anatomical, experimental, radiographic and clinical study

This paper describes some anatomical findings relatedto ossification of the distal phalanx cartilages by anatomical and computerized tomographic sections. Radiographic findings of ossification were analyzed and correlated to age and breed. Ossification was found in 10% of warmblood horses and in 80% of draft horses and was much more severe in draft horses than in warmblood horses. The expansion of the hoof was measured in the laboratory in several feet of warmblood and draft horses and was found to be minimal with no differences whether ossification was present or not. Computerized tomography was performed on a foot of a slaughtered horse before and after up to 7000N loading in the laboratory in order to study the eventual changes of the cartilages and the hoof. These structures seemed quite unaffected by the load and expansion of the horny capsule was minimal. Minor expansion seems an inevitable structural behavior of the hoof and the classical hoof mechanism is questioned. The clinical significance of ossification in its relation to lameness was individually determined during clinical examination and by comparison of groups of horses with and without ossification with groups of horses with lameness from the foot and proximal to the foot. The severity of the ossification was related to the onset of lameness and no correlation was found. It is concluded that the clinical significance of ossification is almost nil. Ossification is not painful when developing and not thereafter. There is no correlation between navicular disease and ossification of the cartilages either. Orthopedic shoeing is of no significance at all. An unfavorable advice in purchase examinations in sporting horses due to cartilage ossification is not justified in the author's opinion.     

Navicular disease in the hindlimbs of the horse

Of 124 horses determined to have navicular disease during a 5-year period, 6 had clinical and radiographic signs of the disease in both hindlimbs. These 6 were all castrated males, ranging in age from 3 to 12 years, and were used for work of similar nature: roping, cutting, and pleasure. Treatment consisted of posterior digital neurectomy and corrective shoeing in 2 cases, posterior digital neurectomy alone in 2 cases, and corrective shoeing alone in 2 cases. Following treatment, lameness subsided, and all 6 horses were returned to full use.     

Surgical treatment of navicular syndrome in the horse using navicular suspensory desmotomy

Seventeen horses diagnosed as having navicular syndrome on the basis of history, clinical findings, regional local anaesthesia and radiography were subjected to bilateral navicular suspensory desmotomy. Before surgery, the duration of navicular lameness ranged from 6 weeks to 4 years. Previous unsuccessful treatments prior to surgery included nonsteroidal anti-inflammatories, corrective shoeing, rest and isoxsuprine. For the seventeen horses subject to surgery, twelve horses were sound, one horse was improved and four horses were lame at a minimum of 6 months after surgery.     

The Incidence of Australian Stringhalt in Horses in New Zealand

Seventeen horses diagnosed as having navicular syndrome on the basis of history, clinical findings, regional local anaesthesia and radiography were subjected to bilateral navicular suspensory desmotomy. Before surgery, the duration of navicular lameness ranged from 6 weeks to 4 years. Previous unsuccessful treatments prior to surgery included nonsteroidal anti-inflammatories, corrective shoeing, rest and isoxsuprine. For the seventeen horses subject to surgery, twelve horses were sound, one horse was improved and four horses were lame at a minimum of 6 months after surgery.     

Quantitative comparison of three commonly used treatments for navicular syndrome in horses

OBJECTIVE: To quantitatively compare 3 commonly used treatments for navicular syndrome (NS) in horses: heel-elevation shoeing alone, heel-elevation shoeing and phenylbutazone administration, heel-elevation shoeing and injection of the distal interphalangeal joint (DIPJ) with triamcinolone acetonide (TA), and all 3 treatments in combination. ANIMALS: 12 horses with NS. PROCEDURE: A force plate was used to measure baseline peak vertical ground reaction force (PVGRF) of the forelimbs. Each horse's forelimbs were shod with 3 degrees heel-elevation horseshoes; PVGRF was measured 24 hours and 14 days after shoeing. Fourteen days after shoeing (following data collection), phenylbutazone (4.4 mg/kg, i.v., q 12 h) was administered (5 treatments). Two hours after the fifth treatment, PVGRF was measured; TA (6 mg) was injected into the DIPJ of the forelimb that generated the lower baseline PVGRF Fourteen days later, PVGRF was measured. Phenylbutazone was administered as before, and PVGRF was measured. Percentage body weight of force (%BWF) was calculated from PVGRF measurements and used for comparisons. RESULTS: 14 days after shoeing, mean %BWF in both forelimbs significantly increased from baseline; additional administration of phenylbutazone significantly increased %BWF applied from the more lame forelimb. Compared with shoeing alone, there was no significant change in %BWF after injection of the DIPJ with TA in shod horses. CONCLUSIONS AND CLINICAL RELEVANCE: Heel-elevation shoeing alone and in combination with phenylbutazone administration quantitatively decreased lameness in horses with NS. Although not significant, additional DIPJ injection with TA resulted in further quantitative decrease in lameness, compared with that achieved via shoeing alone.     

Pelvic fractures in horses: 19 cases (1974-1984)

The clinical features of 19 horses with pelvic fractures were reviewed. The most common problem was a grade III or IV unilateral hind limb lameness. The prevalence of fractures was greater in females and horses less than 4 years old. All horses were treated with a combination of analgesic administration and stall rest for 2 to 6 months. Seven of 11 horses (64%) available for long-term follow-up evaluation recovered and 4 of 11 (36%) had no lameness when being ridden. Five of seven (71%) horses with fractures that involved the acetabulum recovered, and 4 (57%) had complete resolution of lameness. No correlation was found between the long-term outcome of the horses and the bone fractured, age of horse, or duration of injury before admission.     

Retrospective evaluation of surgical versus conservative treatment of keratomas in 41 lame horses (1995-2001)

A keratoma is a rather uncommon disorder of the equine hoof that can lead to lameness. Few quantitative data exist about the prognosis of different treatment regimens. The outcome of 41 cases that were presented to the Department of Equine Sciences in the period 1995-2001 and that were treated according to different regimens was retrospectively evaluated. All horses showed lameness that could be attributed to the keratoma: 23 (56%) were treated surgically using a standardized procedure, while the other 18 (44%) were treated conservatively. Results were based upon 35 horses; 6 were lost to follow-up. Range of recovery time for the surgically treated patients, was 2-12 months and for the conservatively treated group 2 weeks to 6 months. Of the surgically treated patients 83% (n =23) returned to the same or higher performance level as before the onset of the lameness, as opposed to 42% (n = 12) of the conservatively treated horses (p<0.05). The average hospitalization period was significanty longer for the surgically treated patients (35 vs. 5 days, p<0.05). It is concluded that surgical excision of the keratoma is the preferred treatment for horses suffering from lameness caused by a keratoma, because the better outcome outweighs the longer hospitalization and the longer overall recovery time.     

Lameness associated with foot pain: results of magnetic resonance imaging in 199 horses (January 2001--December 2003) and response to treatment

REASONS FOR PERFORMING STUDY: The diagnosis of foot-related lameness often remains elusive and it can be difficult to offer rational treatment, or to predict outcome. OBJECTIVES: To describe the spectrum of injuries of the foot identified using magnetic resonance imaging (MRI), to determine their relative prevalence among MRI diagnoses and to establish the long-term results of treatment. METHODS: The MR images of horses examined from January 2001--December 2003 were reviewed. Horses were selected for MRI if the pain causing lameness was localised to the foot using perineural analgesia but any clinical, radiological or ultrasonographic abnormalities were insufficient to explain the degree of lameness. The clinical significance of lesions identified using MRI was determined with reference to the results of local analgesia, radiography, ultrasonography and nuclear scintigraphy. Follow-up information was obtained in January 2004 for horses which had been examined 6-36 months previously and the outcome classified as excellent (horse returned to full athletic function without recurrent lameness), moderate (sound, but only in light work), or poor (persistent or recurrent lameness). RESULTS: One hundred and ninety-nine horses underwent MRI examinations. Deep digital flexor (DDF) tendonitis was the most common injury (59%) with primary injury in 65 horses (33%) and a further 27 horses (14%) having lesions of the DDF tendon and navicular bone. Seventeen percent of horses had injuries to multiple structures, including 24 with DDF tendonitis. Desmitis of a collateral ligament (CL) of the distal interphalangeal (DIP) joint was the second most common injury (62 horses, 31%), with primary injuries in 30 horses (15%) and a further 32 horses (16%) that had CL desmitis in conjunction with other injuries. Prognosis was best for horses with traumatic injuries of the middle or distal phalanges, with 5 of 7 horses (71%) having an excellent outcome. Horses with primary lesions of the DDF tendon or CL of the DIP joint had excellent results in only 13 of 47 (28%) and 5 of 17 horses (29%), respectively. Horses with combined injuries of the DDF tendon and navicular bone, or primary navicular bone abnormalities, had a poor outcome, with the majority of horses suffering persistent lameness. CONCLUSIONS: A wide variety of lesions associated with foot pain were identified using MRI, a high proportion of which were primary soft tissue injuries with a guarded prognosis for return to full athletic function. POTENTIAL RELEVANCE: It is now possible to propose more rational treatment strategies for the variety of foot injuries identified using MRI than had previously been possible; however, further information concerning aetiopathogenesis of these injuries is needed to improve their management.     

A randomised, double-blinded, placebo-controlled study on the efficacy of a unique extract of green-lipped mussel (Perna canaliculus) in horses with chronic fetlock lameness attributed to osteoarthritis

Reasons for performing study: Lyophilised products from green‐lipped mussel (Perna canaliculus[LPPC]) are used to orally treat horses with osteoarthritis (OA). However, no randomised, controlled or double‐blinded studies on the efficacy of this treatment in horses have been reported to date. Objective: To investigate the effects of a unique LPPC (Biolane) ¹ in improving clinical signs of OA in the fetlock. Methods: Data were analysed from 26 horses with primary fetlock lameness in a controlled, randomised and double‐blinded, multi‐centre clinical trial. The study design was a partial crossover with a washout period and consisted of 19 horses treated with LPPC and 20 with a placebo. Horses were dosed orally with 25 mg/kg bwt/day LPPC or placebo for 56 days. Efficacy was evaluated by clinical assessment of lameness, passive flexion, pain, swelling and heat in the affected joint. Relationships between variables were analysed using an ordinal logistic model with random effects for horse and horse x treatment according to a modified intention‐to‐treat analysis. Results: Clinical evaluation of horses with a fetlock lameness treated with LPPC showed a significant reduction in severity of lameness (P<0.001), improved response to the joint flexion test (P<0.001) and reduced joint pain (P = 0.014) when compared with horses treated with placebo. Conclusions: The LPPC significantly alleviated the severity of lameness and joint pain and improved response to joint flexion in horses with lameness attributable to OA in the fetlock.     

Effects of balancing and shoeing of the forelimb feet on kinematic gait analysis in five horses with navicular disease

The effects of balancing the foot and shoeing (B&S) on the kinematics of five Quarter Horses with navicular disease were evaluated using computerized gait analysis. Kinematic measurements of the right forelimb and head were made before and after palmar digital nerve block (PDNB) and before and after B&S of the forelimb feet. Carpal and fetlock joint angle, foot displacement, and temporal gait measurements were made for at least five strides in each horse trotting on a treadmill. Kinematic measurements were compared before and after PDNB and before and after B&S by analysis of variance with an α=0.05. The most significant kinematic changes seen after PDNB were in the vertical head movement parameters studied. Total vertical head excursion and measures of head height asymmetry between right and left forelimb stance phases decreased after PDNB. After B&S mean carpal flexion and maximum hoof height during the swing phase of the stride increased, but none of the head movement parameters significantly changed. Results of this study indicate that the ability of treadmill kinematic gait analysis to evaluate for improvement in lameness by monitoring vertical head movement parameters is not significantly affected in horses with navicular disease three weeks after balancing and shoeing the forelimb feet.     

Efficacy of an Extract of Blue-Green Algae in Amelioration of Lameness Caused by Degenerative Joint Disease in the Horse

Degenerative joint disease (DJD) or osteoarthritis in the equine is largely a result of biomechanical stressors that result in inflammation within the joint, which with continual exposure, leads to progressive degeneration. A myriad of therapies are available for treatment of horses with DJD including nonsteroidal anti-inflammatory drugs, corticosteroids, physiological modifiers, and biological therapies. C-phycocyanin, a protein-bound pigment found in blue-green algae, has been shown to have anti-inflammatory and antioxidant properties and is available as a diet supplement in people, dogs, and horses. Forty-one horses with naturally occurring lameness as a result of DJD were selected for this study. In a blinded study, horses were randomly assigned to either the commercial or placebo product that was fed once daily for 12 months. At selected time points, lameness evaluation was performed through objective gait analysis. Previous medical records for management of lameness were reviewed for all enrolled horses. No statistically significant differences existed within or between the two groups when gait was evaluated objectively nor within individual horses between time points. Review of medical records found that five treated horses had a decreased in frequency of intra-articular injection of corticosteroids. Although this study did not find statistically significant improvement of lameness with oral daily supplementation of C-phycocyanin in equine athletes, there appeared to be a trend of improvement in lameness during the loading period and a decrease in frequency of administration of intra-articular corticosteroids. Further investigations using a higher dose seem warranted.     

Musculoskeletal problems associated with lameness and poor performance among horses used for barrel racing: 118 cases (2000-2003)

OBJECTIVE: To identify types of musculoskeletal problems associated with lameness or poor performance in horses used for barrel racing. DESIGN: Retrospective case series. ANIMALS: 118 horses. PROCEDURE: Medical records were reviewed for information on signalment, history, physical and lameness examination findings, diagnostic tests performed, diagnosis, and treatment. RESULTS: Most horses were examined because of lameness (n = 72 [61%]) rather than poor performance (46 [39%]), but owner complaint was not significantly associated with age or body weight of the horse. The most common performance change was refusal or failure to turn properly around the first barrel (19/46 [41%]). The right forelimb (n = 57 [48%]) was most commonly affected, followed by the left forelimb (51 [43%]), the left hind limb (31 [26%]), and the right hind limb (25 [21%]). In 31 horses (26%), both forelimbs were affected, and in 6 (5%), both hind limbs were affected. The most common musculoskeletal problems were forelimb foot pain only (n = 39 [33%]), osteoarthritis of the distal tarsal joints (17 [14%]), suspensory ligament desmitis (15 [13%]), forelimb foot pain with distal tarsal joint osteoarthritis (11 [9%]), and bruised feet (10 [8.5%]). In 81 (69%) horses, the affected joint was treated with intra-articular medications. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in horses used for barrel racing that are examined because of lameness or poor performance, the forelimbs are more likely to be affected than the hind limbs, with forelimb foot pain and osteoarthritis of the distal tarsal joints being the most common underlying abnormalities.     

Standing MRI lesions of the distal interphalangeal joint and podotrochlear apparatus occur with a high frequency in warmblood horses

Foot pain is a common presenting complaint in Warmblood horses. The aim of this retrospective, cross‐sectional study was to determine the spectrum of foot lesions detected by magnetic resonance imaging (MRI) in Warmblood horses used for dressage, jumping, and eventing. The medical records of 550 Warmblood horses with foot pain that were scanned using standing MRI were reviewed and the following data were recorded: signalment, occupation, lameness, diagnostic analgesia, imaging results, treatments, and follow‐up assessments. Associations between standing MRI lesions and chronic lameness following treatment were tested. Abnormalities of the navicular bone (409 horses, 74%), distal interphalangeal joint (362 horses, 65%), and deep digital flexor (DDF) tendon (260 horses, 47%) occurred with the highest frequency. The following abnormalities were significantly associated (P < .05) with chronic lameness following conservative therapy: moderate to severe MRI lesions in the trabecular bone of the navicular bone, mild or severe erosions of the flexor surface of the navicular bone, moderate sagittal/parasagittal DDF tendinopathies, and moderate collateral sesamoidean desmopathies. Also, identification of concurrent lesions of the DDF tendon, navicular bone, navicular bursa, and distal sesamoidean impar ligament was associated with chronic lameness after conservative therapy. Development of effective treatment options for foot lesions that respond poorly to conservative therapy is necessary.     

Navicular disease in the horse

Navicular disease results in a chronic, progressiveforelimb lameness that is usually bilateral. Although many different horse breeds can be affected, Quarter Horses and Warmbloods appear particularly susceptible. The peak age incidence appears to be in horses aged 6–10 years. The condition has been recognized for many years and has been the source of debate and conflict for at least the last 50 years. Much of the confusion has been caused by different criteria used to establish a diagnosis. In a large series of cases examined at the University of Sydney, only 30 percent of horses that were eventually diagnosed as having navicular disease showed a positive response to hoof testers applied across the middle third of the frog. In contrast, more than 80 percent of horses with navicular disease showed a marked increase in lameness following pastern and fetlock flexion. All horses diagnosed became sound following a palmar digital nerve block and all had positive findings on radiography. However, radiography could not be utilized as a sole diagnostic technique because some horses with radiographic abnormalities of the navicular bone did not show clinical signs of navicular disease.To establish a diagnosis of navicular disease, the following criteria should be met: 1) A chronic progressive unilateral or bilateral forelimb lameness, 2) Pain in areas proximal to the foot has been excluded as a possible cause of the lameness, 3) Other conditions that could cause pain in the palmar heel region are excluded, 4) The lameness is eliminated or substantially improved following a palmar digital nerve block, and 5) There are radiographic abnormalities on upright pedal and/or skyline views of the navicular bone.Treatment of navicular disease has usually fallen into categories of a) pain alleviation, b) drugs with vascular or hemodynamic effects, or c) changing biomechanics either by corrective trimming or corrective shoeing. None of these treatments have been universally accepted and debate about their efficacy is allied to theories about the etiology.