Heel
Pain: Not Always Navicular
A
horse that resists lead changes or has a shortening of
stride
could be suffering from heel pain.
By
Adam Whitehead - Resident Farrier UFVMC
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| Heel
pain may be exhibited from multiple structures within the
palmar aspect of the foot. The deep digital flexor tendon
(DDFT), the distal sesamoidean impar ligaments, the navicular
bursa, the navicular bone, the digital cushion, and the coffin
joint are the main internal structures in which heel pain
originates. Pain can also be elicited from the heel bulbs,
central or collateral sulcus, and weakened or compromised
heels. The navicular bone, being the one structure that is
most often blamed for heel pain, may not be fully responsible.
Often the navicular bone is not involved, yet one of its’
supporting structures may be the root of the problem. So how
do we achieve an accurate diagnosis in a horse with heel pain,
and, once diagnosed, how is heel pain effectively treated?
|
 This
horse’s hoof has a crushed or collapsed heel structure.
The red line indicates the last point of weight bearing,
every thing beyond that point is unsupported.
|
Symptoms
& Diagnosis
An accurate diagnosis of heel pain begins with the veterinarian
and the farrier working as Unwillingness to jump, shortening
of stride, resisting lead changes, and intermittent forelimb
lameness on hard ground may be common complaints from an owner
or rider. Often an actual diagnosis is not made at this time.
Typically, these horses are managed by the farrier, through
a variety of shoeing treatments. However, involving the veterinarian
and imaging techniques can provide an earlier diagnosis and
will establish a base line for any damage that has occurred
within the hoof. |
Less
commonly horses may have a sudden onset of lameness, usually
in a single forelimb. Fractures, cysts, arthritis, sclerosis,
and soft tissue strains and tears are some of the common findings
in horses with an acute onset of lameness. If lameness is
consistently worse in one foot, the feet may become asymmetrical.
The affected hoof will become contracted with a taller heel
over time. Veterinarian involvement is essential to diagnose
and treat these horses effectively. In many cases the ability
to diagnose the full extent of the problem requires advanced
imaging techniques such as nuclear scintigraphy and magnetic
resonance imaging (MRI).
Treatment |
 The
same hoof after a proper trim shows how the heels have been
trimmed back to the widest part of the frog to provide support
to the boney column and to allow the foot to function properly.
Also note the bruising in the heels from the crushed heel
condition.
|
| The
treatment of horses with heel pain can vary greatly. Treatment
of mild cases generally involves shoeing with several goals
in mind. Restoring and maintaining proper alignment of the
horses’ boney column is a primary goal. Many of the
horses that exhibit heel pain are simply out of balance and
the foot is unable function properly. Proper alignment places
the center of weight bearing under the boney column and allows
for normal function. Reduction of the mechanical stress influencing
the effected structures is also a major goal. This is generally
done by easing the point of break over, which is the point
when the mechanical stress is at its greatest. By reducing
the amount of stress on the effected structures we provide
a means to reduce inflammation and promote healing. Protection
of the palmar aspect of the foot may further assist in the
treatment. Different shoes and pads, or a combination of these
can reduce the insult to the affected structure and provide
comfort to the horse. More advanced cases typically involve
coffin joint injections, a regiment of Phenylbutazone (Bute),
and an extended amount of stall rest. Severe cases may require
surgical intervention to alleviate the horse’s discomfort.
|
| It
is important to understand that horses diagnosed with navicular
disease or degenerative changes within the navicular bone,
coffin joint or any of the supportive structures cannot be
“cured.” The goal of the treatment should be to
encourage function of the foot and to significantly reduce
the mechanical stress, slowing the rate of degeneration. Most
horses are able to continue their career at some level, but
intermittent lameness may persist. A veterinarian/farrier
team that specializes in treating horses with lameness may
provide the most effective solution for a horse with heel
pain. |
 The
same finished foot after correct shoeing with support under
the boney column and the toe squared to ease the break over.
|
X-Rays
of Navicular Bone |
 |
 |
| This
image shows an X-ray of a lateral view of a normal navicular
bone in the horse. |
This
X-ray shows a lateral view of a horse that has had gross boney
changes on the proximal aspect of the navicular bone, it is
important to note most change of the navicular bone are not
seen from this view. |
Adam
Whitehead is the resident farrier at the University of Florida
Veterinary Medical Center. Whitehead completed farrier school
in Tennessee and studied animal science at Abraham Baldwin
Agriculture College in Tifton, Ga. Prior to joining the
UF team, Whitehead successfully practiced in the field for
10 years. |
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