Navicular and Ringbone

Navicular and Ringbone: A Step in the Right Direction

Last Updated on February 25, 2022 by Allison Price

The old horseman’s maxim “no horse, no foot” is more relevant than when your horse becomes lame all the time. A sinking feeling will soon follow if your veterinarian mentions “changes” in certain bones and joints.

Many working horses were once unable to get a diagnosis of “navicular Syndrome” without a job. As was the case with ringbone cases, the prognosis was often grim.

Good news is that these conditions can be managed with advances in farrier science and veterinary technology. Your favorite hunter, jumper, or dressage horse doesn’t have to be put down. Both conditions are not curable but can be managed with a constant focus on comfort for the horse.

What are they?

Navicular Syndrome is a general term that describes a painful condition that affects the navicular bone or related structures in the horse’s foot (such the podotrochlea, navicular ligaments, and the navicular bursa). Although the exact cause of the damage to the navicular bones is unknown, it is commonly hypothesized that the injury is caused by trauma or interruptions in blood flow. Some evidence suggests that there is a genetic component to some breeds. This means that individuals may be predisposed to developing abnormalities in the podotrochlear apparatus.

Illustrated Atlas of Clinical Equine Anatomy & Common Disorders of the Horse

This syndrome can affect one or both of the front feet. This causes gradual, progressive lameness. It can be intermittent or more severe when horses are turned in small circles or worked on hard ground.

Navicular and Ringbone

Ringbone refers to the bony calcification found around the pastern or coffin joints, when arthritis develops. This could be due to normal wear and tear, injury, or inflammation. This can happen in any or all of your feet.

Ringbone can be caused by arthritis of the pastern (high-ringbone) or coffin joint (low-ringbone). There is inflammation when there is arthritis.

Illustrated Atlas of Clinical Equine Anatomy & Common Disorders of the Horse

Because there are many factors involved, veterinarians emphasize that it is impossible to make generalizations about what causes these changes. Each case is unique.

Stephanie S. Caston DVM, DACVS–LA put it best when stating that although ringbone syndrome and navicular Syndrome affect different areas of the foot, “both chronic conditions that often get worse over time.”

Dr. Caston is an associate professor of Equine surgery at Iowa State University’s College of Veterinary Medicine. She has published research on navicular problems and fusion of the pastern affected by ringbone. She explained that arthritis can be caused by bony swelling in either the pastern or coffin joints. Arthritis can be caused by normal wear and tear, but it can also happen secondary to infection or an accident (e.g., a broken bone). There is inflammation and pain when arthritis is present. In more severe arthritis, restricted ranges of motion may occur.

Dr. Caston explained that the term “navicular syndrome” refers to lameness in the heel area. She explained that it is sometimes also called navicular disease, caudal heel hurt, or caudal navicular syndrome. While problems with the navicular bones may cause lameness in these cases, it is possible that other structures within the area can also cause lameness. These soft-tissue structures include ligaments, tendons and the navicular Bursa.

Testing and Testing

How can these conditions be best diagnosed? Sometimes, different veterinarians have slightly different opinions.

Craig S. Lesser DVM, CF is an expert in navicular syndromes and ringbone thanks to his experience at Lexington’s Rood & Riddle Equiline Hospital. He explained that the first step in diagnosing a condition is to have it examined by a veterinarian. This includes flexions and local pain medication. Radiographs [Xrays] can be used to diagnose these conditions depending on the location of the lameness. MRIs, which are based on advances in imaging, have been the standard for diagnosing lameness.

Tracy Turner, DVM MS, Dipl is another veterinarian who was also trained as farrier. ACVS, ACVMR of Turner Equine Sport Medicine and Surgery in Stillwater. He said that to diagnose ringbone and navicular syndromes, one must carefully examine the hoof and distal leg, including flexion tests and hoof tester examinations, wedge tests, nerve blocks, and hoof tester examinations. A palmar digital nerve block is used to relieve navicular pain. Ringbone pain requires a more proximal (or higher) nerve block to alleviate or reduce it.

Your veterinarian will conduct a lameness exam to determine if you have navicular or ringbone. This includes flexions.

(c) Amy K. Dragoo

He stressed that imaging is crucial for determining the diagnosis. Ringbone is the diagnosis of arthritis in either the distal or proximal interphalangeal (pastern) joints. Magnetic resonance imaging and computed tomography will provide more detailed imaging, but they are not required to diagnose the condition. The complexity of Navicular Syndrome is greater and radiographic changes in the navicular bones are common, but they are not always indicative or definitive of the disease.

Dr. Turner, like Dr. Caston was quick to point out that “navicular disease”, as it was previously known, was replaced by “navicular syndrome” because the veterinary profession recognized that there could be multiple causes for the pain. He explained that MRI imaging in veterinary medicine allowed for evaluation of soft tissues, which confirmed that the condition is a syndrome. “The podotrochlea (navicular bone and bursa, joint and ligaments, deep flexor tendon, and joint, was able to be examined, which showed that it could be caused by pathology,” he said.

Dr. Caston explained how MRIs can help to confirm and pinpoint these conditions. Radiographs (or ‘Xrays’) will be able to diagnose arthritis cases that show bony changes. Radiographs may not be able to detect early arthritis cases. This is because some structures, such as synovium, cartilage and the joint capsule, are not visible on radiographs. If this is the case, MRI or other diagnostic imaging may be useful in confirming the diagnosis.

It takes a team

Each case is unique and there is no single treatment that will work for ringbone or navicular syndrome. But, the key to successful management and treatment is often a team of professionals that will work together with both the horse owner as well as each other. Dr. Dr. Lesser summarized: “Working together with your veterinarian, farrier, and other medical professionals, you can initiate a combination of mechanical and medical treatments to ensure that your athlete stays comfortable for many years to come.”

Dr. Turner, for his part, stressed that hoof care was of paramount importance in any management program. This will improve the mechanics of your hoof, reduce stress on various aspects of your hoof, and ease breakover. However, Dr. Turner stated that anti-inflammatory therapy is required. It may be as mild as phenylbutazone or firocoxib. This may need intra-articular injection.

Ringbone is treated with intra-articular corticosteroids, either with or without the addition of hyaluronic acids. There are many intra-articular products available these days that can help, including IRAP, hydrogels and alpha-2 macroglobulins. Adequan(r), which can be used to slow down the progression of arthritis, would be a great choice.

Dr. Turner stated that “therapy to reduce inflammation is key” in navicular syndrome management. If bone remodeling is an issue, bisphosphonates (Tildren, OsPhos) are helpful. For tendon and ligament problems, PRP therapy or stem cell therapy might be required. For some aspects, shockwave may be helpful. To control pain, neurectomy (surgical removal of the palmar digital neural nerve) might be required in the latter stages.

This may sound complicated, but modern veterinary medicine has a wide range of options to treat these conditions. There’s a reason that many of the most effective anti-inflammatories are used in treatment. Because reducing inflammation can reduce or eliminate lameness. This could improve the horse’s movement and allow him to return to work. Dr. Caston said that anti-inflammatory drugs are used often both systemically as well as by injection into a joint, bursa or joint.

Dr. Caston said that horses suffering from arthritis of the pastern joint or “high-ringbone” can be treated with fusion. Arthrodesis is a surgical procedure that removes cartilage and stabilizes the joint using plates and screws.

She continued, “Another way to promote joint fusion is to repeatedly inject with ethyl Alcohol to kill remaining cartilage.” Facilitated ankylosis is a method that speeds up the process of arthritis to the point where the joint fused with the bone. Although it is possible to fuse joints in other joints, the pastern joint has very low motion so the horse can still function normally. Once the joint is fused, there is no need for the horse to be lame or have gait abnormalities. Higher-motion joints are not affected by this.

Management is a matter of management

You might be asking yourself if your horse is going to be a trail mount or a pasture ornament, or if he will be safe enough to return to competition. The answer is dependent on many factors, as you probably guessed.

Dr. Lesser explained that a horse diagnosed with navicular syndrome (or ringbone) can have a wide range prognosis depending on the severity of the disease. Lesser explained. “We are improving in medically and mechanically treating horses. However, early diagnosis and intervention is key to long-term success.”

It is important to assess the horse and the activity being done to determine if one discipline is more likely or less likely to cause or worsen these conditions. Dr. Lesser said that every discipline has its own common lameness issues and horses who have suffered from distal concussion are more likely to develop either one. Lesser added, “Poor conformation or genetics can also predispose horses for either one of these conditions.”

Dr. Turner also mentioned other factors that could influence the outlook of an affected horse. These include the severity of the disease, the horse’s attitude, the dedication of its owner, and the quality of farrier work. He stated, “I prefer to talk with owners that this a management problem.” This is teamwork among veterinarian, farriers, owners, riders, barn managers, etc. This involves keeping the hooves in good shape to reduce stress and inflammation, as well as therapy to minimize inflammation.

Your veterinarian and farrier should coordinate their care to ensure your horse has a healthy ringbone. To ensure that your horse is happy, you can use a combination of medical and mechanical treatment.

(c) Amy K. Dragoo

Dr. Turner stated, “I would consider it a failure if one my patients with any of these conditions was made into a pasture ornament.” He added, “My goal in life is to restore the horse to its former level of competition.” This can be difficult as speed and jumps put additional stress on the structures. Horses who perform at high levels put enormous strain on these structures and require constant monitoring to address any issues that arise.

Dr. Caston stressed the fact that prognosis can differ from one horse to the next for these two conditions. She explained that it all depends on the severity and individual horse as well as the discipline. “For example, if a horse has navicular syndrome, arthritis or other severe lameness, it might be harder for them to compete in the hunter showring or dressage ring, even if they have been treated.

Dr. Caston said, “Conversely, horses that are primarily used for trail riding may be able function normally and have good quality of living, even if they still have some lameness after treatment.”

Surfaces and such

You might be unsure about what type of footing or surface is best for your horse if he has been diagnosed as having ringbone or the navicular syndrome.

It is important to determine whether or not it is advisable to ride your horse. If so, what should you pay? Craig S. Lesser DVM, CF acknowledged that many horses can be ridden at the same level or a lower level of competition if they are properly cared for. “But I recommend you consult your veterinarian and farrier in order to find out how much work your horse is capable of handling.”

After you are cleared to ride, our experts recommend consulting your support team regarding the best footing for your horse. Stephanie S. Caston DVM, DACVS–LA, explained that there is no one riding surface that is right for horses with navicular syndrome and arthritis. Some horses may have lameness due to soft-tissue issues. Horses with such a condition may have difficulty walking on softer, deeper feet. Other cases may be more difficult due to hard ground or uneven terrain. It is best to assess each case individually and to work with your veterinarian in order to best manage your horse.

Tracy Turner, DVM MS, Dipl. ACVS, ACVMR, agreed that there is no perfect surface for horses with navicular or ringbone syndrome. He advised that competition should be avoided on hard or uneven surfaces. My advice to clients has been, and will continue to be: Walk away from any competition if you don’t like its surface.”

Jondolar’s Story – Mild to Moderate Navicular Changes

A conscientious horseman must be aware of the limits when jumping. Shana Johnson stated, “With all jumping horse, the question in one’s head is, ‘How many jumps this horse has in him?’ One, two, or ten thousand.

However, the Scituate resident from Rhode Island noted that “a navicular horse owner always asks this question before riding.”

She should be. Johnson is the owner of a 24-year old Selle Francais gelding, Jondolar de la Monteleon. He was diagnosed with mild to moderate navicular problems in 2007. Despite this diagnosis, she was still able to compete in the Adult Equitation 2ft-6 division in Rhode Island, Massachusetts for many years.

Anyone who has owned a horse with similar diagnoses might recognize their story. Johnson said that Jondolar was a horse she rode for two years before I bought him. Johnson didn’t do a pre-purchase exam. Jondolar began experiencing intermittent lameness two months after this date. He would be straight, but sometimes he’d go to the left. After bringing him to a Massachusetts Equine veterinarian several times, they suggested that he have an MRI at Southshore Equine. His right front hoof showed mild to moderate navicular change.

She continued, “I was devastated.” Jondolar, at nine years old, thought that this was the end to his jumping career. My friends convinced me to reconsider and suggested a consult between my vet and a blacksmith. To project the angle of the lifts/wedges Jondolar wore, X-rays were taken. To maintain an exact angle, I maintained a strict schedule for his shoeing. Sometimes I would have to do it four times a summer.

Johnson stated that Jondolar had navicular problems and she prescribed nonsteroidals “…. This is to keep blood flowing through his navicular bones. He should be icing his feet and/or DMSO/MagnaPaste them after competition. This is key to keeping him healthy.

She continued, “I have a small farm so Jondolar is out many hours per day.” “Extremely important! To strengthen his feet, he is on Farrier’s Formula [a feed additive]

Johnson attributes much of their success to Johnson’s trainer, who placed her horse first and kept jumping to a minimum. We were very particular about the surfaces we used for jumping. She asked, “Is the footing too firm, too muddy, or too slippery?” She also mentioned that “There were times when Jondolar lived at home during winter. I would have his shoes pulled if he wasn’t being ridden… I believe the time to rest is a good thing.”

Jondolar was unable to move up with Johnson into the 3-foot division. She reflected that her horse was still a good teacher and knew his job. She explained that she began to search for lease options for her horse. “I’m very picky, this horse owes nothing to me. He will only be allowed to go to a professional facility if I can trust him and the trainer not to over-jump him.

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