Navicular syndrome remains one of the most discussed and sometimes misunderstood conditions in equine medicine. Modern understanding has evolved significantly, and management options have improved considerably.
What Is Navicular Syndrome?
Navicular syndrome is a broad term describing pain arising from the navicular bone and associated structures in the back of the foot. This includes the navicular bone itself, the navicular bursa, the deep digital flexor tendon where it passes over the navicular bone, and the supporting ligaments.
More accurately, the condition should be thought of as “palmar foot pain” since multiple structures may be involved.
Causes and Risk Factors
- Repetitive concussive forces
- Conformation factors (long toe, low heel)
- Work on hard surfaces
- Breed predisposition
- Inadequate hoof balance
Diagnosis
Accurate diagnosis requires systematic evaluation:
- Lameness examination — characterizing the gait abnormality
- Hoof tester evaluation — checking for focal sensitivity
- Diagnostic anesthesia — palmar digital nerve blocks to confirm the pain is in the foot
- Radiography — evaluating bone changes in the navicular bone
- MRI — the gold standard for evaluating all structures in the foot, including soft tissue
MRI has significantly improved our ability to specifically identify which structures are affected, leading to more targeted treatment.
Management Options
Farriery
Corrective shoeing is the foundation of navicular management. Proper hoof balance, heel support, and breakover modification can significantly reduce stress on the navicular apparatus.
Medical Management
- Anti-inflammatory medications
- Joint and bursa injections
- Bisphosphonate therapy (Osphos, Tildren) for bone remodeling
- Shockwave therapy
Regenerative Therapies
PRP and stem cell therapy are being used in some cases, particularly when specific soft tissue pathology is identified on MRI.
Surgical Options
Navicular bursoscopy and neurectomy may be considered in select cases that don’t respond adequately to conservative management.
Prognosis
Prognosis varies significantly depending on which structures are involved and the severity of changes. Many horses with navicular syndrome can be managed successfully and continue in athletic careers with appropriate treatment and farriery. Early detection and intervention improve long-term outcomes.