Navicular ‘changes’, as seen on radiographs, are nearly meaningless in diagnosing ‘caudal heel pain syndrome’; in fact I wonder why they bother taking them. If the horse is lame you don’t need an xray to tell you so, nor do any of the treatments address the lesions or cysts that are considered to be the cause of the problem.
Orthopedic or corrective shoeing works in the short term by restricting the blood supply to the navicular bone by increasing the angle of the hoof/pastern axis, which compresses the artery that enters the foot in that region. It is counterproductive to prescribe shoeing that continues the conditions that caused the problem to begin with. In particular doing so on a young horse will predispose it to this condition for the rest of its life and will shorten its productive lifespan.
Shoes on a horse who has not fully developed his skeleton can be very detrimental in that they restrict the coffin bone from reaching its full developmental characteristics. It restricts the amount of space available for the structures located in the flexible rear part of the hoof and prevents proper development of the palmar processes which by means of the lateral cartilages attach the coffin bone to the short pastern bone.
A more productive course of action would be to address the problem by means of a physiologically correct trim, removing excess, hard horn that is causing pain and inflammation and leading to ‘caudal heel syndrome’.
Barefoot Hoofcare 
December 22, 2006 at 5:32 am
my horse has been diagnosed with suspected caudal heel syndrome, x-rays where normal and he said his feet angle was good, so what do you think this means?
December 23, 2006 at 5:39 am
Hello Vanessa, and thank you for the question.
I think your case illustrates the dubious relationship between caudal heel syndrome, navicular syndrome, etc., and the condition of the bones, since your horse is exhibiting pain but nothing is evident on x-rays. Rather, it tends to be the result of the hoof form, which is created by how the foot has been trimmed over the long term, and to some degree the application of shoes. I believe the popularity of xrays as diagnostic tools is a result of their availability, not because of any known correlation between bone problems and caudal heel pain. Vets can only diagnose something using the tools available to them, and since xrays are one of their primary diagnostic tools, they go looking for problems there.
Are your horse’s feet contracted? This is one of the leading causes of caudal heel syndrome because the contraction of the foot reduces the space available inside the foot for its structures to exist and function comfortably. If the heel bulbs are ‘pinched-together’ looking, chances are the feet are contracted. Other parts of the foot that can be contracted are the bars or sole, which pushes the hard hoof horn up into the foot where there is no room for it. The delicate blood vessels inside are crushed and compressed, which results in inflammation and pain and why anti-inflammatories help in alleviating the pain. If the pain resulted from holes in the bone, anti-inflammatories would not have any effect.
Excess overgrowth of horn resulting from insufficient trimming can have the same effect on the delicate inner structures of the foot without contraction. A well-qualified trimmer can properly evaluate the effectiveness of your horse’s trim.
Improper angles can be responsible for caudal heel pain; this hoof form also tends to be accompanied by long toes and underrun heels which causes or aggravates caudal heel pain. Underrun heels are located too far underneath the foot, causing pressure and inflammation. When your vet says the angles are ‘good’, you should ask what he means by this. Perhaps there is room for improvement there.
To sum up, all these issues of incorrect hoof form can be rectified by good trimming. If contraction is present, it will take some time to reverse its effects. Get names and references of competent farriers or trimmers whose work you evaluate for balanced trimming after you have educated yourself as to what a balanced trim consists of, then seek consultations from them.
Feel free to submit good pictures of your horse’s feet to me for evaluation, comments and have the recommendations posted here. The pertinent views would include soles, heels, laterals, and fronts.
January 10, 2007 at 9:33 pm
I thank you kindly for your article… I have recently recieved a horse with extreme heel pain and have been going back and forth about navicular… Truth is truth… If I solve the problem with the correct trim navicular aside… the horse should improve. I didn’t realize that the heel pain could be simply that…heel pain from an improper trim…It has been 3 trims over the course of 2 months time and the horse is improving however it isn’t as fast as I would like…I guess that means I just have to get more patient and better at the trim. Again thanks…I found inspiration and renewed hope from this article.
Jan
January 12, 2007 at 12:40 am
Hi Jan,
I am pleased to hear that you have found help here. That is a good frequency of trimming for a horse that is afflicted with inflammation resulting from poor hoof form. Inflammation results from the pressure of overgrown horn (e.g. the bars) on the sensitive tissues between the sole and the bottom of the coffin bone. It takes time for such bruising to heal and the resulting inflammation to disperse. Frequent movement by the horse (such as that afforded by full time turnout), can speed along the process. Frequent trimming will also help prevent it from recurring.
If you care to, feel free to submit some pictures of your horses feet to get an opinion of whether there is more going on there that needs addressing.
Good luck,
Christina
February 14, 2007 at 10:27 pm
Help! We are inerested in purchasing an 11 year old appendix qh. He is ridden english and has been doing dressage and jumping up to 3′. His x rays show “signs of change in the navicular” according to the x rays. He shows no signs of lameness.
The owner keeps him in front and back shoes with clips. The vet said, “On a scale of 1-10 with 10 being the worst, he is a 6 regarding the x rays.” Our trainer says to buy him and we can deal with the hooves with corrective shoes when needed, or take the shoes off immediately, let him go lame and toughen his hooves and he will “correct” the navicular. What thoughts do you have?
February 15, 2007 at 12:55 am
Hello Cari,and thanks for your question. There is a lot to address in what you bring up.
As you can see, I don’t think navicular ‘changes’ on xrays can tell you much about whether your horse will stay sound or will become lame. It does, however, indicate that his anlges are probably too steep. Steep angles compress the digital artery, the pressure of which then leads to causing the lesions, or ‘changes’.
The horse’s ‘hoof form’ is a better indicator of whether he will stay sound or not. Good hoof form includes a low heel with a near 30-degree hairline angle, and wide uncontracted heels. When the heel is pushed together and contracted, it compresses the tissues inside the foot and causes inflammation and pain. Many appendixes and quarter horses are prone to contracted hoof form because of the hardness of their hooves and their upbringing in stalls or on soft ground.
I absolutely do not agree that ‘corrective’ shoes will do anything to help him. Because they are more restrictive, they will only serve to contract his feet even more. He does not have to go lame or tough anything out if his shoes are removed, however this approach can ‘correct’ the incipient navicular by allowing his heels to spread. Then, his heels should be lowered to a near 30-degree hairline if they are high. This will enable a correct hoof-pastern axis alignment.
Horse with contracted feet often start showing signs of pain at about 12 years old. Corrective shoeing seems to help for about 3 more years. I am curious why he is shod with clips, as that happens to be a restrictive type of shoeing, (restricts spreading of the hoof) the first step prior to actual ‘corrective’ shoes.
August 6, 2008 at 5:20 pm
I have a horse with the typical high/low heel syndrome. I took shoes off my horse. He was ouchy at first. After several weeks I had the farrier out to trim some heel off the high heel, and some toe off the low heel hoof. My horse walked away very gimpy after that.
I took the horse to the vet. The vet said he had sole bruising and x-rays showed lesions in the low heel hoof, and start of changes in the high heel hoof. He gave me some stuff to toughen the soles.
My horse is out 24/7. This whole episode has been going on for about two months, one month since seeing the vet. My horse is a little better, but still lame especially at the jog.
What do you think?
Thanks, Karen
August 6, 2008 at 6:39 pm
Hi Karen,
Did your horse have any obvious problems before you took the shoes off? What prompted you to take his shoes off? It sounds to me like you need some better help.
First off the farrier – did you instruct him how to trim or was it his decision? When a horse has one high heeled hoof, typically the reason for it is that he doesn’t want to weight the heel because it is painful to do so. The reason it would be painful is because there is usually excessive bar and sole in the area and since this type of foot is usually contracted (compared to the flat one), the excess horn presses up into the hoof capsule making him reluctant to put weight on the back of the hoof. So no pressure there means the heel grows prolifically.
If you trim down the heel without addressing the sole and bar, it is even more painful – as your horse clearly demonstrated. He is now being asked to step directly on bar, pressing up into the soft tissue inside the foot.
There is no way the vet could diagnose sole bruising at this point. Bruising occurs at the level of the blood vessels (inside the foot) and is not visible to the naked eye until it grows out approximately 3 months later. You will likely see bruising at that point, but it will be from the bar that wasn’t trimmeed away.
The diagnosis of changes is neither here nor there. 50% will have changes with no lameness, and vice versa. Changes do not indicate presence of navicular disease. And making the sole harder will make it even less likely that the horn will wear away naturally from him being out 24/7. With your farrier not trimming correctly, that’s your only hope of your horse’s feet getting trimmed right, so ditch the sole hardener.
I hope this helps and you can find someone more helpful for your horse. If you like send me pictures and I’ll tell you whether there is excess horn needing to be trimmed.
February 8, 2009 at 3:57 am
I have just gotten a 7 year old horse who was diagnosed with a “slight change in one navicular”. He was originally going to be purchased by another rider, but after the vet failed him on the pre-purchase (he also has some arthritis in hocks, narrowing of the middle joint on one hock, and an old, but healed fracture on a sesamoid) When the purchase fell through, this horse was given to me by the former owner, otherwise he would have been put down.
He is currently sound, and was still jumping 3’6″ up until the x-rays showed all that wear and tear.
His flexor tests were mostly good, but he was a little still in the hocks.
I know it’s hard to comment without seeing him, but based on what I have written, does this sound like a true “navicular” issue like I have been told? The x-rays made it look like the horse should have difficulty, but he seems just fine. My farrier will be seeing him on the 17th of this month, but in the meantime, I am trying to learn as much as possible about this.
February 12, 2009 at 4:02 pm
Hi Cameron,
You’re right that it’s hard to tell without seeing the horse or the xrays. However, I would say that it sounds like the ‘navicular change’, whatever it may actually be, is low on the list of what would be problematic for him. The hock arthritis and fractured sesamoid, are in fact things that you can see on xrays and use as a diagnosis and expectation of future performance. (Having said that there are horses with terrible hock xrays that continue to be sound). No, I don’t think this navicular change should be problematic unless it continues to get worse. Thanks for writing and good luck with the horse.