Navicular, a.k.a ‘Caudal Heel Pain Syndrome’

What a Little Good Trimming Can Do

The horse in question, an 18 yo Appaloosa was retired from showing because of the non-specific diagnosis of caudal heel pain syndrome.  Xrays confirmed the presence of ‘changes’ that were attributed to his discomfort.  He was shod according to proper conventional veterinary standards for navicular, which did help to make him comfortable, but he still seemed stiff, definitely not agile, and, at the bottom of the pecking order would allow himself to be cornered and bullied rather than try and run away.

Right Front Leg Lateral View

                   

a.  With shoes                          b.  Shoes Just Removed            c.  First Trim

In examining his feet, there was nothing obvious or terrible about them that would be making him sore but the owner decided, with much trepidation, to give barefoot a try. As it turned out there was quite a bit of fine tuning to do on his feet and with each trim his gait and comfort level improved. In particular his toes were able to be shortened much more than they could be in wedge shoes even though short toes is the standard shoeing protocol for ‘easing breakover’.

 

In the shoes with wedge pads, the toe length looks acceptable, but without it, the excess length is more apparent.  While a wedge does improve breakover, it comes at the cost of shifting the weight of the foot and leg pathologically onto the toe.  With one trim, the toe length is improved and the bulge in the hairline is relaxed and straighter.

                               

d.  Growing out holes           e.  4 mos. later                     f.  7 mos. later 

As the trim progresses, the hairline bulge continues to improve, the toe continues to come back, the heel stands up a little, and the foot comes ‘under the leg’ in balance.  In the last photo, the hairline angle approaches the ideal as toe height improves, and the toe length is nice and short. The horse is standing comfortably with the cannon bone nicely vertical, with all his weight visibly placed onto that leg and into the heels.

Note the difference between figs. c and f.  In the later photo, the heel has been brought back more underneath the boney column, providing a better base of support which is helpful in a navicular diagnosis (as in all cases since the balance is better).  The toe is shorter in lenght but has more depth from coronary band to ground, which improves comfort.  In general the whole shape of the foot is much improved, without having made any drastic changes.

Excess horn can look like caudal heel pain

 

 FIRST TRIM – The sole shows the evidence of why the foot was sore and what can masquerade as unspecific foot or heel pain, but is simply unrecognized excess horn. This view shows the foot in mid-trim with the left side already done and the ridght side just started. The heels have been brought back to the widest part of the frog and lowered to be level with the frog. This alone will help the frog to get healthier as it becomes weightbearing.   The right side of the foot is completely ‘flat’ – straight across, not reflecting the underlying shape of the coffin bone which is vaulted.  This has been corrected on the left side, including shortening the collateral groove (purple arrows).  The red arrows indicate either excess bar or sole which is causing pain on weightbearing.

a.  2nd trim                                      b. 7 mos. later        

     

                 

The early trim shows spots of small abscesses, from where the excess sole was impginging on the sole corium. The toe shows a good deal of separation still leftover from being shod.  Within 7 months, the hoof has become rounder (or the toe is shorter), the frog is healthier in appearance with the heels level with it, and the separation at the toe is almost completely gone.  The bar is now straight, not curving, and the depth of the bars was experimented with over the course of the past trims in order to find what was most comfortable for this horse. He shows immediate improvement in his comfort level with shorter bars.