This will be the last post on the front leg, and so I’ve decided to cover the most common pathologies that we uncounter with our horses: navicular syndrome and tendonitis/tendon injury! I would love to say enjoy, but when it comes to pathology I feel like it’s a bit optimistic, so I’ll just say “carry on” 😉
The navicular syndrome:
Also called navicular disease, I personally much prefer the term syndrome because it discribes the whole thing much better: it’s a “set of medical signs and symptoms that are correlated with each other and, often, with a particular disease or disorder”. So in our case, it means that it’s a type of lameness that relates to changes in the shape of the navicular bone, but actually the issue can be bone, tendon, or ligament of the area!
The lameness is usually diagnosed by X-rays that show a navicular bone with bonie modifications in its shape. This causes pain, the horse then refuses to put weight and load the leg properly, and can result in early retirement in some cases.
Now, that’s the usual way of looking at it, but today I’m going to talk about the perspective of a physical practitioner 🙂
The 4 important things to know about navicular syndrome
The first thing I want you guys to understand is that bone modification doesn’t occur overnight. You don’t wake up one day with a horse that is “navicular”, although it may feel like it, just like you don’t wake up with a horse that has kissing spine. The process of bone modification occurs through inflammation and takes time, so if your horse is diagnosed as navicular, the process has most likely been going on for a while now. I know, it’s depressing. But the good thing about it is that it means you have time, if taken early on, to stop the process!
The second thing, is that the reason why your horse is navicular can come from all over the body. Most people now agree that the changes we see in the navicular bone are due to a change in the loading and weight bearing of the horse. These changes will affect the ligaments and tendons of the lower leg, create inflammation which stimulate bone changes and with enought time, you get a weird looking navicular. And there’s so many reasons for that change in weight bearing: hind leg issue, sacro iliaque pain, foot unbalance, neck dysfunction, issue in the other front leg… Most of which can get addressed by your physical practitioner or vet! Which means, once again, that you can prevent the issue from happening!
The third point is, like I said at the begining, that the reason for the pain, and so for the lameness, might not be the bone. It can be the ligaments, the tendons or even the synovial bags of the area. The issue is that, as all of this happens in the hoof, it’s quite hard to know which one is which. But in certain cases, your physical practitioner will be able to identify the structure causing the pain by specific joint testing and mobilisation. It’s not 100% accurate but it does give an idea. This, for me, is imporant as it can give you an idea of recovery time, and of the type of technics that will help recovery!
Finally, know that an “ugly” X-ray of a navicular doesn’t necessarily mean that there is pain or issue. You’d be surprised what you can get on an X-ray of a horse that is absolutely sound and loving life!
So how to prevent your horse from developping navicular syndrome?
Just by good management. I know, it’s a frustrating answer, but bare with me 🙂 As the changes in the tissues of the area take time to occur and are usualy due to a dysfunctional way of using the leg and loading, you can actually avoid the developpement of inflammation by making sure your horse doesn’t overload the front legs, and you do this by having your animal checked on a regular basis by your practitioner.
You also need to pay attention to the way your horse is shoed, so that your horse walks and spread the weight evenly on his feet, from heel to toe.
The way the saddle fits your horse will have a big impact too, as it can create dysfunction and asymetry in the shoulders and gait of your horse, which means unbalanced loading as a consequence.
Finally you’ll need to bring your attention to how your horse goes during training. A horse that conter bends, always lands on the same front leg or struggle to use on of the hind leg, will compensate in its shoulders. And I’m sure you know by now that shoulders have an impact on the whole body, including front legs 😉
What if your horse already suffers from navicular?
Even if you’ve gone past the point of inflammation and bone modification, there’s still things to do.
First and foremost, you need to get your farrier involved as well as your vet. The first one will have to see which type of shoeing will be the best to support the foot and reduce inflammation (in quite a few cases people actually find barefoot to be a good solution!), the second one will most likely offer medication such as bute to bring the inflammation and pain down.
Both of those things are necessary but both should be temporary.
In a lot of cases, your practitioner will be able to help aleviate the symptoms long term by indentifying the primary cause of the change in weight bearing, working on the actual inflammed tissue with mobilisations, and prevent further issues by releaving the tension caused by the pain coming from the foot. I’m thinking here of the opposite limb in particular, but also the rib cage and spine. This, for me, is obviously the best long term solution possible!
Sometimes it doesn’t go as we’d hoped
From personal experience, I’ve seen both amazing recoveries and no improvements. In the cases where no improvement were seen, I believe it’s a mixture of horse too far gone, and lack of communication with different professionals. But sometimes we have to admit that the damage is done and that, unfortunately, the horse will just be an expensive pet, a field companion or, in certain cases, a brood mare!
I also think that there might be things that can make a horse more likely to develop navicular syndrome. Anything happening as a foal, from the quality of the milk given by the mare (and so the quality of the food she is given) will have an influence on the type of bone the navicular becomes, as well as the strength of the growing tissues. It’s a personal theory, but I think it’s worth thinking about it.
Tendonitis and tendon injury
I think people are as scared of tendon injury as they are navicular, although tendon injury usually is easier to identify as we can actually see and feel the structures. Which, you know, helps.
Just like navicular syndrome, I don’t believe that tendon injuries happen out of nowhere, although the probability of a healthy horse injuring a tendon by going nuts in the field is more likely.
Things to know about tendonitis and tendon injuries
First off, most of the time you will have a form of tendon inflammation before you have an injury. You might not be able to see it, and your horse might seem fine, but like I said, tendon injury rarely happens out of the blue. Most of the time you have a weakness in the structure beforehand, but because horses are so good at carrying on, they keep on working until something breaks. I’ve actually had a case where I told the owner that the horse was likely to have tendon injury if he wasn’t taken care of. And within the year it happened. Your practitioner will be able, in a lot of cases, to tell you the state of the tendons before something happens, but of course it doesn’t work everytime.
Second point is that tendon injury and tendonitis are always ALWAYS secondary. A lot of the time the issue started on the other front leg, or on a hind. And just like navicular, it means you can do your best to avoid it from happening!
Third point is that, as you know if you’ve read the article on the muscles of the foreleg, there’s 3 structures in the area: deep flexor tendon, superficial flexor tendon and suspensory ligament. Your practitioner will have to try to identify which one is the affected one. Remember that suspensory ligament starts behind the “knee” but that the flexors start at the elbow. This means that treatment and compensations might be different depending on which structure is concerned.
How to prevent tendon injury
Just like for the navicular, you’ll have to make sure your management is on point, so I won’t repeat everything I’ve already said, you can go back and read through what I said for the navicular syndrome as it will be the same points. For tendon injury, the use of the horse and its conformation usually has a big impact as well.
What if your horse already has a tendon injury
Once again, your vet and farrier will need to get involved with advice on shoeing (or shoe removal in certain cases) and on pain relief. But again, it’s your manual practitioner that is going to be able to help the most in a lot of cases.
See, when you have tendon injury, the tissue will heal, but by creating random and unorganized fibres far from the original tendon. Your practitioner will be able to help give direction to the fibres as well as stimulate the tissues to heal. If this isn’t done, the chances of having a weakness around the place of injury is far greater.
Just like for the navicular, your practitioner will help the body cope with the compensation from the pain and make sure the rest of the body doesn’t develop tension, as well as identify the primary issue that caused the horse to overload one leg, making it weaker. This might take time but is really worth it!
I have to say that most cases of tendon injury and tendonitis go down quite well when practitioners are involved. The only times it doesn’t is when the owner doesn’t follow rehabilitation programs and session plans. In those cases, the horse usually develops tension in the other leg and in the back, making new problems over time.
What I want you guys to take away from this article is that both of those pathologies can be avoided, and that both can be helped by your practitioner if you have a horse that already suffers from one or the other (or both). Sometimes things happen and we don’t understand why, sometimes we try our hardest and still get an injury or a pathology. But you can still help your horse and that’s the main thing!
As always, you can message me if you have any questions, I’m always happy to discuss a case!