In order to truly understand this disease, which has been known for 2000 years, it is first important to understand the structure of the hoof roll. Riders often say, "My horse is lame, it has hoof roll." Strictly speaking, however, every horse has a hoof roll; this term refers only to the anatomical structure consisting of the navicular bone, bursa, and deep flexor tendon. The navicular bone is a small, elongated bone shaped like a shuttle, which lies transversely at the back of the hoof joint under the deep flexor tendon. Between the tendon and the navicular bone is the navicular bursa, a small fluid-filled sac that prevents pressure and friction between the tendon and the bone. Only the term navicular disease or podotrochlose describes the actual condition, which can affect all three components.
The disease develops very gradually, which is why the first symptoms are often overlooked or not recognized. Owners often do not notice acute lameness, but rather a flat, shorter, or duller gait in their horse. This is because in most cases both front hooves are affected. Some horses show clear signs of pain when turning, while others are so mildly lame that the movement disorder can only be detected on hard ground. When riding, clear symptoms may even improve initially after the warm-up phase. When the horse is standing, alternating relief can be observed by bringing the front hooves forward. This incorrect weight distribution can lead to visible changes in the shape of the hoof, which may include, for example, a clear heel drop and a bulging sole.
Although this condition has been known since the domestication of horses, not all factors leading to its development have been fully elucidated. Since hoof roll inflammation does not occur in wild horses, it is considered certain that the special strain placed on riding horses, and especially sport horses, causes wear and tear and inflammation of the bursa, which leads to tendons and bones no longer being adequately protected. Conversely, changes to the navicular bone can also lead to inflammation of the bursa.
Errors or abnormalities in the hoof shape, toe and limb position, and toe axis are also responsible for the disease. Posture, feeding, and rearing errors can also influence the development of podotrochlose, as even young horses that have never been ridden or shod can develop the disease. A predisposition is assumed, but heredity has not yet been confirmed. Nerve compression in the area of the seventh cervical vertebra, which can lead to reduced blood flow to the front limbs and thus damage to the hoof roll, is also being discussed.
There are various theories about the exact cause of podotrochlose. Some researchers believe that it is caused by blockage of blood vessels in the toe, leading to the death of bone cells (necrosis). This necrosis is visible on X-rays in the form of balloon-like changes, known as "lollipop lesions."
On the other hand, it is suspected that the increased pressure of the deep flexor tendon on the tendon gliding surface of the navicular bone causes increased remodeling processes in the bone, leading to the lesions described above. There is still no uniform scientific confirmation for either theory.
A comprehensive lameness examination by an experienced equine practitioner is essential for a reliable diagnosis. If you notice any prolonged movement disorders or the changes described above in your horse's hooves, consult your veterinarian.
The veterinarian will examine your horse while it is standing, moving, and possibly also under saddle, and will perform appropriate tests such as a flexion test. Various aids are available for further examination. With the help of so-called "conduction anesthesia," the affected area on the horse's leg can be localized. This involves injecting a local anesthetic into the nerves running along the leg and then assessing whether the lameness has improved or even disappeared when the horse is trotted. The affected area can also be narrowed down by anesthetizing the hoof joint, the bursa, or by measuring the pressure in the hoof joint and the hoof roll bursa. The localized area of pain can then be examined more closely using special X-rays. In the case of hoof roll inflammation, it is often observed after conduction anesthesia that the lameness "jumps," meaning that the horse lameness shifts to the less affected side after the more severely affected leg has been anesthetized. X-rays reveal changes in the bone substance of the navicular bone or other causal bone changes.
Further, but far more complex diagnostic methods include computed tomography and scintigraphy. Both methods can be useful if a clear diagnosis cannot be made in advance.
Once the diagnosis has been confirmed, your vet will work with you to develop an appropriate treatment plan. As the disease itself is incurable, treatment should always aim to halt or at least delay the destructive processes in the bone and relieve the pain. The veterinarian must work closely with the farrier, as medication can only achieve the desired results with appropriate orthopedic shoeing. The shoes must be designed to make it easier for the horse to roll and relieve pressure on the deep flexor tendon. Depending on the severity and cause of the disease, the veterinarian may also inject special medications directly into the hoof joint or bursa. Joint or bursa lavage may also be useful in some cases. For safety reasons, however, this should be done in a clinic whenever possible.
In addition, various surgical methods have been developed, the benefits of which are not always undisputed. Some measures only relieve pain, while others improve blood circulation by dilating the blood vessels. Which method is appropriate in which case always depends on the degree and severity of the disease and should therefore only be used by a veterinarian after careful consideration.
An accompanying, targeted exercise program is at least as important as the therapy itself. Avoiding tight turns and good footwork are particularly important here. Talk to your veterinarian about which medications to use for your horse and what the individual exercise plan should look like.
The wide range of treatment options and surgical techniques available highlights the complexity of navicular disease and the fact that there is no single treatment that works for all horses. For this reason, it is essential that a veterinarian conducts a thorough examination and diagnosis before any treatment is initiated.
If significant bone changes have already been detected in the navicular bone, complete healing is no longer possible. The goal of treatment by a veterinarian in close cooperation with a farrier should therefore always be to restore the function of the hoof roll as much as possible. With the help of state-of-the-art diagnostic and treatment methods, this is already possible in many cases of podotrochlose.
Due to the fact that the causes have not yet been fully researched, the disease cannot be completely prevented. However, many factors that contribute to its development can be positively influenced.
The following points are particularly important:
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