Effects of radial extracorporeal shock wave therapy on radiographic and scintigraphic outcomes in horses with palmar heel pain.

Authors: Byron, Stewart, Benson, Tennent-Brown, Foreman

Journal: Veterinary and comparative orthopaedics and traumatology : V.C.O.T

DOI: 10.3415/vcot-08-04-0037 PubMed: 19290391Log in to save

Summary

Radial extracorporeal shock wave therapy (RESWT) is increasingly used to manage heel pain in horses, yet its mechanisms of action remain poorly understood. Byron and colleagues treated eight lame horses with three RESWT sessions, using nuclear scintigraphy and radiography before and after treatment to assess whether the therapy stimulated healing responses in the navicular region. Neither scintigraphic uptake ratios nor radiographic scores of navicular bone changes showed meaningful improvement following treatment; moreover, treated limbs continued to demonstrate elevated metabolic activity compared to sound control horses, suggesting the underlying pathology persisted. These findings suggest that any short-term clinical improvement observed after RESWT likely results from analgesic rather than tissue-regenerative effects, which has important implications for treatment protocols and owner expectations. Farriers and veterinarians should consider RESWT as a potentially useful tool for pain management in heel pain cases, but should counsel clients that the therapy does not appear to reverse structural or metabolic abnormalities in the navicular apparatus, and that comprehensive farriery and management strategies remain essential for long-term outcomes.

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Practical Takeaways

•RESWT did not produce measurable improvements in bone metabolism or radiographic changes in horses with palmar heel pain in this study
•If RESWT provides clinical benefit in palmar heel pain, it may work through analgesic mechanisms rather than tissue healing stimulation
•Radiographic and scintigraphic imaging are unlikely to show objective improvement even if horses experience symptomatic relief after RESWT treatment

Key Findings

•No significant difference in scintigraphic navicular pool phase or delayed phase ROI density ratios before and after RESWT treatment in treated limbs
•No difference in scintigraphic outcomes between treated and untreated limbs
•Delayed phase ROI density was increased in central navicular region in treated limbs compared to non-lame comparison horses at both timepoints
•Radiographic scores for navicular bone appearance and synovial fossae remained unchanged after RESWT treatment

Conditions Studied

palmar heel painnavicular syndrome

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