Diagnosis and treatment of the navicular syndrome in horses.
Authors: Turner
Journal: The Veterinary clinics of North America. Equine practice
Summary
# Editorial Summary: Navicular Syndrome Diagnosis and Treatment Turner's 1989 review characterises navicular syndrome as a multifactorial condition requiring tailored management rather than a one-size-fits-all approach, acknowledging that its varied aetiologies demand equally diverse treatment strategies. Despite the array of therapeutic options available, prognostic expectations remain modest, with approximately 50% of affected horses achieving useful soundness for at least one year regardless of intervention—a finding that should temper expectations when counselling owners. The author advocates a hierarchical treatment protocol prioritising corrective and physiologically sound farriery as the foundation, reserving systemic medications and intra-articular therapies for specific indications: nonsteroidal anti-inflammatories only after significant shoeing modifications, intra-articular sodium hyaluronate or polysulfated glycosaminoglycans when distal interphalangeal joint synovitis is confirmed, and isoxsuprine for documented circulatory compromise. For cases unresponsive to conservative management within 6–12 weeks, palmar digital neurectomy represents the final option before retirement. Since navicular syndrome remains progressive and ultimately necessitates retirement, this staged approach allows practitioners to optimise welfare and functional longevity, though the realistic ceiling of one year's improvement underscores the importance of early, meticulous farriery and honest prognostic discussions with stakeholders.
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Practical Takeaways
- •Shoeing should be the foundation of navicular treatment, correcting structural problems and ensuring physiological soundness before adding medications
- •Expect about 50% of cases to achieve useful soundness for 1 year; counsel owners on the progressive nature of the disease and eventual retirement likelihood
- •Reserve NSAIDs for cases where significant shoeing changes have been made; consider joint medications or vasodilators only if shoeing alone is insufficient after 6 weeks, with neurectomy as final option after 6-12 weeks
Key Findings
- •Approximately 50% of horses with navicular syndrome become useably sound for 1 year regardless of treatment modality
- •Navicular syndrome is progressive and eventually requires retirement due to lameness
- •Corrective shoeing combined with medication (hyaluronate, polysulfated glycosaminoglycans, or isoxsuprine) forms the primary treatment approach
- •Palmar digital neurectomy is recommended when conservative therapy fails after 6-12 weeks