Navicular Disease: What the Research Says
Evidence from 66 peer-reviewed studies
2 Systematic Review
5 RCT
15 Cohort Study
17 Case Report
25 Expert Opinion
2 Thesis
What Professionals Should Know
- •ECSWT remains an experimental treatment with insufficient evidence for routine clinical use in equine or companion animal practice
- •If considering ECSWT, reserve use for short-term analgesia, ligament injury, or osteoarthritis cases where conventional options have failed, while acknowledging limited scientific support
- •Request high-quality outcome data from ECSWT providers and maintain realistic client expectations regarding evidence base for this therapy
- •Genetic screening and marker-assisted selection can help reduce prevalence of radiological navicular changes in breeding populations
- •Performance and navicular health are not genetically opposed—horses can be selected for both sound limbs and competitive ability simultaneously
- •Early radiographic screening of young horses combined with genomic testing offers practical tools to identify at-risk individuals before clinical lameness develops
- •If using bisphosphonates off-label in young performance horses, current evidence suggests they do not adversely affect normal bone structure or remodeling over a 60-day period
- •Bisphosphonates do not appear to accelerate bone healing in acute bone injuries, so should not be relied upon as a primary fracture treatment strategy
- •The lack of structural changes with bisphosphonate use suggests their clinical benefit in navicular disease likely operates through pain modulation rather than bone remodeling
- •Firocoxib at 0.1 mg/kg once daily is the effective dose for treating chronic osteoarthritis-related lameness in horses, with measurable improvements within 2-6 days of treatment
- •Force plate measurements provide objective evidence of lameness improvement that may not be apparent on clinical grading alone, useful for evaluating treatment response
- •Higher doses (0.25 mg/kg) offer no additional benefit over the 0.1 mg/kg dose, suggesting dose optimization can reduce costs without sacrificing efficacy
- •Tiludronate at 1 mg/kg bwt is an evidence-based pharmacological option for navicular disease management, particularly effective when initiated early in disease progression
- •Earlier intervention with bisphosphonates may yield better outcomes; chronic cases show diminished response suggesting bone remodeling changes may become less reversible with time
- •The 10-day IV protocol requires veterinary administration and 6-month monitoring, making it a commitment-level treatment suitable for valuable horses or those with good prognosis
- •Isoxsuprine hydrochloride is an effective medical treatment for navicular disease with clinically significant benefits—consider as part of multimodal management strategy
- •Lowest effective dose (0.6 mg/kg) appears sufficient; higher doses do not provide additional benefit, reducing treatment costs
- •Radiographic appearance of navicular changes does not predict clinical outcome or response to medical therapy; clinical assessment is the more reliable prognostic indicator
- •Orgotein administered by juxtabursal injection shows modest but statistically significant efficacy for navicular disease (43% response rate), though a majority of treated horses still did not respond
- •This early evidence suggests orgotein may have a role in navicular management, but should not be relied upon as a primary or sole treatment given the high non-response rate
- •Double-blind design confirms genuine therapeutic effect beyond placebo, warranting further investigation into patient selection factors that predict responders
- •Calcium dobesilate is absorbed orally in horses and reaches therapeutic plasma levels, making it a viable option for treating navicular disease and bone-related lameness conditions.
- •Oral administration in mash appears to be an effective and practical delivery method with no reported adverse effects, though longer-term safety and efficacy data are still needed.
- •This pharmacokinetic data supports further clinical trials to evaluate whether calcium dobesilate's microvascular and intraosseous pressure-reducing properties translate to improved healing outcomes in lameness cases.
- •Distal border fragments on MRI are part of navicular disease pathology and associate with other bone abnormalities, but their individual role in causing lameness cannot yet be determined from imaging alone
- •MRI grading of total navicular changes may be more diagnostically useful than fragment presence in isolation when evaluating chronic foot lameness
- •Further research is needed to establish whether managing distal border fragments specifically will improve clinical outcomes
- •DDFT pathology is commonly present alongside navicular bone lesions in lame horses; diagnostic imaging should assess both structures systematically
- •Dorsal DDFT changes appear more significant than palmar changes in chronic palmar foot pain, which may inform therapeutic targeting
- •Early intervention addressing vascular and matrix integrity of the DDFT may potentially prevent or slow progression of navicular disease pathology
- •Palmar foot pain involves multiple structures beyond the navicular bone alone—assess DSIL, navicular bursa, and DDFT as part of a functional unit in lame horses
- •Not all navicular bone changes correlate with lameness; focal medullary lesions dorsal to FFC lesions appear most clinically relevant
- •Adaptive changes occur in navicular apparatuses of all horses; identifying which lesions cause pain and dysfunction should guide targeted treatment rather than treating all structural changes identically
- •When assessing hoof conformation, prioritize measuring the distal phalanx angle and heel-to-toe height ratio rather than relying on visual heel-toe parallelism, as these correlate directly with forces on the navicular bone
- •Farriers should aim to maintain adequate heel height relative to toe length, as this reduces compressive forces on the navicular bone and may help prevent or manage navicular disease
- •Heel collapse defined by heel-toe angle parallelism alone is insufficient for predicting navicular disease risk; a more detailed biomechanical assessment is warranted in cases of concern
- •Radiographic findings must be interpreted alongside clinical lameness examination—radiographic changes alone, particularly in the tarsus, do not reliably predict future soundness or performance
- •Horses with significant tarsal osteoarthritis can still compete at their expected level, so purchasers should not reflexively reject horses based on tarsal radiographs alone
- •Prepurchase examinations significantly influence sale outcomes; ensure radiographic interpretation is contextual to the individual horse's clinical presentation and intended use
- •Navicular disease involves biochemical breakdown of multiple tissue types (cartilage and tendon), not just cartilage damage, which may require multi-modal treatment approaches
- •Elevated metalloproteinase activity (MMP-2 and MMP-9) indicates active matrix degradation in affected horses, potentially supporting the use of anti-inflammatory or anti-protease strategies in management
- •The disease process extends beyond the navicular bone to involve adjacent joint structures, suggesting early intervention and comprehensive joint management may help slow progression
- •Quantitative scintigraphic assessment combined with local analgesia blocks can help pinpoint the source of foot pain in lame horses, but should not be interpreted in isolation—correlation with clinical response is essential
- •Be cautious interpreting DDFT insertion region findings as these frequently produce false positives, particularly in horses with low heel conformation; lateral pool phase imaging is more reliable for DDFT pathology
- •Normal navicular bone uptake should show <10% variance compared to peripheral distal phalanx regions; significant increases suggest navicular pain even without radiological changes
- •Synovial fluid biomarkers, particularly elevated MMPs and reduced GAG levels, may aid in diagnosing navicular disease in clinical practice
- •DIP joint fluid sampling may serve as a non-invasive alternative to navicular bursa aspiration for assessing some biochemical markers of navicular disease, though not all markers correlate between sites
- •COMP appears to be a reliable internal standard for normalizing other synovial fluid measurements across different joint compartments in navicular disease evaluation
- •Navicular bone shape on radiographs is a fundamental predisposing factor independent of age; horses with unfavourable shapes require proactive management regardless of age
- •Radiological grade (severity of degenerative changes) is more predictive of clinical disease than bone shape alone; mild radiological changes may not cause clinical signs
- •Older horses developing favourable bone shape morphology may have natural protective mechanisms; monitor younger affected horses more closely for progressive disease
- •Navicular disease horses show abnormal loading patterns early in stance phase, suggesting therapeutic interventions (shoeing, muscle conditioning) should target this period to reduce compensatory tension
- •The attempt to unload heels observed in diseased horses indicates pain-driven compensation; farriery that naturally supports heel loading early in stride may help normalize deep digital flexor recruitment patterns
- •Standard force measurements alone may mask pathological stress concentrations—assessment of contact area and pressure distribution provides more complete understanding of navicular pathomechanics
- •Radiographic evaluation of navicular bone shape for predisposition to navicular disease can be reliably performed from 12 months of age in young horses
- •Hereditary proximal articular border shape appears fixed early in development and may identify individual and breed susceptibility to navicular disease before clinical signs appear
- •The early manifestation of mature radiographic appearance supports early identification strategies for at-risk foals, potentially enabling preventive management decisions
- •Radiographic enlargement of the navicular bone in both directions is a reliable indicator of advanced navicular disease and should prompt consideration of farriery and management modifications to reduce load on the navicular apparatus
- •Pedal bone changes in clinical cases without radiographic confirmation suggest that early navicular disease may involve structural changes detectable on radiographs before full osteoarthrotic progression
- •Age-related changes in hoof geometry (increased dorsopalmar length and reduced cranial angle) occur independently of navicular disease, indicating that farriery management must account for age-related biomechanical changes in all horses over 4 years
- •Cartilage erosions and discoloration on the navicular bone alone are not reliable indicators of navicular disease and should not guide diagnosis or treatment decisions
- •Vascular insufficiency (thrombosis of nutrient arteries) appears to be the primary pathological mechanism in navicular disease, suggesting anticoagulant or vascular-targeted therapies warrant investigation
- •Existing standard treatments for navicular disease are largely ineffective; practitioners should consider novel approaches while longer-term studies on anticoagulation are completed
- •Navicular disease carries a poor prognosis regardless of treatment type—expect that most affected horses will not return to prelameness work capacity, so manage owner expectations accordingly
- •Radiographic evidence of navicular changes does not reliably predict treatment outcome or help select between medical, surgical, or corrective shoeing approaches
- •Consider breed, age, and sex as risk factors when evaluating lameness cases, particularly in Quarter Horses and geldings aged 4-9 years
- •DECT may offer an alternative imaging modality for detecting bone edema in the equine foot when MRI is unavailable or impractical
- •Post-mortem validation against histopathology supports DECT's diagnostic accuracy, but clinical use in live horses requires further validation
- •This emerging technology could expand diagnostic options for lameness investigation, particularly for navicular-related conditions
- •When MRI is unavailable or ultrasound is impossible, contrast-enhanced DPr-PaDiO radiography offers a practical and affordable alternative to diagnose navicular bursa pathology and guide intrabursal treatment decisions
- •Successful bursal injection combined with contrast radiography can reveal concurrent DDFT lesions and bursal ruptures that may not be apparent on conventional imaging, improving diagnostic accuracy
- •The 25% rate of contrast leakage beyond the bursa suggests careful injection technique and post-injection monitoring are necessary to ensure medication reaches the intended structure
- •Bursography with contrast medium can detect navicular pathology missed on standard radiographs in approximately 20% of cases, making it useful when MRI is unavailable or when therapeutic injection is already planned
- •Native radiographs alone are insufficient for ruling out navicular disease; consider contrast-enhanced bursography if clinical suspicion remains high despite normal plain films
- •Multiple positive radiographic projections (>2) have excellent specificity (100%) for identifying horses with moderate to severe navicular pathology, supporting diagnosis when present
- •DDFT cells show distinct regional properties that may influence how they respond to injury and regenerative therapies — understanding these differences is important for optimizing cell-based treatment approaches for intrasynovial tendon injuries
- •The fibrocartilaginous zone of the DDFT has unique cellular characteristics that may explain why this region is particularly prone to injury and why DDFT lesions associated with navicular disease have poor healing outcomes
- •Future cell-based therapies targeting DDFT injuries may need to account for zonal differences in cell populations to maximize healing potential and reduce reinjury rates
- •Bilateral bipartite navicular disease carries a guarded to poor prognosis for return to previous performance levels in athletic horses; MRI should be considered to fully assess concurrent soft tissue involvement
- •Radiography alone may underestimate the extent of pathology in navicular disease; MRI provides critical additional diagnostic information about podotrochlear apparatus integrity
- •When evaluating chronic forelimb lameness in performance horses, consider MRI imaging to identify occult soft tissue lesions that may explain poor response to conventional treatments
- •This lateral ultrasound-guided technique offers a safe, effective alternative to traditional navicular bursa injection without requiring radiographic guidance or risking deep digital flexor tendon penetration
- •Success depends heavily on image quality—adequate ultrasound visualization is critical; poor images significantly increase risk of off-target injection
- •Practitioners should recognize that bursa entry is confirmed by synovial fluid appearance at the needle hub, making real-time ultrasound feedback valuable for clinical application
- •Navicular disease affecting hind limbs is treatable with multimodal therapy combining rest, shoeing modifications, systemic and intrabursal medications, though recurrence may occur requiring repeated intervention
- •Bursascopy is a useful diagnostic tool for confirming navicular disease and may support treatment planning
- •Even older performance horses (12 years) can return to previous work levels with appropriate management of navicular disease
- •Navicular disease involves progressive degenerative changes extending throughout the bone structure, not just palmar surface damage, requiring comprehensive diagnostic imaging and assessment.
- •The involvement of flexor tendon degeneration, fibrillation and adhesions alongside bone changes means management must address soft tissue healing alongside any farriery or joint interventions.
- •Early detection of palmar fibrocartilage partial thickness loss and distal border fragmentation may help identify navicular disease before full thickness defects develop, supporting earlier intervention strategies.
- •Elevated intraosseous pressure in the navicular bone is a hallmark of navicular disease and may be a therapeutic target for management strategies
- •Pathologic changes are most pronounced on the flexor surface and in marrow spaces, informing understanding of pain mechanisms in this condition
- •Systemic vascular pressure changes are not the primary driver of navicular disease, suggesting local bone perfusion and pressure dynamics are key to pathogenesis
- •Navicular disease involves progressive vascular compromise with a shift from distal to proximal blood supply; understanding this hemodynamic change helps explain disease progression and supports early intervention strategies
- •The presence and pattern of nutrient foramina on radiographs may serve as indicators of vascular insufficiency and bone remodelling severity, potentially helping stratify disease cases
- •Management approaches targeting vascular health, pressure reduction, and perfusion (e.g., palliative therapies, shoeing modifications to reduce intra-articular pressure) align with the underlying pathophysiology of blood supply disruption
- •Navicular disease involves progressive cartilage degeneration similar to osteoarthritis, supporting the need for early intervention and long-term management strategies
- •Understanding that fibrocartilage undergoes osteoarthritic changes helps explain the chronic, progressive nature of navicular disease in practice
- •Histological evidence of cartilage degradation supports the rationale for treatments aimed at slowing degenerative processes rather than expecting full recovery
- •Navicular disease involves compromised blood flow and venous congestion in the navicular bone, explaining why rest and pain management are key to symptom relief
- •Understanding navicular disease as an arthrosis-type condition supports therapeutic approaches aimed at improving circulation and reducing intraosseous pressure
- •Recognition of resting pain as the primary mechanism guides treatment selection toward interventions that enhance bone perfusion and reduce venous stasis
- •Navicular disease shares pathophysiological mechanisms with osteoarthritis, suggesting similar degenerative processes may underlie the condition
- •Vascular changes and contrast pooling indicate compromised subchondral blood flow, which may explain pain and progressive cartilage degeneration in affected horses
- •Understanding the arthritic nature of navicular disease may guide treatment strategies toward managing inflammation and supporting joint health rather than pursuing purely biomechanical interventions
- •Navicular disease should be understood and managed as an osteoarthritic condition rather than as a isolated soft tissue or vascular problem, which may influence treatment approach selection
- •The similarity of pathology across joints suggests that management principles proven effective for other joint arthrosis may be applicable to navicular cases
- •Early recognition of the degenerative nature of this condition may help owners and practitioners set realistic expectations for recovery and long-term management
- •Use the upright pedal view with 20° pastern angulation and a grid for the clearest navicular bone detail in practice
- •When using the special navicular view, set your anode-film distance to 900 mm and tube-head angle to 55° centered between the heel bulbs for optimal diagnostic imaging
- •Always use a combination of both the upright pedal and special navicular views rather than relying on a single projection to diagnose navicular disease
- •Evaluate both radiological and clinical signs together rather than in isolation, as their relationship varies with horse age and workload
- •Monitor younger or recently worked horses more closely for early navicular changes, as detection at early stages may allow intervention
- •Work-load management should be considered in conjunction with radiological findings when assessing navicular disease progression and prognosis
- •Radiographic changes in nutrient foramina shape (circular or mushroom appearance) are diagnostic indicators of vascular compromise in navicular disease and can guide clinical decision-making
- •Progressive work conditioning normally develops secondary blood supply in young horses; understanding this timeline helps distinguish normal development from pathological vascular changes
- •Navicular lameness requires significant vascular compromise—single artery occlusion alone is insufficient, so multiple arterial involvement must be confirmed before attributing lameness solely to navicular ischaemia
- •MSC-derived extracellular vesicles show promise as a potential therapeutic approach for navicular disease, with early evidence supporting anti-inflammatory mechanisms
- •This in vitro research provides foundational support for further development of EV-based therapies before clinical trials in lame horses
- •While encouraging, results are currently limited to laboratory conditions; clinical efficacy and safety in treated horses remain to be determined
- •Ensure proper radiographic technique and positioning when imaging the navicular bone, as image quality directly impacts diagnostic accuracy and clinical decision-making
- •Familiarize yourself with the appearance of common navicular lesions (sclerosis, invaginations, fragments, erosions) to better communicate findings with veterinarians and clients
- •Include foot radiographs as part of pre-purchase examinations, as they are a standard diagnostic tool for identifying early navicular changes that could affect performance or longevity
- •Navicular bone morphology significantly influences stress distribution and disease risk — horses with wedge-shaped bones may be predisposed to more severe navicular disease and warrant closer monitoring
- •Understanding individual anatomical variations in moment arm ratios and bone positioning can help explain why some horses develop more severe navicular pathology despite similar workloads
- •Farriers and veterinarians should consider a horse's individual navicular bone anatomy when evaluating lameness severity and prognosis in suspected navicular disease cases
- •Intrabursal corticosteroid injections may have differential protective effects on DDFT versus navicular bone tissues; current dosing protocols do not account for these tissue-specific responses
- •NBF cells appear more vulnerable to inflammatory insult than DDFT cells, suggesting navicular disease pathology may require distinct therapeutic approaches from flexor tendon conditions
- •Future corticosteroid regimens for navicular disease need to be refined based on tissue-specific cellular responses to balance inflammation control with preservation of fibrocartilage matrix synthesis
- •While intrasynovial methylprednisolone reduces inflammation, it may suppress the tendon and cartilage cells' ability to produce matrix components—the long-term clinical significance of this requires further investigation
- •Current in-vitro evidence does not support concerns about corticosteroids preventing cell recovery at therapeutic doses, but real-world inflammatory conditions may produce different results
- •Until longer-term studies are completed, intrasynovial corticosteroids remain appropriate for navicular disease management, but clinicians should monitor for adequate healing response
- •Ensure high-quality radiographic positioning and technique when imaging the navicular bone for accurate lesion identification and pre-purchase evaluation
- •Understand the significance of common radiographic findings (sclerosis, invaginations, fragments, erosions) as these guide diagnosis and prognosis of navicular disease
- •Use radiographic interpretation alongside clinical examination and diagnostic analgesia blocks for comprehensive navicular syndrome assessment
- •Understanding that navicular disease results from mechanical stress mismanagement at the enthesis can guide farrier and veterinary management toward reducing compressive loading through trimming, shoeing, and movement modifications.
- •The navicular apparatus functions as a sophisticated pulley system; shoeing and trimming changes that alter foot angle or loading distribution directly affect force dissipation at the enthesis and disease risk.
- •Recognition of the bursa and fat pad's protective roles suggests that interventions preserving fluid dynamics and reducing pressure spikes (e.g., appropriate shoe design, controlled exercise) may help prevent or manage navicular pathology.
- •Managing navicular disease should focus on reducing forelimb overload and preventing habitual dorsiflexion through farrier and training modifications
- •Understanding that navicular lesions result from biomechanical overload rather than primary bone pathology supports conservative, load-management approaches over invasive interventions
- •Rehabilitation protocols should aim to restore normal foot mechanics and weight distribution to reduce chronic stress on the navicular apparatus
- •Pursue advanced imaging (MRI) for suspected navicular cases to confirm diagnosis and guide specific treatment decisions rather than empirical management
- •Understanding the underlying pathology of navicular disease allows you to tailor treatment protocols to individual cases, potentially improving outcomes
- •Early accurate diagnosis via MRI may enable earlier intervention and better long-term prognosis for lame horses
- •MRI signal changes in the navicular bone spongiosa should not be interpreted in isolation—increased signal may indicate fibrocartilage disease, subchondral bone pathology, or primary marrow changes, requiring careful correlation with clinical signs.
- •Early navicular disease involves complex interactions between cartilage, calcified cartilage, and bone; lesions in one structure are frequently accompanied by pathology in adjacent tissues.
- •MRI grading systems can help identify and monitor marrow fat changes and early degenerative lesions in navicular disease, supporting earlier intervention and prognostic assessment in lame horses.
- •Single ESWT treatment shows no measurable immediate pain relief for navicular disease lameness—do not expect improved gait within 7 days post-treatment
- •Current competition bans on pre-competition ESWT appear unjustified based on acute analgesic properties, though long-term benefits remain unproven
- •Objective gait analysis (force plate assessment) should be used to evaluate ESWT efficacy rather than relying on subjective lameness grades alone
- •The navicular bone exhibits small but consistent independent motions relative to the coffin bone during weight-bearing; these micro-motions may be relevant to navicular disease pathogenesis and should inform therapeutic and farriery approaches
- •Understanding that the navicular bone's motion is primarily coupled to coffin joint flexion can help guide management strategies targeting joint stability and load distribution
- •In vitro findings suggest that interventions reducing excessive coffin joint flexion or stabilizing navicular-coffin bone interactions may be beneficial in navicular disease prevention or management
- •Standard dorsopalmar and lateromedial radiographic views are sufficient for navicular bone evaluation; the palmaroproximal-palmarodistal view does not add diagnostic value for clinical decision-making
- •Practitioners can streamline radiographic protocols and reduce imaging time by eliminating the palmaroproximal-palmarodistal projection without compromising diagnostic accuracy
- •This evidence supports simplifying navicular bone imaging while maintaining diagnostic confidence in identifying navicular disease
- •Pain in the heel region causes horses to shift loading patterns in ways that increase stress on the navicular bone, potentially creating a pain cycle that perpetuates navicular disease
- •Early identification and treatment of heel pain may prevent the biomechanical changes that lead to navicular bone remodelling and cartilage damage
- •Navicular disease management should consider the underlying heel pain that may have initiated the condition, not just treat the navicular bone itself
- •Expect realistic recovery rates around 75% with standard treatment regimens; early intervention before structural changes develop is crucial
- •Prioritize preventive hoof care and regular hoof balance assessment rather than waiting for clinical signs to appear
- •Maintain consistent hoof husbandry practices and ensure hoof wall-pastern axis alignment to reduce navicular disease incidence
- •Expect bilateral navicular disease in most cases; unilateral presentation should not rule out contralateral involvement and warrants thorough evaluation of both feet
- •Assess foot conformation carefully as broken axes and mediolateral imbalance are present in majority of cases and may guide farriery interventions
- •Use distal interphalangeal joint and navicular bursa local anesthesia as reliable diagnostic confirmatory tests, as hoof testers and percussion have poor sensitivity (11% and 3% respectively)
- •Multiple radiographic features of navicular disease correlate with clinical lameness; flexor cortex defects and medullary changes are most prognostically significant
- •Not all radiological findings in navicular disease are clinically relevant—distal border invaginations and flexor cortex thinning do not reliably predict lameness severity
- •In bilateral cases, focus on poor corticomedullary demarcation and distal border fragmentation as better indicators of asymmetrical disease severity
- •Consider biomechanical interventions and farriery-based treatments as primary management strategies alongside or instead of relying solely on vascular-focused therapies
- •Evaluate individual treatment outcomes critically as different biomechanical techniques show variable results in clinical practice
- •Focus on anatomical understanding and load distribution through the navicular bone when assessing and treating affected horses
- •When clinical signs of navicular disease are present but radiographs appear normal, scintigraphy should be considered as it detects lesions radiography misses
- •Use radiography and scintigraphy together for most reliable diagnosis rather than relying on either modality alone
- •Both soft tissue-phase and bone-phase scintigraphy typically give similar results, so either phase can contribute diagnostically
- •Understanding that vascular compromise may be central to navicular disease pathogenesis could guide future therapeutic approaches targeting improved blood supply to the navicular bone
- •The experimental reproduction of navicular disease features through arterial occlusion supports investigation of vascular insufficiency as a clinical target in affected horses
- •Recognition of navicular disease as a vascular problem may influence diagnostic imaging selection (arteriography, scintigraphy) and treatment planning strategies
- •Early intervention with corrective shoeing designed to improve breakover and foot physiology can resolve navicular lameness in most cases without surgical intervention
- •Timing matters: refer horses for corrective shoeing within the first 8 months of lameness for optimal outcomes
- •Realistic expectations depend on use type—sport horses may have better prognosis than high-impact disciplines
- •If referring horses for warfarin therapy for navicular disease, understand that this requires regular laboratory monitoring and is not a simple 'start and forget' treatment
- •Work closely with your veterinarian on warfarin cases—dosing adjustments and drug interactions are critical to avoid both therapeutic failure and bleeding complications
- •Know that vitamin K-1 is the antidote for warfarin overdose and should be available in emergency situations
- •Degenerative changes visible on imaging or necropsy do not confirm navicular disease as a cause of lameness—clinical correlation is essential, as many sound horses have similar lesions
- •The presence of adhesions and subchondral cavitation appears more specific to clinical navicular disease than simple degenerative changes or osteophyte formation
- •Vascular insufficiency as previously theorized does not appear to be a primary driver of navicular disease pathology based on absence of thrombosis and ischemic necrosis
- •Egg-bar shoeing should be considered as a first-line conservative treatment option for navicular disease, with >50% success rate in causing permanent remission of clinical signs
- •Early intervention before irreversible secondary changes develop (adhesions, bone spurs) is critical for treatment success
- •This shoeing technique is practical to implement in routine equine practice and warrants wider adoption
- •Navicular disease is a remodelling problem, not a death-of-bone problem—this means early intervention through corrective shoeing has genuine potential to reverse damage
- •Focus on reducing load through the caudal navicular bone via hoof conformation changes and appropriate shoeing strategies rather than assuming the condition is inevitably progressive
- •Once secondary changes (adhesions, bone spurs) develop, the disease becomes irreversible, so early detection and load management are critical to preserve function
- •Recognize subtle behavioral and gait changes in horses as early warning signs—intervention at this stage can prevent irreversible navicular disease
- •Maintain proper hoof-pastern axis through corrective shoeing every 4-6 weeks; address both anterior-posterior and medio-lateral imbalances to prevent heel collapse
- •Keep horses in regular daily work during corrective treatment for optimal response to farriery interventions
- •For acute laminitis cases, implement heart bar shoes with full heel support immediately and avoid any toe pressure to prevent further sole damage
- •Address club foot early in foals using tips and heel reduction combined with exercise management—delay risks permanent joint complications
- •Deep abscesses may need sectional hoof wall removal for complete drainage; don't shy away from aggressive treatment as horses return to work successfully with proper follow-up
Key Research Findings
27 relevant articles identified on ECSWT in horses, 9 in dogs, 0 in cats published 1980-2020
Scientific evidence for ECSWT clinical effects is very limited across all indications studied
Many studies had methodological flaws with favorable results typically not replicated in independent studies
Most promising results found for short-term pain relief, ligament ailments, and osteoarthritis warranting further high-quality research
Radiological alterations in navicular bone occur in warmblood populations at frequencies between 14.9% and 87.6%
Heritability estimates for navicular disease range from h² = 0.09 to h² = 0.40, indicating genetic factors play an important role
Significant QTL for navicular pathology were identified on equine chromosomes 2, 3, 4, 10, and 26, with genome-wide significance on ECA2 and ECA10
Simultaneous selection for both reduced radiological changes and improved performance traits can achieve genetic improvement in both navicular health and competition success
Tiludronate and clodronate did not significantly affect bone structure or remodeling kinetics over 60 days in clinically normal young horses
Clodronate did not demonstrate enhancement of bone healing in induced bone defects at 60 days post-injury
Bisphosphonate administration in young horses showed no detectable adverse effects on normal bone metabolism during the study period
Firocoxib at 0.1 mg/kg bwt once daily significantly improved peak vertical force (PVF) measurements at Days 2 and 6 compared to vehicle control (P < 0.05)
Mean clinical lameness grades decreased by >1 grade at Day 6 with both 0.1 and 0.25 mg/kg bwt doses
The 0.1 mg/kg bwt dose was as effective as the 0.25 mg/kg bwt dose, making it the optimal therapeutic dosage
Force plate analysis of peak vertical force proved superior to lameness grading alone for detecting drug efficacy
Evidence Base
Systematic Review of Complementary and Alternative Veterinary Medicine in Sport and Companion Animals: Extracorporeal Shockwave Therapy.
Boström Anna, Bergh Anna, Hyytiäinen Heli et al. (2022) — Animals : an open access journal from MDPI
Systematic Review
Review of genetic aspects of radiological alterations in the navicular bone of the horse.
Diesterbeck, Distl (2008) — DTW. Deutsche tierarztliche Wochenschrift
Systematic Review
Tiludronate and clodronate do not affect bone structure or remodeling kinetics over a 60 day randomized trial.
Richbourg Heather A, Mitchell Colin F, Gillett Ashley N et al. (2018) — BMC veterinary research
RCT
The use of force plate measurements to titrate the dosage of a new COX-2 inhibitor in lame horses.
Back W, MacAllister C G, van Heel M C V et al. (2009) — Equine veterinary journal
RCT
Tiludronate as a new therapeutic agent in the treatment of navicular disease: a double-blind placebo-controlled clinical trial.
Denoix J M, Thibaud D, Riccio B (2003) — Equine veterinary journal
RCT
The evaluation of isoxsuprine hydrochloride for the treatment of navicular disease: a double blind study.
Turner, Tucker (1989) — Equine veterinary journal
RCT
Orgotein in equine navicular disease: a double blind study.
Coffman, Johnson, Tritschler et al. (1979) — Journal of the American Veterinary Medical Association
RCT
Pharmacokinetics of orally administered calcium dobesilate in Warmblood horses.
J. Harder, A. Fürst, P. M. Montavon et al. (2025) — Schweizer Archiv fur Tierheilkunde
Cohort Study
High-field magnetic resonance imaging investigation of distal border fragments of the navicular bone in horses with foot pain.
Biggi M, Dyson S (2011) — Equine veterinary journal
Cohort Study
Histopathology in horses with chronic palmar foot pain and age-matched controls. Part 2: The deep digital flexor tendon.
Blunden, Dyson, Murray et al. (2006) — Equine veterinary journal
Cohort Study
Histopathology in horses with chronic palmar foot pain and age-matched controls. Part 1: Navicular bone and related structures.
Blunden, Dyson, Murray et al. (2006) — Equine veterinary journal
Cohort Study
Relationship of foot conformation and force applied to the navicular bone of sound horses at the trot.
Eliashar, McGuigan, Wilson (2004) — Equine veterinary journal
Cohort Study
Retrospective evaluation of equine prepurchase examinations performed 1991-2000.
van Hoogmoed, Snyder, Thomas et al. (2003) — Equine veterinary journal
Cohort Study
Biochemical characterisation of navicular hyaline cartilage, navicular fibrocartilage and the deep digital flexor tendon in horses with navicular disease.
Viitanen, Bird, Smith et al. (2003) — Research in veterinary science
Cohort Study
Subjective and quantitative scintigraphic assessment of the equine foot and its relationship with foot pain.
Dyson S J (2002) — Equine veterinary journal
Cohort Study
Synovial fluid studies in navicular disease.
Viitanen, Bird, Makela et al. (2002) — Research in veterinary science
Cohort Study
Relationships of age and shape of the navicular bone to the development of navicular disease: a radiological study.
Dik, van den Belt, van den Broek (2001) — Equine veterinary journal
Cohort Study
The force and contact stress on the navicular bone during trot locomotion in sound horses and horses with navicular disease.
Wilson, McGuigan, Fouracre et al. (2001) — Equine veterinary journal
Cohort Study
The radiographic development of the distal and proximal double contours of the equine navicular bone on dorsoproximal-palmarodistal oblique (upright pedal) radiographs, from age 1 to 11 months.
Dik K J, van den Belt A J, Enzerink E et al. (2001) — Equine veterinary journal
Cohort Study
Radiographic measurement from the lateromedial projection of the equine foot with navicular disease.
Verschooten, Roels, Lampo et al. (1989) — Research in veterinary science
Cohort Study
Show 46 more references
Ischaemic necrosis of the navicular bone and its treatment.
Colles (1979) — The Veterinary record
Cohort Study
Navicular disease in the horse: risk factors, radiographic changes, and response to therapy.
Ackerman, Johnson, Dorn (1977) — Journal of the American Veterinary Medical Association
Cohort Study
Post-mortem feasibility of dual-energy computed tomography in the detection of bone edema-like lesions in the equine foot: a proof of concept.
Germonpré Jolien, Vandekerckhove Louis M J, Raes Els et al. (2023) — Frontiers in veterinary science
Case Report
"Contrast Medium Controlled Injection in the Navicular Bursa and the Following Bursography in 23 Cases"
Christian Staufenbiel (2021) — Biomedical Journal of Scientific & Technical Research
Case Report
Blinded Comparison of Palmaroproximal-palmarodistal-oblique and Dorsoproximal-palmarodistal Oblique Radiographic Projections With Contrast Medium in the Navicular Bursa in Dissected Horse Front Feet With Native Radiographs and Gross Pathology
Christian Staufenbiel, H. Gerhards, Jens Koerner (2021)
Case Report
Zonal characterization and differential trilineage potentials of equine intrasynovial deep digital flexor tendon-derived cells.
Quam Vivian G, Altmann Nadine N, Brokken Matthew T et al. (2021) — BMC veterinary research
Case Report
Magnetic resonance and radiographic imaging of a case of bilateral bipartite navicular bones in a horse.
Harcourt, Smith, Bell et al. (2018) — Australian veterinary journal
Case Report
An ultrasound-guided, tendon-sparing, lateral approach to injection of the navicular bursa.
Nottrott K, De Guio C, Khairoun A et al. (2017) — Equine veterinary journal
Case Report
[Navicular disease in the hind limb of a Warmblood horse].
Meijer, Rijkenhuizen (1999) — Tijdschrift voor diergeneeskunde
Case Report
Gross, histological and histomorphometric features of the navicular bone and related structures in the horse.
Wright, Kidd, Thorp (1998) — Equine veterinary journal
Case Report
Intraosseous pressure and pathologic changes in horses with navicular disease.
Pleasant, Baker, Foreman et al. (1993) — American journal of veterinary research
Case Report
The arterial supply of the navicular bone in adult horses with navicular disease.
Rijkenhuizen, Németh, Dik et al. (1990) — Equine veterinary journal
Case Report
Changes of the fibrocartilage in navicular disease in horses. A histological and histochemical investigation of navicular bones.
Svalastoga, Reimann, Nielsen (1984) — Nordisk veterinaermedicin
Case Report
Navicular disease in the horse. The subchondral bone pressure.
Svalastoga, Smith (1983) — Nordisk veterinaermedicin
Case Report
Navicular disease in the horse. A microangiographic investigation.
Svalastoga (1983) — Nordisk veterinaermedicin
Case Report
Navicular disease in the horse. The synovial membrane of bursa podotrochlearis.
Svalastoga, Nielsen (1983) — Nordisk veterinaermedicin
Case Report
Assessment of radiographic positioning for the diagnosis of navicular disease in the horse.
Rose (1981) — Journal of the South African Veterinary Association
Case Report
[Radiological and clinical considerations on navicular disease (author's transl)].
Dik, Németh, Merkens (1978) — Tijdschrift voor diergeneeskunde
Case Report
The arterial supply of the navicular bone and its variations in navicular disease.
Colles, Hickman (1977) — Equine veterinary journal
Case Report
Equine bone marrow MSC-derived extracellular vesicles mitigate the inflammatory effects of interleukin-1β on navicular tissues in vitro.
Quam Vivian G, Belacic Zarah A, Long Sidney et al. (2025) — Equine veterinary journal
Expert Opinion
A review of radiographic interpretation of the navicular bone
F. Hinkle, Myra Barrett (2024) — UK-Vet Equine
Expert Opinion
Joint Stress Analysis of the Navicular Bone of the Horse and Its Implications for Navicular Disease
Fuss Franz Konstantin (2024) — Bioengineering
Expert Opinion
Interleukin-1β and methylprednisolone acetate demonstrate differential effects on equine deep digital flexor tendon and navicular bone fibrocartilage cells in vitro.
Z. Belacic, S. Sullivan, H. Rice et al. (2023) — American journal of veterinary research
Expert Opinion
Sullivan Stasia N, Altmann Nadine N, Brokken Matthew T et al. (2020) — Frontiers in veterinary science
Expert Opinion
CPD article: Radiographic interpretation of the navicular bone: a review
F. Hinkle, M. Barrett (2020) — UK-Vet Equine
Expert Opinion
Human Achilles and Equine Navicular Apparatus: A Structural and Functional Comparison of Two Premier Enthesis Organs
M. Osborn, U. Blas-Machado, E. Uhl (2016) — The FASEB Journal
Expert Opinion
Analysis of Forces Acting on the Equine Navicular Bone in Normal and Dorsiflexed Positions
Kaitlyn C Ruff, Michelle L. Osborn, E. Uhl (2016) — The FASEB Journal
Expert Opinion
Diagnosing navicular disease and the role of MRI
Smith Meredith (2015) — Equine Health
Expert Opinion
Comparison between magnetic resonance imaging and histological findings in the navicular bone of horses with foot pain.
Dyson, Blunden, Murray (2013) — Equine veterinary journal
Expert Opinion
Investigation of the immediate analgesic effects of extracorporeal shock wave therapy for treatment of navicular disease in horses.
Brown, Nickels, Caron et al. (2006) — Veterinary surgery : VS
Expert Opinion
A description of the motion of the navicular bone during in vitro vertical loading of the equine forelimb.
van Dixhoorn I D E, Meershoek L S, Huiskes R et al. (2002) — Equine veterinary journal
Expert Opinion
A comparison of the palmaroproximal-palmarodistal view of the isolated navicular bone to other views.
de Clercq, Verschooten, Ysebaert (2001) — Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association
Expert Opinion
The effect of bilateral palmar digital nerve analgesia on the compressive force experienced by the navicular bone in horses with navicular disease.
McGuigan M P, Wilson A M (2001) — Equine veterinary journal
Expert Opinion
Treatment and pathogenesis of navicular disease ('syndrome') in horses.
Leach (1994) — Equine veterinary journal
Expert Opinion
A study of 118 cases of navicular disease: clinical features.
Wright (1994) — Equine veterinary journal
Expert Opinion
A study of 118 cases of navicular disease: radiological features.
Wright (1994) — Equine veterinary journal
Expert Opinion
Biomechanical considerations in the treatment of navicular disease.
Wright, Douglas (1993) — The Veterinary record
Expert Opinion
Soft tissue- and bone-phase scintigraphy for diagnosis of navicular disease in horses.
Trout, Hornof, O'Brien (1991) — Journal of the American Veterinary Medical Association
Expert Opinion
The effect of artificial occlusion of the Ramus navicularis and its branching arteries on the navicular bone in horses: an experimental study.
Rijkenhuizen, Németh, Dik et al. (1990) — Equine veterinary journal
Expert Opinion
Shoeing principles for the management of navicular disease in horses.
Turner (1986) — Journal of the American Veterinary Medical Association
Expert Opinion
[The treatment of podotrochilosis with oral anticoagulants. An instruction insert desired].
van den Bogaard, Thijssen, Hemker (1985) — Tijdschrift voor diergeneeskunde
Expert Opinion
Pathological changes in the navicular bone and associated structures of the horse.
Doige, Hoffer (1984) — Canadian journal of comparative medicine : Revue canadienne de medecine comparee
Expert Opinion
Navicular bone disease: results of treatment using egg-bar shoeing technique.
Ostblom, Lund, Melsen (1984) — Equine veterinary journal
Expert Opinion
Histological study of navicular bone disease.
Ostblom, Lund, Melsen (1982) — Equine veterinary journal
Expert Opinion
Pre-navicular syndrome
Caldwell, M. (1987) — FWCF Fellowship Thesis
Thesis
Problems I have found in horses feet and methods of shoeing
Stern, P.J. (1977) — FWCF Fellowship Thesis
Thesis