Navicular Syndrome: What the Research Says

Evidence from 78 peer-reviewed studies

1 Systematic Review
4 RCT
10 Cohort Study
28 Case Report
35 Expert Opinion

What Professionals Should Know

  • •ESWT is a viable non-invasive therapeutic option for common performance-limiting musculoskeletal injuries in equine athletes, with established biological mechanisms supporting its use
  • •Treatment protocols should be tailored to the specific condition (tendinitis vs. desmitis vs. osteoarthritis vs. navicular syndrome) with optimized shock wave parameters
  • •Consider ESWT as part of a comprehensive injury management strategy to potentially reduce early retirement and improve return to performance
  • •Proper therapeutic shoeing combined with intra-articular anti-inflammatory injection provides substantial lameness improvement in navicular cases; tiludronate IVRLP does not meaningfully enhance these established treatments in the short-to-medium term.
  • •If considering tiludronate IVRLP as adjunctive therapy, high-dose protocols (0.2 mg/kg) may offer marginal advantage over low-dose or placebo by 120 days, though clinical significance of this finding is unclear.
  • •Focus your navicular management on optimizing farrier work and DIPJ injection protocols rather than expecting additional benefit from regional perfusion techniques.
  • •Clodronate appears clinically effective for improving forelimb lameness in navicular syndrome cases, with improvements noted within 1 week and sustained performance gains by 8 weeks
  • •The improvement in lameness occurs without measurable effects on bone remodeling, suggesting clodronate's clinical benefit may involve mechanisms other than direct effects on bone turnover
  • •Further research is needed on multiple-dose protocols, as this study examined only single-dose effects and bisphosphonates have long half-lives that may produce cumulative effects
  • •Cosequin supplementation may provide clinical lameness improvement in navicular syndrome horses within 8 weeks, as perceived by both veterinary assessment and owners, making it a viable non-invasive adjunctive therapy option
  • •Radiographic changes do not correlate with clinical improvement, suggesting this nutraceutical addresses clinical signs and pain rather than reversing bony pathology
  • •Consider recommending this supplement to clients with navicular-diagnosed horses seeking conservative management before or alongside other interventions
  • •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
  • •Clodronate's antiresorptive effects persist well beyond a single dose in horses, which may impact bone remodeling and healing in athletic animals
  • •Extra-label use of clodronate in racehorses and performance horses warrants caution due to potential impairment of natural bone repair mechanisms critical for stress fracture healing
  • •Practitioners should consider the prolonged systemic effects of clodronate when using it off-label in young or athletic horses requiring normal bone turnover
  • •Tiludronate is a very safe treatment option for lameness in horses, with minimal side effects reported in over 2,400 injections—mild colic is the main concern but occurs in <1% of cases
  • •Expect significant lameness improvement within 30 days in approximately half of treated horses, with sustained benefits at one year, making it suitable for performance horses
  • •Most competing horses maintain or improve their performance level post-treatment, supporting use in athletic populations seeking to return to sport
  • •Navicular syndrome involves measurable structural changes in flexor tendon collagen organization, suggesting this is a multifactorial tissue condition beyond just bony changes
  • •The distal phalanx insertion site of the deep digital flexor tendon appears to be a critical area affected in navicular syndrome, relevant for treatment targeting and prognosis
  • •Increased disorganized collagen in affected tendons may compromise mechanical function and healing capacity, supporting the need for rehabilitation protocols that address tendon quality alongside lameness management
  • •When MRI shows a cystic structure in the distal navicular bone or increased signal at the DSIL insertion, expect significant internal ligament damage even if external signs are subtle—this guides prognosis and treatment decisions
  • •Distal border fragments and navicular bone cysts rarely occur in isolation; finding one should prompt careful evaluation of the entire DSIL, navicular bone, and distal phalanx attachment
  • •MRI swelling of the DSIL body and increased signal intensity in fat-suppressed sequences are reliable indicators of histological deterioration and should influence rehabilitation timelines and workload management
  • •Medical management of foot pain has guarded long-term prognosis: expect that 60% of cases will not return to previous performance levels despite treatment with corrective shoeing, rest, and intrasynovial medication
  • •Deep digital flexor tendon involvement is a negative prognostic indicator—cases with DDFT pathology are significantly less likely to respond to conservative therapy
  • •Multiple concurrent foot lesions substantially worsen outcome; horses with isolated lesions have better prognosis than those with involvement of multiple structures
  • •PSGAG injections administered in 3 doses 8 days apart shows superior success rate (67%) compared to single MPA injection followed by PSGAG if needed (46%)
  • •Dressage horses respond better to DIP joint treatment than jumping disciplines; discipline type should factor into prognosis discussions with owners
  • •Pre-treatment diagnostic analgesia response (≥75% lameness reduction in 10 min) is a reliable predictor of treatment candidacy and should guide case selection
  • •Using scintigraphy and MRI together provides complementary diagnostic information about podotrochlear apparatus injury that neither imaging modality alone can deliver
  • •Finding increased radiopharmaceutical uptake in the navicular bone suggests checking for concurrent soft tissue lesions, particularly combined CSL, DSIL, and bursal pathology
  • •Horses with DDFT lesions are at higher risk of showing moderate to severe navicular bone changes, warranting thorough evaluation of both structures
  • •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
  • •99mTc-MDP scintigraphy is a useful diagnostic tool for confirming navicular bone involvement in horses with palmar foot pain; consider imaging at 1 hour post-injection rather than waiting longer
  • •Always obtain palmar view images as they are more diagnostic than lateral views alone for navicular area evaluation
  • •This imaging modality helps differentiate navicular syndrome from other causes of forelimb lameness after palmar digital nerve blocks isolate pain to the foot
  • •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
  • •Micro-CT imaging can detect early microarchitectural changes in the distal sesamoid bone before conventional imaging shows pathology, potentially enabling earlier intervention in navicular syndrome
  • •Quantifiable metrics from micro-CT (trabecular thickness, separation, porosity) may become useful biomarkers for monitoring disease progression and treatment response in navicular cases
  • •Current diagnostic limitations of radiography, ultrasound, and scintigraphy mean early-stage navicular syndrome changes in bone structure are being missed—this technique warrants clinical validation as a more sensitive diagnostic tool
  • •T2 mapping may enable earlier detection of cartilage damage in horses with DIPJ problems, potentially allowing intervention before irreversible changes occur
  • •Low-field MRI alone may miss early cartilage disease; practitioners should be aware of this limitation when interpreting negative scans in lame horses
  • •Higher field strength MRI with quantitative T2 mapping protocols may be worth considering for horses with suspected early cartilage pathology when available
  • •Navicular bursa anesthesia may have inconsistent diagnostic and analgesic specificity—some horses show non-specific spreading to dorsal lamellae while others show none, limiting its reliability as a sole diagnostic test.
  • •Use navicular bursa blocks as part of a multi-step lameness workup rather than in isolation; combine with other regional anesthesia (e.g., palmar digital nerve blocks) and imaging for clearer diagnosis.
  • •Be aware that positive response to navicular bursa anesthesia may not guarantee pathology is confined to the bursa itself; clinical response should always be interpreted alongside radiographic and ultrasonographic findings.
  • •Understanding normal microscopic anatomy of podotrochlear structures is essential for recognizing pathological changes on imaging and clinical examination
  • •The structural complexity of the distal sesamoid bone (three distinct tissue layers) explains why navicular syndrome often involves multiple anatomical components beyond bone alone
  • •Familiarity with normal histological appearance of tendons, ligaments, and bursal membranes helps practitioners and veterinarians interpret ultrasound findings and predict tissue failure patterns
  • •Navicular bursoscopy may improve short-term lameness despite MRI showing bursal proliferation and worsening appearance—manage client expectations about imaging vs. clinical recovery.
  • •Poor return-to-work rates (29%) suggest bursoscopy alone is insufficient; multimodal treatment of concurrent foot lesions (DDFT, navicular bone, ligaments) should be considered.
  • •Post-operative rehabilitation protocols may be critical to functional recovery even when imaging appears to worsen—prioritize structured rehabilitation rather than relying on imaging resolution.
  • •Consider CT imaging when radiographic findings are inconclusive or you need detailed assessment of navicular bone lesions and adjacent soft tissue changes before committing to treatment
  • •Intra-bursal corticosteroid and antibiotic injection can be effective for navicular syndrome, with some horses showing rapid clinical improvement
  • •CT allows you to differentiate between various navicular pathologies (cysts, sclerosis, vascular changes) which may influence prognosis and treatment selection
  • •PEA-um supplementation may offer a non-pharmacological option for managing chronic joint disease and lameness in performance horses, particularly those unresponsive to standard treatments
  • •Consider adding ultramicronized PEA to the management protocol for navicular syndrome and distal intertarsal arthritis; treatment duration of 4 months was required to observe clinical improvement
  • •This small case series suggests potential benefit but controlled trials in larger horse populations are needed before making firm clinical recommendations
  • •Distal border fragments should be considered clinically significant especially when large or concurrent with other lesions; radiographic findings must be interpreted alongside clinical signs as imaging doesn't always correlate with soft tissue pathology
  • •Intensive exercise and training stress are key drivers of navicular bone deterioration through disrupted bone remodeling; managing workload appropriately is critical for prevention and management of navicular disease
  • •Synovial invaginations and nutrient foramina changes may indicate circulatory disturbances and abnormal bone turnover—consider vascular and metabolic factors when managing horses with navicular pathology, not just mechanical factors
  • •You can obtain a single DPr-PaDiO view optimized for the distal phalanx and use post-processing to visualize the navicular bone, eliminating the need for a second radiograph
  • •This streamlined approach saves time during radiographic examinations and reduces radiation exposure without compromising diagnostic quality
  • •Modern computerized radiography systems make this protocol change feasible for equine foot radiography series
  • •Radiographic measurements can reliably predict the presence and type of soft tissue lesions in the foot—use this to guide advanced imaging decisions and treatment planning
  • •Long-toed conformation is a significant risk factor for navicular bone pathology; address toe length in remedial farriery protocols
  • •Specific radiographic parameters (palmar angle, phalanx angles, navicular bone dimensions) should prompt investigation of particular structures on MRI rather than generic foot imaging
  • •Needle endoscopy is a viable diagnostic technique for investigating navicular bursa pathology in lame horses, with the direct approach offering better visualization of key anatomical structures
  • •Both direct and transthecal approaches are similarly efficient in terms of access time and attempt number, allowing choice based on clinical circumstances and operator preference
  • •Risk of significant iatrogenic damage from needle endoscopy is minimal with either approach, making this a relatively safe complementary diagnostic tool for navicular region lameness
  • •Early intervention matters: horses lame for less than 6 months have significantly better outcomes with navicular bursa injection, so early diagnosis and treatment are critical
  • •MRI findings predict success: horses with primary DDF tendonitis respond best, while those with scar tissue, adhesions, or multiple pathologies should have realistic expectations about treatment outcomes
  • •Set client expectations appropriately: while 75% return to work, only 35% are sound long-term, and outcomes vary substantially based on underlying pathology
  • •Consider adopting the modified transthecal bursoscopy technique when navicular bursa exploration is indicated, as it provides superior visualization (80% vs 60%) with substantially less damage to the navicular bone and deep digital flexor tendon despite slightly longer access time
  • •The modified approach is most suitable for practitioners with arthroscopic experience; the additional dissection technique requires skill but becomes straightforward with practice
  • •This technique may improve diagnostic accuracy and reduce secondary damage during navicular bursa investigations, potentially affecting prognosis and post-operative outcomes
  • •Navicular bursa injections are effective for lameness when primary pathology is bursitis alone; use adequate corticosteroid doses (≥10 mg triamcinolone) for optimal results
  • •MRI screening is valuable—horses with erosions on the flexor surface of the navicular bone coupled with DDFT adhesions should be counselled that injection response will likely be poor
  • •Expect 7–8 months of usable soundness in successful cases, allowing time to implement complementary therapeutic strategies before lameness recurs
  • •Standing MR imaging should be used for suspected palmar navicular erosions as radiography often appears normal or equivocal and delays diagnosis
  • •Deep palmar navicular erosions carry a poor prognosis—44% of cases resulted in euthanasia and only one horse returned to work, supporting early diagnosis of shallow lesions to allow therapeutic intervention
  • •Sudden onset lameness with positive MR findings on the palmar navicular aspect warrants careful prognosis discussion with owners regarding likelihood of return to performance
  • •Navicular syndrome involves cumulative cyclic loading damage rather than simple bone resorption; management should focus on reducing repetitive impact and bending loads through farriery and exercise modification
  • •Early detection of microcrack accumulation and poor bone quality may be possible through advanced imaging, allowing intervention before extensive cyst formation and cartilage damage occurs
  • •The bone's attempt to remodel in response to loading can fail, leading to osteocyte death and poor skeletal integrity; this supports the need for load management in at-risk horses rather than relying on adaptation
  • •Pull-through PDN is a practical surgical alternative for navicular syndrome cases that have failed conservative management, with 88% remaining sound at 1 year
  • •This technique is technically straightforward, requires minimal specialized equipment, and appears to have good safety profile with low complication rates
  • •Long-term benefit averages 4+ years, providing practitioners with realistic timeline to discuss with owners regarding treatment durability
  • •Navicular bursoscopy should be considered in lame horses with foot pain localised to the navicular region, as it identifies lesions missed by standard imaging (CT/MRI)
  • •Expect to find DDFT tears in nearly all cases of clinical navicular bursa disease, and cartilage damage in approximately one-third of cases
  • •Bursoscopy enables minimally invasive treatment, with good prognosis: ~73% of followed horses returned to soundness and pre-injury performance
  • •When radiographs and ultrasound fail to explain severe coffin joint lameness despite positive nerve blocks, MRI should be pursued as it can reveal soft tissue ligament injuries missed by conventional imaging
  • •CT provides superior visualization of small bone defects at ligament insertion sites and complements MRI findings in navicular region pathology
  • •Conservative management with extended box rest and cast immobilization can achieve full recovery in acute collateral sesamoidean ligament injuries, offering an alternative to aggressive intervention
  • •Transcuneal ultrasound is a reliable diagnostic tool for evaluating navicular syndrome—use it to identify bursal inflammation, DDFT changes, and impar ligament involvement that correlate with clinical caudal heel lameness
  • •Normal measurements alone don't diagnose navicular disease; focus on subjective findings like bursitis, mineralization patterns, and cortical bone changes visible on ultrasound
  • •This imaging approach helps differentiate navicular syndrome components, allowing more targeted management and prognosis discussions with owners
  • •MR imaging reliably identifies DDFT pathology in navicular syndrome, particularly lesions at the distal sesamoid level, supporting its use for diagnostic confirmation before treatment decisions
  • •Distal sesamoid bone marrow changes are consistent findings in navicular disease and may indicate the extent of degenerative changes affecting prognosis
  • •Understanding the correlation between MR signal patterns and specific histologic lesions (edema, necrosis, cyst formation) helps interpret clinical MR images and explain lameness severity
  • •MRI provides superior diagnostic capability for equine foot lameness compared to traditional imaging methods when soft tissue and cartilage pathology is suspected
  • •This technology offers a non-invasive diagnostic tool that can identify lesions missed by radiography, scintigraphy, and ultrasound, potentially improving clinical outcomes
  • •Early adoption of MRI imaging in equine practice may enhance diagnostic accuracy and treatment planning for chronic or refractory foot lameness cases
  • •Podotrochlear bursa endoscopy shows promise for detecting early pathologic changes in navicular disease, but cadaver validation suggests it may have limitations in mild cases
  • •If using this technique clinically, be aware of anatomical risks including inadvertent penetration of the distal interphalangeal joint and digital sheath, and potential for iatrogenic fibrocartilage damage
  • •Endoscopic findings should be interpreted cautiously in mild radiographic disease and correlated with other diagnostic imaging
  • •If navicular syndrome is suspected but radiographs appear normal or inconsistent with clinical signs, CT or MRI can reveal significant pathology not visible on conventional radiography and guide more targeted therapeutic decisions
  • •CT provides superior bony detail while MRI excels at soft tissue visualization; consider requesting CT for osseous assessment and MRI for tendon and ligament evaluation of the navicular region
  • •Radiographic changes alone should not be used to rule out navicular syndrome; advocate for advanced imaging when clinical signs persist despite normal or equivocal radiographic findings
  • •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
  • •Early radiographic changes (nutrient foramina enlargement) visible within 2 weeks of birth may predict later navicular pathology; monitor young horses showing these signs closely
  • •Significant arterial wall changes occur in the first weeks of life in susceptible horses; understanding this developmental timeline helps explain why navicular problems often emerge in young performance horses
  • •Horses with radiographic abnormalities show 3-4 times higher rates of arterial pathology than normal horses, supporting radiographic screening as a useful prognostic indicator for navicular disease risk
  • •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
  • •MRI findings of hyperintense lesions on the dorsal DDFT border within the navicular bursa are reliable indicators for surgical intervention via bursoscopy
  • •While bursoscopy allows direct visualization and removal of synovial masses, prognosis remains cautious—manage owner expectations accordingly
  • •Correlation between imaging and endoscopic findings is good, so bursoscopy can be confidently recommended when MRI shows these lesions
  • •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
  • •Scintigraphy is your established tool for screening multiple body regions and whole-body lameness workups in horses when functional information is needed
  • •PET offers superior detail for distal limb cases where high-resolution three-dimensional imaging can guide treatment decisions, though availability may be limited
  • •Nuclear medicine imaging identifies areas of abnormal metabolic activity that may not show on radiographs or ultrasound, helping prioritize treatment and prognosis
  • •Bisphosphonates offer a multi-target approach to bone disease management in horses beyond simple anti-resorptive effects, including pain and inflammation reduction
  • •Understanding the distinction between nitrogenous and non-nitrogenous bisphosphonates is critical, as only non-nitrogenous forms are approved for equine use
  • •Practitioners should review current safety data and regulatory guidelines before implementing bisphosphonate therapy in clinical practice
  • •ESWT technology has evolved significantly with electrohydraulic systems now dominant; ensure your chosen system can properly focus and control the therapeutic waveform
  • •While ESWT shows experimental and clinical promise for common orthopaedic problems (navicular, tendinopathy, suspensory lesions), definitive protocol recommendations don't yet exist—treatment decisions should remain based on individual case assessment
  • •Current safety advancements including hearing protection and light sedation protocols should be standard practice; continued research is refining optimal treatment parameters
  • •This radiographic-guided injection technique allows less experienced practitioners to safely inject the navicular bursa with similar success rates as experienced veterinarians, reducing operator dependency
  • •The technique significantly reduces the risk of accidentally penetrating the distal interphalangeal joint or other synovial structures, improving safety for the horse
  • •A standard 40mm 20-gauge needle is sufficient for this technique, making it practical and economical for routine navicular bursa injections in clinical practice
  • •Understand the established blocking patterns for your distal limb nerve blocks—know what structures each block desensitises and recognise that blocks have recognised limitations in specificity
  • •Use diagnostic blocks to localise lameness to a region, not definitively identify a specific structure—always correlate block results with clinical examination and imaging findings
  • •Be transparent with clients about what a positive block does and does not tell you, ensuring realistic expectations about diagnosis and prognosis before proceeding to imaging
  • •Navicular syndrome should be understood as a systemic failure of the entire navicular apparatus rather than isolated bone disease, requiring assessment of how mechanical forces distribute through the entire foot structure.
  • •Therapeutic approaches should emphasize correcting whole-body posture and movement patterns rather than focusing solely on local foot structures, mirroring successful human rehabilitation strategies.
  • •Farriers and veterinarians should collaborate to address biomechanical loading of the foot through shoeing and movement management to prevent or slow enthesis organ degeneration.
  • •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
  • •Clodronic acid may help reduce lameness in some horses with navicular syndrome, but expect variable response with roughly 50% of cases showing clinical improvement
  • •Objective gait analysis (accelerometry) can identify which horses are truly responding to treatment, improving on subjective lameness assessment alone
  • •This treatment option addresses bone turnover pathology in navicular disease and could be considered alongside or instead of conventional management strategies
  • •Use this expert resource to improve your understanding of what radiographs show in navicular cases and to better communicate with your veterinary diagnostic team
  • •Familiarize yourself with the normal radiological appearance of the navicular bone to recognize when changes warrant clinical concern
  • •The transthecal arthroscopic approach may improve diagnostic accuracy for non-infected DIPJ conditions by providing superior visualization of the navicular bone and palmar joint structures compared to conventional blind arthroscopy
  • •Do not use the transthecal approach if synovial sepsis is suspected, as it creates communication between the DIPJ and digital flexor tendon sheath, risking spread of infection
  • •This technique is a valid alternative for investigating chronic, non-septic DIPJ problems where improved visualization could guide treatment decisions
  • •Stay current with evolving diagnostic methods for navicular syndrome beyond traditional radiography
  • •Multiple treatment options exist; tailor approach based on individual case presentation and diagnostic findings
  • •Work with your veterinary team to implement evidence-based protocols that have evolved since earlier management approaches
  • •Invest time in proper foot preparation and patient positioning before radiographs—poor technique requires costly retakes and delays therapeutic farriery decisions.
  • •Systematic radiographic protocols for the foot provide the anatomical framework needed to plan and evaluate therapeutic farriery interventions.
  • •Quality radiographs are non-negotiable for accurate podiatry diagnosis and should be obtained before committing to corrective farriery work.
  • •Do not rely solely on radiographs to diagnose or rule out navicular syndrome; advanced imaging (MRI/CT) may be necessary when clinical signs suggest navicular disease but radiographs are inconclusive
  • •Navicular syndrome diagnosis requires integration of history, physical examination, lameness evaluation, and diagnostic anesthesia alongside imaging—no single test is definitive
  • •Consider structures beyond the traditional navicular complex (bone, bursa, DDFT) when investigating chronic forelimb lameness, as newer imaging reveals additional pathologic involvement
  • •Develop treatment plans by considering severity of clinical signs, intended use and workload demands, and owner compliance—no one-size-fits-all approach exists for navicular cases.
  • •Hoof balance and corrective trimming/shoeing form the foundation of nonsurgical management alongside medical therapy; these should be primary focus before pursuing surgical intervention.
  • •When medical therapy fails, palmar digital neurectomy is the most commonly performed surgical option, though collateral ligament desmotomy remains an alternative depending on pathology.
  • •DIPJ steroid injections do successfully reach the navicular bursa in horses with palmar foot pain, supporting current treatment protocols
  • •Horses with advanced radiographic changes (grade >2) may require higher steroid doses or alternative treatment approaches, as drug penetration decreases with severity
  • •Consider this evidence when counseling clients on prognosis and treatment response expectations for navicular disease cases
  • •Understanding the comparative strengths of CT, CECT, and standing LFMRI helps practitioners select the most appropriate imaging modality for specific foot pathology types
  • •Standing LFMRI offers a non-invasive alternative to traditional imaging without requiring general anesthesia, but clinicians need to know when each modality has superior diagnostic capability
  • •Knowledge of imaging limitations prevents missed diagnoses and guides whether additional or alternative imaging is warranted in equine foot lameness cases
  • •Core decompression surgery structurally weakens the navicular bone in vitro, which may have implications for load-bearing capacity and post-operative rehabilitation protocols
  • •Horse age and bone density status should be considered when evaluating candidates for core decompression, as stronger bones tolerate drilling better
  • •Surgical technique variations (hole size/number) appear less critical than the decompression itself, suggesting standardized protocols are acceptable
  • •High-field MRI is superior to low-field systems for detecting articular cartilage lesions and early degenerative changes in lame horses, particularly in the foot and pastern regions
  • •Low-field standing MRI systems are useful for screening soft tissue (tendon and ligament) injuries but may miss subtle cartilage pathology critical to lameness diagnosis
  • •Consider high-field MRI for cases where cartilage or navicular disease is suspected, despite the need for general anaesthesia
  • •Radiographic and CT findings for navicular evaluation should be interpreted cautiously, as observers show only fair to moderate agreement—consider obtaining second opinions before making treatment decisions based on imaging alone
  • •CT imaging provides greater diagnostic certainty than radiography, but this confidence does not guarantee superior agreement between observers, so clinical signs and lameness localization remain critical
  • •Standardized evaluation criteria exist, but their application varies considerably; ensure your veterinary diagnostician is using consistent criteria and ideally correlating imaging findings with physical examination findings
  • •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
  • •Scintigraphy is useful for lameness investigation but results must be interpreted cautiously, especially when changes are subtle—correlation with clinical signs and other imaging is essential
  • •Current evidence does not definitively establish the accuracy of scintigraphy for diagnosis; use it as part of a complete diagnostic protocol rather than as a standalone test
  • •Request high-quality prospective studies from imaging centres and remain skeptical of scintigraphic findings until better validation studies are published
  • •Heel-elevation shoeing alone provides significant and measurable improvement in lameness in navicular syndrome cases within 2 weeks
  • •Adding phenylbutazone to heel-elevation shoeing provides additional quantifiable lameness reduction beyond shoeing alone
  • •DIPJ injection with triamcinolone did not demonstrate statistically significant additional benefit over shoeing alone, despite numerical trends favoring combination therapy
  • •Perform lameness evaluations 15 minutes to 1 hour after palmar digital nerve block to ensure complete analgesic effect before diagnostic interpretation
  • •Be aware that some analgesia persists beyond 2 hours, which may influence gait assessment timing in subsequent diagnostic blocks or procedures
  • •Plan re-blocking or follow-up procedures accordingly, as mepivacaine effect is substantially diminished by 2 hours but not completely absent
  • •Standardized positioning and consistent exposure factors are essential for obtaining radiographs that allow accurate diagnosis and comparison over time
  • •Both farriers and veterinarians rely on high-quality foot radiographs to make informed decisions about trimming, shoeing, and treatment
  • •Technical proficiency in foot radiography directly impacts the quality of diagnostic information available for foot problem management
  • •Oral isoxsuprine is unlikely to be effective for navicular syndrome or laminitis in horses due to extremely poor bioavailability (2.2%) and lack of cardiovascular effects from oral dosing
  • •If considering isoxsuprine, intravenous administration may theoretically provide benefits, but the short half-life (<3 hours) and questionable clinical evidence make it a poor first-line therapeutic choice
  • •Current understanding of navicular syndrome pathogenesis has moved beyond the vasodilatory mechanism this drug targets; consider evidence-based alternatives with stronger clinical support
  • •Use the anatomical landmark of 1 cm distal to the coronary band, halfway between dorsal and palmar aspects, to reliably inject the navicular bursa regardless of individual foot shape
  • •This standardized approach enables consistent needle placement by operators with minimal experience, improving reproducibility of navicular bursa injections in clinical practice
  • •Establishing a consensus technique based on predictable anatomy reduces variability between practitioners and improves treatment reliability for navicular conditions
  • •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
  • •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
  • •Standing surgical procedures eliminate anesthesia risks and costs, making foot treatment more accessible for ambulatory practice and pregnant mares
  • •Patient selection based on temperament and condition type is critical; not all horses or conditions are suitable for standing procedures
  • •Understanding which foot pathologies respond well to standing surgery allows practitioners to offer clients economical treatment options without compromising outcomes
  • •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
  • •Foot conformation assessment is critical in identifying at-risk horses before clinical signs develop; faulty conformation is the predisposing factor for symptomatic navicular syndrome
  • •Understanding the pathophysiologic cascade from abnormal pressure to venous hypertension explains why early intervention on foot mechanics and pressure distribution may prevent or slow disease progression
  • •Recognize that clinical signs result from vascular compromise and pain rather than structural failure alone, informing both preventive and therapeutic management strategies
  • •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
  • •Add the skyline projection to your standard navicular radiographic protocol when lameness localizes to the navicular area but findings on routine views are inconclusive
  • •Use skyline view as a problem-solving tool when clinical signs and standard radiographs don't align, rather than as a routine first-line view
  • •The skyline projection may clarify lesions of uncertain significance seen on the Oxspring view, improving diagnostic confidence and treatment decisions

Key Research Findings

ESWT produces analgesia, anti-inflammatory effects, and autologous repair responses through multiple signaling pathways and biological factors

Qiu Zhongsheng, 2025

ESWT is clinically effective for managing major equine musculoskeletal injuries including tendon, ligament, joint, and soft tissue conditions

Qiu Zhongsheng, 2025

Specific ESWT parameters vary depending on the type of musculoskeletal injury being treated

Qiu Zhongsheng, 2025

Tiludronate IVRLP at low-dose (0.1 mg/kg) or high-dose (0.2 mg/kg) protocols provided no additional lameness improvement over therapeutic shoeing and DIPJ anti-inflammatory injection alone.

Schoonover, 2019

All horses showed improved peak vertical ground reaction force by day 14 regardless of treatment group.

Schoonover, 2019

High-dose tiludronate-treated horses demonstrated objectively lower lameness scores at 120 days compared to low-dose and placebo groups.

Schoonover, 2019

No significant differences in subjective lameness scores or PVGRF were detected between treatment groups at any timepoint except day 120.

Schoonover, 2019

Single clodronate dose (1.4 mg/kg) significantly reduced forelimb lameness 1 week post-treatment (P = 0.005) in horses with navicular syndrome

Mitchell A, 2019

Coaches reported significant improvement in ridden performance in clodronate-treated horses versus control at week 8 (P = 0.01)

Mitchell A, 2019

Clodronate treatment produced no detectable changes in bone turnover markers (CTX-I and osteocalcin) or in vitro bone cell recruitment

Mitchell A, 2019

No significant differences in hindlimb lameness were observed between treatment and control groups

Mitchell A, 2019

Oral Cosequin (glucosamine HCl 9g + chondroitin sulfate 3g + manganese ascorbate 600mg twice daily) significantly improved algofunctional lameness index scores in treatment group versus placebo (P = .05)

Hanson, 2009

Owner-assessed lameness improvement after 8 weeks was significantly better in treatment group compared to placebo (P = .045)

Hanson, 2009

Overall clinical condition scores showed significant improvement with nutraceutical treatment versus placebo (P = .05)

Hanson, 2009

Radiographic scores of navicular bones showed no significant difference between treatment and placebo groups after 8 weeks (P > .05)

Hanson, 2009

Evidence Base

Extracorporeal shock wave therapy for equine musculoskeletal disorders: from biological mechanisms to clinical applications.

Qiu Zhongsheng, Wang Jiaqi, Zhang Yukun et al. (2025) — Frontiers in veterinary science

Systematic Review

Quantitative assessment of intravenous regional limb perfusion of tiludronate as an adjunctive treatment for lameness caused by navicular syndrome in horses.

Schoonover, Whitfield, Young et al. (2019) — American journal of veterinary research

RCT

Clodronate improves lameness in horses without changing bone turnover markers.

Mitchell A, Wright G, Sampson S N et al. (2019) — Equine veterinary journal

RCT

Oral treatment with a nutraceutical (Cosequin) for ameliorating signs of navicular syndrome in horses.

Hanson, Brawner, Blaik et al. (2009) — Veterinary therapeutics : research in applied veterinary medicine

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

Clodronate detection and effects on markers of bone resorption are prolonged following a single administration to horses.

Knych Heather K, Finno Carrie J, Katzman Scott et al. (2023) — Equine veterinary journal

Cohort Study

Retrospective Analysis of the Use of Tiludronate in Equine Practice: Safety on 1804 Horses, Efficacy on 343 Horses.

Tischmacher Adeline, Wilford Sophie, Allen Kent et al. (2022) — Journal of equine veterinary science

Cohort Study

Navicular Syndrome-related changes to collagen proportion of different cross-sections of the flexor tendons in equine distal forelimb.

Salinas, Lira-Vel&#xe1;squez, Bongiorno et al. (2021) — Research in veterinary science

Cohort Study

The distal sesamoidean impar ligament: comparison between its appearance on magnetic resonance imaging and histology of the axial third of the ligament.

Dyson S, Pool R, Blunden T et al. (2010) — Equine veterinary journal

Cohort Study

Outcome of medical treatment for horses with foot pain: 56 cases.

Gutierrez-Nibeyro S D, White Ii N A, Werpy N M (2010) — Equine veterinary journal

Cohort Study

Multivariable analysis of factors influencing outcome of 2 treatment protocols in 128 cases of horses responding positively to intra-articular analgesia of the distal interphalangeal joint.

Kristiansen K K, Kold S E (2007) — Equine veterinary journal

Cohort Study

Use of concurrent scintigraphic and magnetic resonance imaging evaluation to improve understanding of the pathogenesis of injury of the podotrochlear apparatus.

Dyson, Murray (2007) — Equine veterinary journal

Cohort Study

Synovial fluid studies in navicular disease.

Viitanen, Bird, Makela et al. (2002) — Research in veterinary science

Cohort Study

Scintigraphic evaluation of 99mTc-methylene diphosphonate uptake in the navicular area of horses with lameness isolated to the foot by anesthesia of the palmar digital nerves.

Keegan, Wilson, Lattimer et al. (1996) — American journal of veterinary research

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

Three-dimensional anatomical description of the microarchitecture of the distal sesamoid bone in healthy and navicular syndrome-affected horses by computed microtomography.

P. Salinas, Matías Vergara, Danae Tapia (2026) — Anatomical record

Case Report

T2 mapping of cartilage in the equine distal interphalangeal joint with corresponding histology using 0.27 T and 3.0 T magnetic resonance imaging.

Baker Melissa Eve, Kershaw Lucy Elizabeth, Carstens Ann et al. (2023) — Equine veterinary journal

Case Report

Mechanical nociceptive assessment of the equine hoof after navicular bursa anesthetic infiltration validated by bursography.

Cota Let&#xed;cia de Oliveira, Malacarne Bruno Dondoni, Dias Lucas Antunes et al. (2022) — PloS one

Case Report

Equine Podotrochlear Apparatus - Histologic Characterization

G. De Bastiani, F. D. De La Côrte, A. Ramos et al. (2022) — Acta Scientiae Veterinariae

Case Report

Magnetic resonance imaging changes of the navicular bursa following navicular bursoscopy in seven horses

Hoaglund E. L., Barrett M. F. (2021) — Equine Veterinary Education

Case Report
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Computed Tomographic Findings of Navicular Syndrome in a Horse

Seyoung Lee, Eun-bee Lee, Kyung-won Park et al. (2021)

Case Report

Oral Supplementation with Ultramicronized Palmitoylethanolamide for Joint Disease and Lameness Management in Four Jumping Horses: A Case Report.

Gugliandolo Enrico, Barbagallo Alfio, Peritore Alessio Filippo et al. (2020) — Animals : an open access journal from MDPI

Case Report

Insight into the pathomorphology of the distal border of the equine navicular bone

M. Frątczak, J. Włodarek, H. Frąckowiak et al. (2017) — Acta Veterinaria Brno

Case Report

Technical innovation changes standard radiographic protocols in veterinary medicine: is it necessary to obtain two dorsoproximal-palmarodistal oblique views of the equine foot when using computerised radiography systems?

Whitlock J, Dixon J, Sherlock C et al. (2016) — The Veterinary record

Case Report

Correlation of radiographic measurements of structures of the equine foot with lesions detected on magnetic resonance imaging.

de Zani, Polidori, di Giancamillo et al. (2016) — Equine veterinary journal

Case Report

Diagnostic endoscopy of the navicular bursa using a needle endoscope by direct or transthecal approach: A comparative cadaver study.

M&#xe4;hlmann Kathrin, Koch Christoph, Bod&#xf3; G&#xe1;bor (2015) — Veterinary surgery : VS

Case Report

Response to injection of the navicular bursa with corticosteroid and hyaluronan following high-field magnetic resonance imaging in horses with signs of navicular syndrome: 101 cases (2000-2008).

Marsh, Schneider, Sampson et al. (2013) — Journal of the American Veterinary Medical Association

Case Report

Navicular bursoscopy in the horse: a comparative study.

Haupt Jennifer L, Caron John P (2010) — Veterinary surgery : VS

Case Report

Outcomes of podotrochlear (navicular) bursa injections for signs of foot pain in horses evaluated via magnetic resonance imaging: 23 cases (2005-2007).

Bell, Howard, Taylor et al. (2009) — Journal of the American Veterinary Medical Association

Case Report

Deep erosions of the palmar aspect of the navicular bone diagnosed by standing magnetic resonance imaging.

Sherlock, Mair, Blunden (2009) — Equine veterinary journal

Case Report

Morphologic changes associated with functional adaptation of the navicular bone of horses.

Bentley, Sample, Livesey et al. (2008) — Journal of anatomy

Case Report

Pull-through technique for palmar digital neurectomy: forty-one horses (1998-2004).

Maher Omar, Davis David Michael, Drake Christiana et al. (2008) — Veterinary surgery : VS

Case Report

Endoscopic assessment and treatment of lesions of the deep digital flexor tendon in the navicular bursae of 20 lame horses.

Smith, Wright, Smith (2007) — Equine veterinary journal

Case Report

MRI and CT diagnosis of acute desmopathy of the lateral collateral sesmoidean (navicular) ligament and long-term outcome in a horse.

Kofler J, Kneissl S, Malleczek D (2007) — Veterinary journal (London, England : 1997)

Case Report

Assessment of the ultrasonographic characteristics of the podotrochlear apparatus in clinically normal horses and horses with navicular syndrome.

Grewal, McClure, Booth et al. (2005) — Journal of the American Veterinary Medical Association

Case Report

Magnetic resonance imaging findings in the equine deep digital flexor tendon and distal sesamoid bone in advanced navicular disease--an ex vivo study.

Busoni, Heimann, Trenteseaux et al. (2005) — Veterinary radiology &amp; ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association

Case Report

Magnetic resonance imaging of the equine foot: 15 horses.

Dyson S, Murray R, Schramme M et al. (2003) — Equine veterinary journal

Case Report

Podotrochlear bursa endoscopy in the horse: a cadaver study.

Cruz A M, Pharr J W, Bailey J V et al. (2001) — Veterinary surgery : VS

Case Report

Use of radiography, computed tomography and magnetic resonance imaging for evaluation of navicular syndrome in the horse.

Widmer, Buckwalter, Fessler et al. (2000) — Veterinary radiology &amp; ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association

Case Report

The arterial supply of the navicular bone in adult horses with navicular disease.

Rijkenhuizen, N&#xe9;meth, Dik et al. (1990) — Equine veterinary journal

Case Report

Development of the navicular bone in foetal and young horses, including the arterial supply.

Rijkenhuizen, N&#xe9;meth, Dik et al. (1990) — Equine veterinary journal

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

Presence and size of synovial masses within the navicular bursa correlate well between magnetic resonance imaging and bursoscopy and have a guarded prognosis.

Giorio Maria Elisabetta, Graham Robyn J, Berner Dagmar et al. (2024) — Equine veterinary journal

Expert Opinion

A review of radiographic interpretation of the navicular bone

F. Hinkle, Myra Barrett (2024) — UK-Vet Equine

Expert Opinion

Equine Nuclear Medicine in 2024: Use and Value of Scintigraphy and PET in Equine Lameness Diagnosis.

Spriet Mathieu, Vandenberghe Filip (2024) — Animals : an open access journal from MDPI

Expert Opinion

Review of the Mechanism of Action and Use of Bisphosphonates in Horses.

Yocom Alicia, Contino Erin, Kawcak Christopher (2023) — Journal of equine veterinary science

Expert Opinion

Equine shock wave therapy - where are we now?

Johnson Sherry A, Richards Roderick B, Frisbie David D et al. (2023) — Equine veterinary journal

Expert Opinion

An Alternate Radiographic Guided Technique for Injection of the Equine Navicular Bursa Using a 40 mm (1.5-inch) 20-Gauge Needle: A Pilot Study.

McInturff Colton, Zanotto Gustavo, McInturff Monty et al. (2022) — Journal of equine veterinary science

Expert Opinion

Interpretation of distal limb nerve blocks in the horse

Findley Judith (2021) — UK-Vet Equine

Expert Opinion

The equine navicular apparatus as a premier enthesis organ: Functional implications.

Osborn, Cornille, Blas-Machado et al. (2021) — Veterinary surgery : VS

Expert Opinion

CPD article: Radiographic interpretation of the navicular bone: a review

F. Hinkle, M. Barrett (2020) — UK-Vet Equine

Expert Opinion

Clinical efficacy of clodronic acid in horses diagnosed with navicular syndrome: A field study using objective and subjective lameness evaluation.

D. Argüelles, A. Saitua, Antonia Sánchez de Medina et al. (2019) — Research in veterinary science

Expert Opinion

Radiological appearance of the navicular bone

Biggi Marianna (2018) — Equine Health

Expert Opinion

Transthecal Arthroscopy of the Palmar Distal Interphalangeal Joint in the Horse: A Cadaver Study.

Rubio-Mart&#xed;nez Luis M, Bracamonte Jose L, Tompkins Samantha et al. (2015) — Veterinary surgery : VS

Expert Opinion

Navicular syndrome

Shepherd Chris (2014) — Equine Health

Expert Opinion

Equine imaging: the framework for applying therapeutic farriery.

Eggleston (2013) — The Veterinary clinics of North America. Equine practice

Expert Opinion

Navicular syndrome in equine patients anatomy, causes, and diagnosis.

Waguespack, Hanson (2013) — Compendium (Yardley, PA)

Expert Opinion

Treating navicular syndrome in equine patients.

Waguespack, Hanson (2013) — Compendium (Yardley, PA)

Expert Opinion

Steroid diffusion into the navicular bursa occurs in horses affected by palmar foot pain.

Manfredi J M, Boyce M, Malone E D et al. (2012) — The Veterinary record

Expert Opinion

Comparisons of computed tomography, contrast-enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot. Part 2: Lesion identification.

Vallance S A, Bell R J W, Spriet M et al. (2012) — Equine veterinary journal

Expert Opinion

Core decompression of the equine navicular bone: an in vitro biomechanical study.

Jenner Florien, Kirker-Head Carl (2011) — Veterinary surgery : VS

Expert Opinion

Comparison of high-field and low-field magnetic resonance images of cadaver limbs of horses.

Murray R C, Mair T S, Sherlock C E et al. (2009) — The Veterinary record

Expert Opinion

Intra- and interobserver agreement in the interpretation of navicular bones on radiographs and computed tomography scans.

Groth, May, Weaver et al. (2009) — Equine veterinary journal

Expert Opinion

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

Byron, Stewart, Benson et al. (2009) — Veterinary and comparative orthopaedics and traumatology : V.C.O.T

Expert Opinion

Skeletal scintigraphy in the horse: current indications and validity as a diagnostic test.

Archer D C, Boswell J C, Voute L C et al. (2007) — Veterinary journal (London, England : 1997)

Expert Opinion

Quantitative comparison of three commonly used treatments for navicular syndrome in horses.

Schoonover, Jann, Blaik (2005) — American journal of veterinary research

Expert Opinion

Mepivacaine local anaesthetic duration in equine palmar digital nerve blocks.

Bidwell L A, Brown K E, Cordier A et al. (2004) — Equine veterinary journal

Expert Opinion

Radiographic imaging of the equine foot.

Redden (2003) — The Veterinary clinics of North America. Equine practice

Expert Opinion

Isoxsuprine hydrochloride in the horse: a review.

Erkert, Macallister (2002) — Journal of veterinary pharmacology and therapeutics

Expert Opinion

An in vitro study to compare 5 different techniques for injection of the navicular bursa in the horse.

Schramme M C, Boswell J C, Hamhougias K et al. (2000) — Equine veterinary journal

Expert Opinion

Treatment and pathogenesis of navicular disease ('syndrome') in horses.

Leach (1994) — Equine veterinary journal

Expert Opinion

Biomechanical considerations in the treatment of navicular disease.

Wright, Douglas (1993) — The Veterinary record

Expert Opinion

Standing surgical procedures of the foot.

Honnas (1992) — The Veterinary clinics of North America. Equine practice

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

Pathophysiology of navicular syndrome.

Pool, Meagher, Stover (1989) — The Veterinary clinics of North America. Equine practice

Expert Opinion

Diagnosis and treatment of the navicular syndrome in horses.

Turner (1989) — The Veterinary clinics of North America. Equine practice

Expert Opinion

[The diagnostic value of the 'skyline' view for the radiographic study of the navicular bone in horses].

Zweers, Dik (1988) — Tijdschrift voor diergeneeskunde

Expert Opinion