Navicular Syndrome- lame mare MRI

Here is the text of the MRI report. The MRI vet believes that this lameness is the result of a lifetime of crooked legs and balance issues with a fairly large horse. I have tried 2 other farriers and a barefoot farrier. He has kept her toes short and based on her collateral groove depth and my inexperienced visual judgement she appears balanced. She is moving better with this trimmer than the previous 2 others. Here is the report.

“Katie Girl” has had a low grade LF distal limb lameness for over 18 months. The last time “Katie Girl” underwent a comprehensive lameness evaluation, including diagnostic peripheral nerve anesthesia was in June, 2018. At that time “Katie Girl” was noted to be 2/5 lame LF most noticeable on a circle to the right. PD nerve anesthesia improved the lameness by 75% and she was then noted to be 1-2/5 lame RF on a left circle. PD nerve anesthesia of the RF abolished the lameness.

“Katie Girl” was not evaluated again for lameness by Genesee Valley Equine Clinic until July 3, 2019. “Katie Girl’s” owner, Maureen, had been away for a few weeks and upon her return felt that the mare was very off in both front feet and expressed some concern about laminitis. An evaluation revealed a baseline level of soundness, but DP and lateral radiographs of both front feet were taken to check for evidence of rotation of the distal phalanx.

Since this last evaluation, the LF lameness has waxed and waned. “Katie Girl” appears to be more comfortable when her toes are shortened. “Katie Girl” is and has been barefoot. MR imaging requested by Maureen. It was recommended that prior to coming in for advanced diagnostic imaging a comprehensive lameness evaluation be repeated but due to environmental restrictions this was not able to be performed.

Left fore: There is mild to moderate synovitis and mild arthrosis affecting the distal interphalangeal joint with mild to moderate joint capsule enthesopathy characterized by osseous proliferation on the dorsal aspect of the middle phalanx. The navicular bone has mild distal margin remodeling. Multifocal mild fiber abnormalities are present in the deep digital flexor tendon at the level of the navicular bone. There is focal mild to moderate resorption of the palmar aspect of the medial fossa of the middle phalanx at the attachment of the medial collateral ligament of the distal interphalangeal joint. There are moderate fiber abnormalities and multifocal fiber disruption in the medial collateral ligament of the distal interphalangeal joint through out its length. There is mild to moderate ossification of the collateral cartilages of the distal phalanx. There is mild to moderate remodeling of the medial fossa of the distal phalanx at the insertion of the medial collateral ligament of the distal interphalangeal joint characterized by resorption and enthesophyte formation. There is peripheral study artifact preventing complete evaluation of the dorsal distal aspect of the distal phalanx and the associated lamina, and there are probable laminar and possible distal phalanx defects in this region.

Right fore: There is mild to moderate synovitis and mild arthrosis affecting the distal interphalangeal joint. There is a laminar and osseous defect on the solar margin of the distal phalanx medial of midline. The navicular bone has mild palmar fluid and mild distal margin remodeling. There is mild bursitis in the proximal recess of the navicular bursa characterized by increased fluid as well as focal lateral synovial proliferation in the distal recess. There are mild to moderate fiber abnormalities in the medial lobe of the deep digital flexor tendon at the level of the middle phalanx with associated lobe enlargement. There is mild to moderate fiber abnormalities in the medial collateral ligament of the distal interphalangeal joint at the distal aspect of the middle phalanx. The appearance of the lateral collateral ligament of the distal interphalangeal joint is consistent with magic angle effect. However, mild

[Report of Imaging Findings Referring Practice Dr. Stacey Kent VMD EQUIGEN, LLC Thursday, December 5, 2019 MR (Magnetic Resonance) Imaging Details Report created through Asteris Keystone Teleconsultation Page 1 of 2 Dr. Natasha Werpy DACVR DVM Equine Diagnostic Imaging, Inc.]

degenerative injury cannot be ruled out with this appearance. There is mild to moderate remodeling of the fossae of the distal phalanx at the insertions of the collateral ligaments of the distal interphalangeal joint characterized by resorption and enthesophyte formation. The extensive moderate desmopathy and mild to moderate enthesopathy affecting the medial collateral ligament of the distal interphalangeal joint is the most clinically relevant finding in the left front foot. The right front foot has mild to moderate desmopathy affecting the medial collateral ligament of the distal interphalangeal joint, focal mild to moderate deep digital flexor tendinopathy and mild navicular bone fluid. In addition, there is a solar laminar and distal phalanx defect in the right front foot and probable laminar and possible distal phalanx defects in the left front foot. Further investigation of the front feet is recommended as a space occupying lesion, such as a keratoma, should be considered for these findings. The remaining findings on this study should be clinically correlated. Osseous fluid can be the result of contusion and/or degenerative injury. Osseous fluid as a result of contusion typically resolves with rest, while degenerative injury can result in persistent fluid that may be associated with chronic lameness.

Conclusions:
Left fore: Mild to moderate synovitis and mild arthrosis and mild to moderate joint capsule enthesopathy, distal interphalangeal joint Mild distal margin remodeling, navicular bone Multifocal mild deep digital flexor tendinopathy Extensive moderate desmopathy and mild to moderate enthesopathy, medial collateral ligament of the distal interphalangeal joint Mild to moderate collateral cartilage ossification, distal phalanx Peripheral study artifact and probable laminar and possible osseous defects, distal phalanx and the associated lamina
Right fore: Mild to moderate synovitis and mild arthrosis, distal interphalangeal joint Laminar and osseous defect, distal phalanx solar margin Mild palmar fluid and mild distal margin remodeling, navicular bone Mild navicular bursitis Focal mild to moderate deep digital flexor tendinopathy Mild to moderate desmopathy, medial collateral ligament of the distal interphalangeal joint Probable magic angle effect, lateral collateral ligament of the distal interphalangeal joint Mild to moderate insertional enthesopathy, collateral ligaments of the distal interphalangeal joint

Thank you very much! Am I correct in understanding that shock wave will relieve pain but not help with healing the problems that exist? Does it only kill pain or does it have long term beneficial effects for a horse like Katie? The last thing I want to do is make her problems worse for a temporary fix. My vet is out of town and we will speak next week but the more I know about this the better. If this was your long term, family pet, keeper horse- what would you do?

Thanks very much! I read more about ECSWT as well as IRAP and PRP.There just aren’t any magic fixes:-). I’m going to work with my farrier to understand more about keeping her feet balanced. She gets done every 4 weeks and I’m not sure if anything can be improved. In the spring I am going to redo her paddock so that she has better footing in our muddy, snowy, icy winters.I always want to do something to try and “fix things” but it doesn’t look like this is possible. Katie is a pleasure to have around and retirement from riding her seems to be the right thing.