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  Discussion on Confusion of terms
Author Message
Member:
Miamoo

Posted on Friday, Aug 26, 2005 - 7:43 am:

Hi all,

I am trying to sort out in my mind what the difference between Navicular SynDrOme and Caudal Heel SynDrOme are and how to tell one from the other. As far as I can tell Navicular SynDrOme is pain in the feet that can be localized around the Navicular bone and Caudal Heel is pain localized in the heel. As the Navicular bone is quite close to the heel I am not sure how to tell the difference.

Thanks for any help in advance.

Ella :-)
Moderator:
DrO

Posted on Saturday, Aug 27, 2005 - 11:05 am:

There are really synonymous and both mean pain of unknown cause that localizes to the heel which also includes the navicular region. The current preferred term is "caudal heel pain synDrOme" because some of the previous undiagnosed problems turn out to be not associated with the navicular bone or its supporting structures. One researcher recently raised the objection that, "isn't the heel always caudal in the foot or are we just talking about the back of the heel?" and suggested changing this to "caudal foot pain synDrOme" or simply "heel pain synDrOme". Watch for future updates!
DrO
Member:
Fpony

Posted on Sunday, Aug 28, 2005 - 8:36 am:

Dr. O, Has there been any information about the digital cushion and damage to it? It must be innervated, right?
My own horse has had difficulty with hard surfaces even with shoes on. He has been barefoot for almost a year. His feet look great but I made the most progress when I started protecting his heels from moisture. I put desitin on his heel bulbs and frogs every morning before turn out in the dew soaked pastures. He is now tolerating more impact on his heels. The bulbs and frogs are dried and hard. Before doing the desitin his heels were a bit contracted and both frogs and heel bulbs soft. I tried boots for the road riding and it made no change as there was still impact with no cushion. I haven't had x-rays as my vet didn't think there could be anything wrong. He was never "lame" just not forward and stabbing in the front when on hard surfaces(gravel road or smooth pavement).On the gravel road he would be fine if he was on the loose but very rocky shoulder.Kim
Moderator:
DrO

Posted on Sunday, Aug 28, 2005 - 10:04 am:

Though we are categorizing changes in the digital cushion associated with chronic lameness we don't as yet recognize any diseases of the digitial cushion. There is new research on the function of the digital cushion and it appears that its main function is to support the bones above it. Interestingly the degree of pressure applied to the dc was independent of the amount of solar protection. I have seen many horses that step carefully on pavement that seem to me to be just being careful because they sense the surface might be slippery.
DrO
Member:
Miamoo

Posted on Monday, Aug 29, 2005 - 8:16 am:

Dr O,

Sorry I am so late getting back to this post. Horseshow weekend, you know how that goes.

Thank you for your answer. I guess my lack of understanding is o.k. because the experts are still trying to decide what the correct term is. My previously diagnosed navicular synDrOme mare is now being considered a caulal heel synDrOme horse. I wasn't sure if this was good news, bad news or just news. I guess it is just news......:-)
Moderator:
DrO

Posted on Monday, Aug 29, 2005 - 9:12 am:

You are right, you still don't know, but at least you have a brand new spanking name for it!
DrO
Member:
Miamoo

Posted on Monday, Aug 29, 2005 - 9:16 am:

Hi Again,

My Navicular/Caudal Heel SynDrOme (or whatever it is) Mare has had a flair up. She seems to get significant relief (from not wanting to move faster than a walk to wanting to run around like an idiot) from DMSO on the back of her pasterns and her heels. Might this give any ideas to someone who knows more than me regarding where in her heal that the flair up is coming from?

Ella :-)
Member:
Miamoo

Posted on Wednesday, Sep 7, 2005 - 8:30 am:

Hi Dr. O,

My mare has had an injection in the coffin joint and wedge rim pads added to aluminum shoes (She is better but not perfect. I can still see her slightly off going around corners to the right). I am more interested in a long term health of this mare than being able to ride her today. What is my best option?

1. Turn her out in a pasture for 6 months and start her back slowly.

2. stall rest and/ or hand walking (some combination of the two) to turnout and then start back in March or so.

3. Keep riding her if she seems comfortable.

My vet seems to think she should keep going but I read so many articles that say that too often horses don't recover simply because they don't get enough healing time. What are your thoughts?

Ella :-)oH
Moderator:
DrO

Posted on Thursday, Sep 8, 2005 - 7:38 am:

Concerning trimming and shoeing and medical therapy see the article. Since we don't know what exactly is wrong the proper amount of exercise is a ongoing experiment. If this is an acute lameness your sources could be right, further rest, antiinflammatories, and hand walking may allow tissues to heal better. This is particularly true in cases of acute soft tissue damage.

However many cases of undiagnosed chronic heel pain worsen standing in a stall and I find pasture rest along with the other suggestions in the article keeps the horse quite usable for light work. I guess what we need is a concise yet thorough history.
DrO
Member:
Miamoo

Posted on Thursday, Sep 8, 2005 - 11:00 am:

Hi Dr. O,

Thanks for the reply. This mare had (what became) quite severe heel pain about 2 years ago. It became severe because it was bilateral and therefore she didn't limp and we didn't know what was wrong. We could tell that there was a problem but it got diagnosed a bunch of different places - probably from pain that got referred from sore untreated feet. When we finally got the source of pain localized we treated the feet with bar shoes and injected them. Her feet were better but she was sore other places, just body sore. I turned her out for the winter to let the rest of her body heal. I was not able to leave the bar shoes on because she pulled them (about twice a week), I became the sole support of the local bell boot trade (or so it felt) but it did not work. We then went to regular shoes with really short toes. She came back last spring quite good and was worked lightly for the summer with good results. She came back this spring good but has come back sore after another pulled shoe. I t was only one shoe but she ended up sore in both feet????? This was when I started this post. The vet called it Caudal Heel SynDrOme which they had diagnosed as Navicular synDrOme originally which confused me.

What really seemed to help was DMSO on h er heals. She was much more comfortable but they skurfed up in two days so the vet had me stop. He injected the coffin joint and had the blacksmith put on wedge rim pads with an aluminum shoe. She looks "almost" sound. He says ride her lightly that it is better to keep her moving. I just don't want to make the problem worse if rest will make it more likely for her to be sound in the future.

One thing you said did ring a bell however. When we did not know what was wrong Tufts thought it was in her b a ck. They injected her back and had me stall rest her for 3 weeks with bute. She came out of her stall worse then she went in so I guess stall rest would not do the trick. I guess I need to decide between turning her out to pasture and continuing to r ide her lightly.

Hopefully this rambling is making some sense.

Ella :-)
Member:
Miamoo

Posted on Saturday, Sep 10, 2005 - 10:33 am:

Does anyone have any thoughts about continuing to ride lightly versus turn out for a number of months for long term prognosis of caudal heel pain?

Thanks,

Ella :-)

p.s. Does anyone know how thick is the hoof wall up about 1/2 inch down from the coronary band?
Moderator:
DrO

Posted on Sunday, Sep 11, 2005 - 9:12 am:

Sorry Ella,
I posted earlier and apparently did not push the final post button.

I would think after 2 years you are pass the healing phase and into seeing what the horse can do phase. The amount of work you can do without increasing the lameness is trial and error however and a carefully kept diary will help you make decisions. Go slow and if you find the horse is unable to work consider a neurectomy if there are no progressive lesions in the foot.

The thickness of the wall would vary by size and weight of the horse and, if you measuring by radiographs, the technique used as there is some magnification.
DrO
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