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  Discussion on Research Study: Raising the Heels and Chronic Heel Pain
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Moderator:
DrO

Posted on Thursday, Jul 16, 2009 - 8:27 am:

Elevating heels is a time honored management technique for chronic heel pain (CHP) in horses. This report finds that while the procedure does relieve pressure on the palmar surface of the bone it moves it to other areas that are also prone to disease.
DrO

Vet Comp Orthop Traumatol. 2009;22(4):278-82.
Pressure distribution between the deep digital flexor tendon and the navicular bone, and the effect of raising the heels in vitro.

Weaver MP, Shaw DJ, Munaiwa G, Fitzpatrick DP, Bellenger CR.

Martin Weaver, Easter Bush Veterinary Centre, University of Edinburgh, Roslin, Midlothian EH25 9RG, United Kingdom, Phone: +44 131 650 6253, Fax: +44 131 650 8824, E-mail: martin.weaver@ed.ac.uk.

The objectives of this study were to topographically map pressure distribution across the palmar surface of the navicular bone in response to forces applied by the deep digital flexor tendon (DDFT), and evaluate the effect of raising the heels in vitro . A rig was constructed to hold an equine cadaver limb and apply controlled pressure to the navicular bone from the DDFT. Pressure-sensitive paper was used to quantify and map the resultant pressure. Changes in response to heel wedges (5 degrees and 10 degrees ) were recorded. The areas subject to maximum pressure from the DDFT were: the central ridge, the paired symmetrical areas adjacent to the ridge and the distal edge of the palmar bone surface. These regions correspond to the known sites of navicular pathology. Heel wedges redistributed the pressure exerted on the palmar surface of the navicular bone, with measurements varying depending on fetlock angle and wedge angle. These in vitro results support the hypothesis that inappropriate forces exerted via the DDFT on the bone cause navicular disease. However, they throw doubt on the practice of shoeing such horses with heel wedges as the redistribution of pressure may increase the force exerted on regions predisposed to disease.
Member:
imogen

Posted on Thursday, Jul 16, 2009 - 9:42 am:

Thank you Dr O I will print this out and give it to both my farriers!

Imogen
Member:
vickiann

Posted on Thursday, Jul 16, 2009 - 11:15 pm:

Thanks, Dr. O.

Very interesting.
Member:
lynnland

Posted on Thursday, Jun 16, 2011 - 8:56 am:

OK...so if we shouldn't use wedges...what do we do if the hoof is already in balance and we still have a lame horse after a lot of rest (min 4 months)?
Member:
paul303

Posted on Friday, Jun 17, 2011 - 12:56 am:

I've been reading a lot on these changing ideas on Navicular. I understand what is behind them, but I would think twice if any one has a horse in raised heels for a long time. My mare has been in raised heels(and rolled toes) since 1985. Every few years we have the shoes pulled to take x-rays, then replace the shoes immediately. The vet and farrier usually come together.

Her last x-rays, about 3 years ago, the farrier pulled the shoes, but the vet had an emergency and couldn't come. She came the next day, but then the farrier was injured and couldn't come back right away. The mare was barefoot for about 4 days. She first became very tender, and then bowed the tendon's in both legs ( even though we confined her ). I guess, after most of her life in raised heels, her tendons shortened a bit.

I wouldn't hesitate to try the new ideas on a newly or recently diagnosed horse. But if the horse has been in raised heels for years....lowering the heels back down would probably have to be done very gradually. I'd never attempt it on my 31 year old. She's been in raised heels too long.
Member:
lynnland

Posted on Friday, Jun 17, 2011 - 7:11 am:

Hi Lee,

Couldn't agree with you more, that taking a horse that has been in wedges off of them should be done very carefully and slowly. In the case of your mare - I wouldn't do it a all. However, would you put a newly diagnosed horse that had not previously been in wedges in them? (which is what I have decided to do-I think- with my horse.)
Moderator:
DrO

Posted on Friday, Jun 17, 2011 - 8:01 am:

Hello LynnL,
I don't think this summary says you should not use heel wedges but it says that it "suggests" to "throw doubt" on the routine recommendation of this practice. The problem is that chronic heel pain is not a single disease so while pain coming from painful structures that wedges decrease the pressure on may experience relief while it may exacerbate problem with other locations. We address your specific question in the article associated with this discussion area. Look under the Treatment topic, Trimming and Shoeing subtopic.
DrO
Member:
ajudson1

Posted on Friday, Jun 17, 2011 - 10:48 am:

I would think using wedges TEMPORARILY should be done at first sign of lameness due to this type of injury. Then the wedges should be slowly but consistently lowered the while other measures are being taken. I would think it would a mistake to:

Use the wedges and for a long period of time since anytime you provide a "crutch" for an injury it will heal in that form for lack of a better way of saying it.

Extended stall rest is not strengthening the injured area. Just as giving something like Bute masks the pain of an injury, and reduces inflammation, you don't want pain masked too much and the horse re-injures himself.

I think the statement DrO makes above says it all:
The problem is that chronic heel pain is not a single disease so while pain coming from structures that wedges decrease the pressure may experience relief, otherwise ti may exacerbate problems."

Just my 2 cents worth. And honestly, I am thinking about human injuries here too, my own, and my basketball playing daughter's many ankle/knee/feet pain/injuries!
Member:
paul303

Posted on Saturday, Jun 18, 2011 - 1:19 am:

Lynn, I guess that with a horse already in good hoof balance yet still sore, I would be willing to try a wedge.

I know that a number of years back, there was a movement that claimed that navicular could be cured with the proper barefoot trim. The explanation was reasonable and logical, but the horseowner is left to wonder how many farriers have the knowledge and expertise to carry out the procedure?

As Dr.O notes, this is a "heads up" to an alternate direction that navicular synDrOme treatment is heading. It will probably be awhile before a viable proven treatment conclusion emerges. Until then, you'll try what you can to get your horse out of pain...yet, at the same time, you'll be aware of the promise of possible new solutions that may be on the horizon.

If you want to know my experience, the wedges worked decently. I had to take her out of reining, but she was still able to show pleasure quite comfortably. It took me about 6 years to figure out that my mare needed her toes rolled ( or rockered )with the raised heels. Easing of the breakover, with her, was very important.

In the winter, with the chance of snow, ice and slush, I always have Equipak put over her soles. It almost completely protects her from snowballs in her feet - which totally aggravated her navicular.

If you can get your horse straightened out, just remember to never go overtime on your shoeings. You can't let that angle grow too far out of shape.
Moderator:
DrO

Posted on Saturday, Jun 18, 2011 - 9:27 am:

Angie, wedges are not the first thing I would recommend, the first thing I would recommend is to follow the instructions in our article and see if these changes help. If not, then wedges can be considered.

Lee your practical advice is spot on but your hope for a treatment suggests a misunderstanding of the term "Navicular SynDrOme". NS is a constellation of many disease and each will need their own unique treatment if one is available. However many of these diseases are degenerative conditions of bone and/or soft tissue that are not curable by any known interventions so therefore they must be managed to the point of as irritation as possible. We lump them all together under the term "NS" or more recently "Chronic Heel Pain" because from a diagnostic standpoint what is available in the field can only get so far with separating out the various specific diseases from one another. The use of more technically challenging blocks, ultrasound, and MRI have greatly improved our ability to determine the cause of CHP and better prognose all causes and treat some causes. For more on this see the article associated with this discussion area.
DrO
Member:
paul303

Posted on Sunday, Jun 19, 2011 - 1:18 am:

Yes, I see what you mean. Not a solution, but a mitigation of the pain and slowing of the breakdown of the particular tissues and structures involved. All horses will not need the same treatment.

But I have to give you credit for making me tighten up my treatment plan years ago. The different things we've tried I've been able to become familiar with here before I ever approach my vet and farrier. Thanks to you, I've understood just what the vet was after each time she wanted nerve blocks, and the importance of working with the farrier to set a strict shoeing schedule. I gained insight on Adequan, Legend and HA injections and could make a decision with my vet on what might be worth a try. I give much credit to the guidance and discussions on this site for my comfortable 31 year old lady.
Moderator:
DrO

Posted on Sunday, Jun 19, 2011 - 9:52 am:

Thanks Lee for the kudos and thank you for your support of this site.
DrO
Member:
babychop

Posted on Sunday, Jun 19, 2011 - 11:46 am:

When I lived in Alaska they were experimenting with severing the ligament that runs over the navicular bone and re-attaching it above, I don't know what came of that but from what the owner of the horse in question told me it seemed to be working. Sounded rather severe but it would relieve the pain of the tendon/ligament (I'm really not sure what parts do what in this so forgive my layman's talk) as it no longer rubbed across the pitted bone. The horse I saw still had wraps around it's fetlocks and was in recovery. Might be something to consider if that study went anywhere but I doubt the legs would be as good as new - I would think the movement and soundness would be affected in another way as the body compensates for these things.

I once had a mare with severe navicular and she would stand with that foot pointed out in front to relive it. Nothing we did ever helped her, it was such a hopeless feeling, I felt guilty for not being able to help her and guilty for not putting her down because of the pain but she had so much heart and such a will to live. It's a tough disease.
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