While all horse owners deal with day-to-day, simple lameness problems, when you get into the next level of problems, we all can use some advice. In this article we'll discuss management of navicular disease, laminitis and arthritis.

“One of the biggest factors in dealing with any chronically lame horse is making sure you have the right diagnosis, and then dealing with it with the help of your veterinarian and farrier,” said Melinda Freckleton, DVM, of Haymarket Veterinary Service in Haymarket, Virginia.

In most cases, appropriate footing is a key piece of the cure. “Make sure it is not too hard, and not too deep. It should be a happy medium, to put the least stress on joints,” she said.

Freckleton noted that slippery, muddy or hard ground and steep slopes are difficult for arthritic horses.

“This is also true for other lameness conditions, including navicular or laminitic horses,” said Julie Bullock, DVM, of Mt. Sidney, Virginia.

And footing matters most for older horses. “Ice storms and other bad weather may make it very difficult for the older horse, and he will need shelter and protection—someplace dry and flat,” explained Bullock.

Navicular Disease

It’s hard to give specific recommendations for the navicular horse, said Freckleton, since the term refers generally to heel pain. “With magnetic resonance imaging (MRI) and other modern diagnostic tools, we’ve now learned that ‘navicular’ encompasses a wide variety of disorders—and all look the same, in terms of clinical signs,” she said. But the appropriate treatments are quite different.

“The navicular horse has two different potential management paths,” said Freckleton.

Managing Acute Navicular Injury

“If pain is related to repetitive stress or acute soft tissue injury, the horse may need to be managed as if he sustained an acute injury, with a period of strict rest followed by rehab,” Freckleton explained. With adequate rest, the prognosis is often good.

Chronic Navicular Injury

A second, more classic navicular scenario is the horse with permanent damage that requires a change in management for the rest of his life. This horse would benefit from good footing, with diligent attention paid to shoeing.

“Trimming and shoeing must be appropriate for the problem, and be done frequently—every four to five weeks compared with the six- to eight-weeks (or longer) that other horses may tolerate. Frequent and proper shoeing is a huge factor for horses with any kind of foot-related lameness,” said Freckleton.

“Individuals that don’t have an acute soft-tissue injury can benefit from consistent exercise—the same amount of time, many days a week—and plenty of turnout, although they don’t need to be out 24/7,” said Freckleton. “They also need consistent follow-up to make sure these things are working and that the horse is staying sound. They may need repeat X rays to help guide the farrier. They may also need follow-up medical care, such as injections of Adequan or Legend, or joint injections,” Freckleton said.

Medications vary. Some are more effective with specific breeds. Your veterinarian may select what has worked well in his experience with a certain type of horse. “Here in northern Virginia, I don’t see a lot of working Quarter Horses. Consequently, I might not reach for the best drug for that breed on my first try. I see lots of off-the-track Thoroughbreds, warmbloods, and walking horses, and they have a little different physiology and tendency about what happens inside the foot,” Freckleton said.

A proper diagnosis is essential. “Some horses with chronic heel pain get a neurectomy (to eliminate the pain) rather than a proper diagnosis,” said Bullock. “The horse is then turned out for exercise or the owner starts riding, then the horse ruptures the flexor tendon because there was a big hole in it. On the other side of the coin are the horses where we pull the shoes, trim them, and just turn them out, and some improve.” Those horses just needed a chance to heal.

If the horse seems to get worse with exercise, however, limit his movement. “This is a big red flag, and you need to re-evaluate what might be causing the heel pain,” said Bullock.

General Navicular Considerations

“The quality of footing is paramount with any navicular horse. Riders should be very picky and make sure footing is not too deep, not too hard and very consistent,” Freckleton said. Even the turn-out area at the barn needs ideal footing for the navicular horse.

“In summer, fly management is crucial for the horse with heel pain. If he’s stomping his feet all the time, this will aggravate the condition. Fly management can make a big difference,” she said.

Laminitis and Founder

Managing a laminitic horse varies depending on whether the condition is acute or chronic, Bullock says.

Acute Laminitis

“A horse suffering from acute laminitis should not be moved or exercised. These animals must be kept in a stall until they stabilize. You determine the length of confinement via radiographs, a venogram, or response to therapy,” Bullock said.

“There should be a cooperative relationship between the veterinarian, the farrier, the owner and the people taking care of the horse,” said Freckleton. “There will be a lot of time spent with the farrier because these horses need frequent shoe resets. This may mean two- or three-week intervals during early convalescence.”

The horse will need X rays, too. In some cases, feed needs to be reduced or changed. “Most of these horses need a special diet, with low starch, low soluble-sugar content. Hay may also need to be analyzed,” she said.

Chronic Laminitis

“Many of the chronically laminitic horses in my practice either have Cushing's disease or are insulin-resistant and, in some cases, are overfed and under-exercised,” said Bullock. “Those animals may need to be in a dry lot diet paddock. They can be difficult to manage because often their hay must be soaked (to reduce sugar content) for 30 minutes to an hour—and the water poured off to leach out the sugar.”

In the past, horse owners often relied on appearance of the hay to gauge sugar content. Even if it looks dead and brown, it can still be high in sugar. “Unless you test it, you don’t know whether the grass is actually safe for the horse,” Bullock said.

“If you turn a laminitic horse out on pasture for exercise, you may need to put a muzzle on him or limit the amount of time he has access to grazing. Any hay fed should be low in sugar, and any other feeds should be low in starch. Most of these horses merely need a little hay and a vitamin-mineral supplement.

“If they can be exercised, this can help keep their metabolic rate up (to burn sugars and starches), but some can’t tolerate exercise. Some can only be pasture sound,” said Bullock.

“The horse may need to be on pergolide or thyroid hormone supplement (a prescription drug) to help with the metabolic situation if there’s an endocrine problem,” said Freckleton. “The horse may also be on NSAIDs for pain control, such as Equioxx, phenylbutazone or something similar. DMSO can help ease pain and inflammation, and other drugs (such as pentoxifylline or isoxsuprine) may be used to try to change the blood flow to the feet. The horse will need to be re-tested periodically to make sure the medication and dosage remains correct—as the horse gets older, the dosage needs to be increased,” Freckleton said.

One important management step is providing a small space with cushioned footing. “The stall or pen needs to have six to eight inches of bedding or four to six inches of sand so the feet are well padded. Soft bedding will encourage the horse to lie down, and when he’s on his feet, they won’t be stressed. This makes a huge difference for these horses,” she noted.

Followup Care

“The owner needs to realize why the horse foundered in the first place. If it was related to an isolated illness, the horse will need less long-term management after recovery. But more commonly, we see horses with endocrine problems that need special care for the rest of their lives. If they are given medication for Cushing's, this will be a life-long commitment the owner must accept,” said Freckleton.

When the horse is recovering and returning to normal life, farrier care is very important. “This is usually crucial for the rest of the horse’s life. You need a top-notch farrier who is willing to work with the vet. The horse may periodically need X rays to help guide the farrier. The outside of the hoof can be deceptive; you can’t always tell the angle/alignment of the coffin bone by looking at the foot,” she explained.

“Frequent trimming is paramount, to keep the toe short to ease break-over,” said Bullock. “You need to keep the lever arm of the toe trimmed back. Some foundered horses grow very little sole, so they are often sore. Some must be shod, and some wear clogs. Some I put in Softride boots that can be taken on and off with Velcro. Those boots can be used intermittently” when the horse is on hard ground, she said.

“Ideally, it is great if you can get a chronic laminitic horse able to go barefoot. That’s easier on the horse and the pocketbook—just doing frequent trimming to keep the feet short and at proper angle,” said Bullock.

Diet and weight management are important, especially if the problem was metabolic, such as insulin resistance or Cushings. “Those horses need to be permanently on a strict diet to keep body condition low, so they don’t founder again,” said Freckleton.

Exercise can help, too. “With some horses, staying slim is not enough. They need exercise. Turnout is a good start, as long as they are not eating rich grass. But the best program is active exercise. Workouts don’t need to be long, but they do need to be aerobic to shift the horse’s metabolism into athletic mode,” Freckleton said.

Sometimes, relinquishing control of care eases stress on the owner. “I’ve taken some of these horses out of the owners’ hands and sent them to a boarding facility. The barn staff may be able to care for the horse less emotionally,” she explained.

Arthritis

Many older horses develop arthritis in various joints, including the lower joints in the foot. “Most arthritic horses do better with some degree of exercise,” said Bullock. A horse that is inactive tends to get worse. The old saying “move it or lose it” applies here.

“When you turn the horse out, they may be stiff and sore for the first 30 minutes to an hour (depending on the conditions). Then they appear to loosen up and get more comfortable. Ringbone horses, especially, seem to do best with exercise,” said Bullock.

“The geriatric horses that can barely get around need to be protected, however, so other horses don’t pick on them,” Freckleton cautioned.

Horses that are still ridable “need plenty of turnout time and consistent exercise throughout the week. But the rider needs to have realistic demands. If the horse has severe arthritis in the hocks, he may not be able to piaffe, jump big fences, or do any fast cutting work,” she added. These horses need more time for warmup and cool down, too.

Arthritis Medications

“Judicious use of NSAIDs can help, especially if the rider knows there will be more demand on the horse than he’s used to,” said Freckleton. Talk to the vet about a little pre- or post-work medication. This can help if the horse is having a day when he’s sore, or if its cold and damp and he’s not warming up well.

Bute is another option, said Bullock, who added, “We now have some anti-inflammatories that are easier on the gut than bute, and we can keep horses on this type of medication continually if necessary. There is also Surpass, a topical anti-inflammatory. This works very well, and we use it on some of the older performance horses that are still competing at low levels, like fox-hunting horses.”

Adequan, Legend and joint injections can also help. “Discuss this with your vet and try to figure out what might work well for that horse,” said Freckleton.

Supplements can help, too. “There are many ‘joint’ supplements available for arthritis. Many people feel they get results from supplements, so this is an avenue to consider,” she said.

Foot Care for Arthritic Horses

“With arthritis, regular foot care is important, to keep everything in proper alignment and balance and put the least stress on joints. Trimming and shoeing to help ease breakover in the front feet can make the pastern and fetlock joints more comfortable. Sometimes wedging the heels on the hind feet can take some stress off hocks and stifles. This all has to be done very carefully, so you need a good farrier. These horses might need very strict five- to eight-week intervals, and never be left 10 or 12 weeks with the same shoes,” Freckleton said.

As an example, Bullock said, “At one barn here we have two horses that are fox hunting in spite of their ringbone. We keep them shod properly, using radiographs to guide the alignment. And we inject the coffin joint and pastern joint. The farrier enhances the foot breakover—not only forward, but also when turning. The shoe is always beveled to make it easier.”

The main ingredient in managing the chronically lame or arthritic horse is common sense. Proper care and management can extend the useful lives of many horses, and help them stay a lot more comfortable.

Heather Smith Thomas