Navicular Disease – Horse & Rider Magazine (2013)

navicular1 In October 2011 I was asked by Shirley Clifford Thorp to see if some Alexander Technique  would benefit her intermediate eventer.  Unfortunately, in the spring Thomas Tallis had been diagnosed with both navicular disease and syndrome (ie lesions in the navicular bone revealed by radiography and lesions in the  soft tissue associated with navicular bone revealed by MRI scans).There was also damage to the deep flexor tendon.  He was treated conventionally with Tildren r (tiludronate) and remedial farriery but was not making the progress hoped for and Shirley was at a loss as to what to do. Knowing that I had helped my horse Spooks with my Alexander work (see H & R Oct 1993) Shirley thought that it might help Thomas as well.

After visiting and assessing Thomas with my hands at his competition yard, I suggested that we contact Nick West MRCVS who is one of only two vets in the country trained in Equine Podiatry and fortunately he lived locally. I recognised that an holistic approach was needed. This would mean equine podiatry and rehabilitation management, Alexander work and Cranial Osteopathy, as well as nutritional support. Fortunately Shirley agreed with this suggestion.

I also sent her copies of research on navicular from the States which makes fascinating reading. Thankfully research and understanding has moved on and fewer horses are being  written off with the diagnosis.

Nick visited and assessed Thomas to see whether his techniques of Applied Veterinary Equine podiatry would benefit him. Nicks approach is to look at how the ground reaction forces coming through the hoof capsule act upon the bony column and soft tissues of the lower leg  .  The hoof is then trimmed and balanced in such a way as to correct any overgrowth and imbalances to attempt to direct the forces   acting up on the healing tissues in the damaged areas to be as correct/normal as possible.

As the tissue is regenerating it does so with no excessive or misdirected forces acting upon it, and so is more likely to be strong healthy and capable to carry those forces. Importantly it involves a programme of work which will assist the horses muscles and limbs to alter its pattern of compensation to move more freely, but crucially the horse also needs an environment in the field stable and menage which won’t put any undue strain on the healing tissues.

Finally and vitally a sensible well considered exercise and strengthening program is required  This multimodal approach was instigated at a rehabilitation yard  where the individual pracitioners involved attended routinely as required and at times together for progress assessments.

navicular2The following is a diary of Thomas’ rehabilitation over a 12 month period:

DECEMBER 2011

Thomas arrives at Clemmie Prest’s Yard in the beautiful Wye Valley. Clemmie is a talented event rider who specialises in rehabilitation, and both Nick and I have worked with Clemmie over the past 5 years.

The day after his arrival, Thomas’ shoes are removed.

After Thomas had settled in and received the first remedial podiatry treatment, I went to see him. I found a lot of pain and tension in his rights shoulder and back and I started a programme of Alexander work. Horses, like humans need to unlearn patterns of tension which have caused them to alter their manner of movement.  The tension in the shoulder and back was caused by compensation for the lameness pain and by an attempt to avoid  pain. At this stage Thomas wasn’t able to be ridden so I started a course  of Alexander work in the stable every few weeks. Meanwhile his foot shape and balance and strength were improving and the healing process was underway.

Clemmies observations were ;

That Thomas had uneven muscle developement  in the  quarters and  around the withers and his back was dropping.  He moved very much on his forehand which  added to the pressure on his front  feet . Clemmie observed ” Its all a bit of a catch twenty two, Thomas had a stiff and sore back because his feet  were painful so he needs to learn how to use his back correctly again in order to change his balance and movement”

Clemmie also noticed that he held a lot of tension in the jaw and mouth which was probably due to his discomfort, and he was constantly wanting to chew things.

The first problem to be addressed was the thrush that Thomas had in his frog which had been  there  long enough to split the heels. Clemmie treated it with an antiseptic solution and an antifungal ointment daily.

The frog plays a very important role in foot balance in the unshod horse. Clemmie also talked to Roger Hatch of Trinity  consultants who made a bespoke  herbal mixture to aid Thomas metabolism, boost his immune system and promote circulation and horn growth.

JANUARY 2012

Clemmie started to work Thomas in hand and loose school him in walk for a maximum of 20 mins. After a couple of weeks  raised poles were used to encourage Thomas to release  tension in the shoulders and use himself differently. Clemmie also used an electrical acupuncture machine to stimulate points affecting the feet to help Thomas circulation.

Catriona Macdonald, a gifted equine cranial osteopath was also asked for her opinion,

“ Thomas has multiple layers of strain throughout his body and he is compensating for more than just one injury. From an osteopathic perspective in order for the feet to respond most fully,  to Nicks intervention, Thomas body needs to be much freer to allow those shifts to occur. Ie ,as the shoulders  change,the angle of  movement through the  withers is allowed to  rise therefore affecting the distribution of tension in the digital tendon and foot.navicular3

Catriona starts her programme of monthly treatment with Thomas

MARCH 2012

The trims with Nick are making a difference but Thomas is quite sore afterwards and its decided that it would be  better to do less , and the interval reduced to 3 to 4 weeks

At the end of March Clemmie begins to sit on Thomas just in walk, I use my hand to help Thomas learn to release his neck and encourage a new way of going whilst under saddle.

Thomas also has his teeth checked and his old  saddle is exchanged for a saddle which can have new plates inserted in anticipation of his changing withers and back.

MAY/JUNE 2012

Thomas has progressed sufficiently to have a half hour riding lesson with classical trainer Daniel Pevsner FBHS. Danny rides him and gets him more engaged through his back and up through the wither.

Clemmie introduces Thomas to a little road work which is built up  gradually over the next few months.. As it was summer the grass sugars needed to be taken into account as they affect the soles of the feet and are likely to make them more sensitive .

Nick comments on the progress of the feet  “The growth rings on Thomas feet have been a good indicator of the changes they’ve made. In the early photos you can see the growth rings turn down at the heel”

Shirley comes to see Catriona treating Thomas and was not disappointed. Thomas arches his neck and stretched down his back not once but 4 times in succession!

“It was almost as if he was feeling everything letting go” said Shirley, (who completed Badminton several times in the sixties)

AUGUST 2012

Thomas begins to trot more consistently and a new wider saddle plate is inserted. His chest has changed shape as the muscles in his neck and shoulders have released which has affected his back. Catriona comments on how the hindquarters have changed due to the psoas muscle releasing. Clemmie and Thomas also have a lesson from classical trainer Robert  Pring .

SEPTEMBER 2012

By September Thomas was able to sustain a little more canter work although he still finds the  right rein more difficult and has a tendency to be a little nappy. Clemmie feels when he is struggling a bit and does not push him on the days he doesn’t feel so good.

Danny gives her a very useful lesson into  minimizing the strain for Thomas in the canter strike offs. .With a horse like Thomas ,who has had  lots of schooling  it s a question of keeping him happy and interested. I continue to use my hands to help Thomas when under saddle , and notice how much stronger he is  becoming.

Nick takes another scan of Thomas feet

OCTOBER 2012

All meet to look and compare the scans Nick has taken. Its astonishing how much the angle of the bones in the foot has changed  (See Explanation under scan)

NOVEMBER 2012

Thomas is making brilliant progress and we are all excited. Another wider plate is inserted into his saddle.

DECEMBER 2012

The  feet are looking much more of a pair and the heel  is much less under run as showniIn recent pictures. Although both feet had navicular changes, the off fore was worse which meant that the left foot carried more weight and so ended up flatter As the health of the right foot has improved it has taken more weight and therefore lifted some of the burden from the left foot.

To summarize: Thomas is moving completely differently and his back and quarters have become a different shape. He has expanded  three sizes in his saddle plate. Thomas future is looking a lot brighter and there are plans for him to enter a dressage competition in February.!  Its been an amazing journey and its been a real delight working with a dedicated and knowledgeable rider, and the rest of the team which has enabled Thomas to derive maximum benefit  from Nick’s treatment.

Lucky Thomas Tallis for having an owner who had the time and patience and belief in us and her horse. I hope that this story will help other horses diagnosed with navicular.

(Copyright Sally A Tottle)

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