Practitioner Updates

Equine Foot Pain: Treatment Options

[horse's hoof]

Foot pain is the most common cause of lameness in horses. Frequent sources of foot pain include lesions in the navicular apparatus (NA), the distal aspect of the deep digital flexor (DDF) tendon, the distal interphalangeal joint (DIPJ), the collateral ligaments of the DIPJ, the distal phalanx, and the hoof capsule.

Abnormalities of any of these structures rarely occurs in isolation due to the close anatomical and functional relationships of osseous and soft tissue structures of the equine foot.

Although many novel treatment options for equine foot problems initially seem promising, their clinical efficacy remains to be objectively demonstrated. Poor foot conformation negatively impacts mechanical efficiency, which is an important factor in hoof and distal limb health and performance. Current evidence suggests that the severity of injury and the intended use of the horse play a significant role in the response to conservative therapy. In horses with refractory foot pain, palmar/plantar digital neurectomy is still the most common surgical technique used to try to achieve some level of athletic function.

Conservative Treatment Options

  • Intrasynovial anti-inflammatory medication
  • Intralesional and intrasynovial use of biological products
  • Bisphosphonates
  • Botulinum toxin type-B
  • Intraneural injection of alcohol in the palmar digital nerves
  • Extracorporeal shock wave therapy
  • Corrective/therapeutic farriery

Surgical Treatment Options

  • Arthroscopy of the distal interphalangeal joint
  • Navicular bursoscopy
  • Desmotomy of the accessory ligament of the deep digital flexor tendon
  • Cortical fenestration of the navicular bone
  • Distal digital annular ligament desmotomy
  • Transection of the collateral sesamoidean ligament
  • Forage and bone grafting of distal attachment collateral desmopathies of the DIPJ
  • Palmar digital neurectomy

For discussion of each treatment option, see:  Gutierrez-Nibeyro SD, McCoy AM, Selberg KT. Recent advances in conservative and surgical treatment options of common equine foot problems. Vet J. 2018 Jul;237:9-15. doi: 10.1016/j.tvjl.2018.05.003.

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