Navicular Syndrome in Horses: Symptoms, Treatments, and Buying Considerations

Last updated: June 19, 2025

By: Miles HenryFact Checked

Navicular syndrome—sometimes referred to as navicular disease or caudal heel pain syndrome—is a complex condition that affects multiple structures in the horse’s hoof, not just the navicular bone.

With over 25 years of hands-on experience caring for and evaluating horses, I’ve encountered several cases firsthand. When a neighbor asked me to assess a horse he was considering buying, I noticed signs many might overlook: short, choppy strides and a tendency to point one front foot. I recommended a vet check, which confirmed navicular syndrome, leading him to pass on the purchase. Is this always the right call? This guide explores navicular syndrome, its symptoms, causes, diagnosis, treatment, prognosis, and whether buying an affected horse is wise.

What Is Navicular Syndrome?

💡 Navicular syndrome in horses is one of the most common causes of chronic lameness in a horse’s front feet—affecting both bone and soft tissue.

Navicular disease in horses is a degenerative condition involving the navicular bone and adjacent structures, commonly causing heel pain in the front feet. The navicular bone—a small, canoe-shaped structure (from the Latin navicula, meaning “small boat”)—sits behind the coffin bone. It acts as a fulcrum for the deep digital flexor tendon (DDFT) and is cushioned by the navicular bursa. Ligaments, including the impar and collateral sesamoidean, help stabilize the area.

The condition may involve:

• Navicular bone degeneration (e.g., cysts, enthesophytes)
• Navicular bursa inflammation (bursitis)
• DDFT or ligament injury
• Coffin joint arthritis

This is a leading cause of horse lameness in the front feet, particularly in breeds like Quarter Horses, Thoroughbreds, and Warmbloods. For more details, see this University of Illinois guide on navicular syndrome

Symptoms of Navicular Syndrome

Early recognition is crucial, as symptoms of navicular syndrome can be subtle and progress. Signs include:

• Lameness: Often bilateral, though one foot may seem worse, worsening with work.
• Toe-First Landings: Horses avoid heel pain, creating short, choppy strides.
• Pointing a Foot: Resting one forelimb forward to relieve pressure.
• Stumbling: Hesitation on uneven terrain.
• Reluctance to Move: Resistance on hard surfaces.
• Hoof Tester Sensitivity: Pain over the frog or heel.
• Circling Lameness: Worse when the affected foot is inside a circle.

Owners may mistake these for shoulder issues due to gait compensation.

Example: My neighbor’s horse pointed its left front foot and moved cautiously on hard ground, prompting a vet exam that confirmed navicular syndrome.

Causes and Risk Factors

Navicular syndrome arises from multiple factors:

• Conformational Faults: Long toes, low or underrun heels, or small hooves increase the risk.
• Breed Predisposition: Quarter Horses and Warmbloods are more affected.
• Repetitive Stress: Jumping or hard-surface work stresses the navicular apparatus.
• Poor Hoof Care: Improper trimming or shoeing exacerbates issues associated with navicular syndrome.
• Vascular Changes: Reduced blood flow may cause bone degeneration leading to navicular disease in horses.

Dr. Susan Dyson notes that soft tissue injuries (e.g., DDFT, ligaments) are often misdiagnosed as navicular bone issues.

Diagnosing Navicular Syndrome

Accurate diagnosis distinguishes navicular syndrome from other heel pain causes. Methods include:

• Hoof Testers: Detect heel sensitivity.
• Palmar Digital Nerve Blocks: Confirm pain source, with bilateral lameness potentially “switching” feet.
• Flexion Tests: Trigger lameness post-flexion.
• Radiographs (X-rays): Show bone changes, though not always symptomatic.
• MRI: The gold standard for identifying abnormalities in recent lameness cases is the MRI, which is effective in 86% of cases.
• Ultrasound: Limited for intra-hoof structures.

Dr. Matt Durham emphasizes, “MRI is critical for pinpointing affected structures.”

Differential Diagnosis

Navicular syndrome must be differentiated from:

• Collateral ligament injuries.
• Coffin joint arthritis.
• Sole bruising or abscesses.
• Laminitis in the heels.
• Pedal osteitis.

Misdiagnosis of navicular disease in horses is common without the use of advanced imaging.

Diagnostic Methods for Navicular Syndrome

Method	Purpose	Pros	Cons
Hoof Testers	Localize heel pain	Quick, affordable	Non-specific
Nerve Blocks	Confirm pain source	Accurate	Temporary response
X-rays	Visualize bone changes	Accessible	Misses soft tissue
MRI	Image soft/bony tissues	Detailed diagnosis	Expensive, requires sedation
Ultrasound	Limited intra-hoof imaging	Non-invasive	Less effective

Treatment and Management Options

Navicular disease in horses cannot be cured, but it is often manageable. The primary goals are to relieve heel pain in horses, restore function, and slow disease progression.

Treatment options include:

Corrective Shoeing: Improves hoof balance and relieves pressure on the heel and deep digital flexor tendon (DDFT). Techniques include:

• Egg bar shoes for heel support
• Wedge pads to elevate the heel
• Rolled toes for easier breakover. See our guide to hoof growth and health for shoeing tips.
  Learn more about corrective shoeing techniques here.

Along with proper shoeing, medications play a critical role in reducing inflammation and improving comfort for horses with navicular syndrome.

Medications:

• NSAIDs like Phenylbutazone or Equioxx for inflammation
• Bisphosphonates (e.g., Tildren, Osphos) to reduce bone resorption
• Corticosteroids to reduce joint/bursa inflammation
• Biologics like PRP or hyaluronic acid for soft tissue healing

Rehabilitation and Exercise: Typically begins with 1–3 months of rest, followed by gradual reintroduction to work on soft surfaces.

• Neurectomy: Surgical option for severe cases, where the palmar digital nerves are cut to eliminate pain—though this carries risks like neuroma formation.
• Shockwave Therapy: A promising modality that stimulates tissue healing and can reduce lameness in certain horses.

With treatment underway, many owners wonder what the future looks like for affected horses.

Prognosis for Horses with Navicular Syndrome

Prognosis varies based on lameness severity, affected structures, and management consistency. About 60% of horses respond positively, achieving soundness for light work, pleasure riding, or pasture comfort.

• Positive Factors: Early diagnosis, primarily bony changes (responsive to bisphosphonates), diligent farriery, and owner compliance. Mild cases often resume light work for years.
• Guarded Factors: Severe or chronic lameness, DDFT tears, ligament desmitis, coffin joint arthritis, or poor treatment response. These horses may only be pasture sound or require intensive care.
• Overall: While rarely life-threatening, unmanageable pain may necessitate euthanasia for welfare reasons. Dr. Douglas Novick notes, “Most horses can be managed comfortably, but expectations must be realistic”.

Can You Ride a Horse with Navicular Syndrome?

Many horses can perform light or recreational riding with proper care, avoiding high-impact activities like jumping. Dr. Novick states, “Navicular syndrome isn’t terminal. Most horses can return to their previous performance level.” Regular farrier and veterinary care are essential.

Should You Buy a Horse with Navicular Syndrome?

Buying a horse with navicular syndrome is risky:

• Costs: Diagnostics (X-rays: $100-$300, MRI: $1,500-$2,500), farrier visits ($50-$150 every 6-8 weeks), medications (bute: $20-$50/month, Tildren: $300-$500/dose). (Costs are approximate and may vary by region or year)
• Emotional Toll: Managing chronic pain or euthanasia is distressing.
• Limited Use: Restricted to light work or companionship.
• Insurance Limits: Pre-existing conditions are uninsurable.

Some owners manage navicular horses for hacking or companionship. A Horse & Hound user shared, “With a good farrier and vet, my mare is sound for hacking.” A pre-purchase veterinary exam is critical.

Checklist: Evaluating a Horse with Navicular Syndrome

• Obtain a pre-purchase exam with nerve blocks and MRI.
• Review X-rays and treatment history.
• Assess lameness and prognosis.
• Calculate ongoing care costs.
• Match intended use to the horse’s limitations.

Preventing Navicular Syndrome

Reduce risk with:

• Regular Farrier Visits: Trim every 6-8 weeks for proper angles.
• Proper Shoeing: Collaborate with a skilled farrier (hoof angles and balance).
• Soft Surfaces: Train on grass or arenas.
• Gradual Conditioning: Avoid overworking young horses.
• Nutrition: Maintain healthy weight. See hoof care essentials.

For a quick and clear visual explanation, watch this short video that breaks down what navicular syndrome is and how it affects horses.

FAQs

Conclusion

Navicular syndrome requires careful consideration before buying an affected horse. While some horses can be managed for light work or companionship, the costs and progressive nature often favor a sound horse. Success hinges on early detection, expert care, and realistic expectations. Consult a veterinarian and download our free Pre Purchase Exam Checklist to help you spot red flags before buy.

Have you managed a horse with navicular syndrome? Share your experiences in the comments or explore our equine health section.

Important Disclaimer: The information provided in this article is for educational purposes only and is not a substitute for professional veterinary advice. Always consult with a qualified veterinarian regarding your horse’s health and any medical conditions.

References

• Navicular Disease in Horses – Merck Veterinary Manual
  (Belknap, J.K., 2015) – Detailed explanation of navicular disease, diagnosis, and treatment.
• Navicular Syndrome in Horses – University of Illinois
  (Madsen, L., 2020) – Discusses terminology, diagnosis via MRI, and case management insights.
• Managing Navicular Syndrome in Horses – Kentucky Equine Research
  (KER Staff, 2013) – Overview of risk factors, shoeing, and long-term management.
• A New Look at Navicular Disease – Practical Horseman
  (Pascoe, E., 2014) – Emphasizes biomechanical causes and personalized farriery approaches.
• Tildren and Osphos for Navicular Syndrome – FDA Center for Veterinary Medicine
  (FDA, 2020) – Regulatory and clinical use guidance for bisphosphonate drugs.
• Shockwave Therapy for Navicular Syndrome – University of Saskatchewan
  (Brickman-Young, K., 2020) – Study results showing ESWT efficacy in navicular-related lameness.
• Neurectomy (Palmar Digital) – Purdue Equine Specialty Hospital
  – Explanation of neurectomy as a surgical option, including risks and indications.
• Use of Imaging in Navicular Syndrome – Veterinary Radiology & Ultrasound
  (Widmer, W.R., 2000) – Early research supporting MRI for diagnosing navicular apparatus lesions.
• Advanced Shoeing Techniques – TheHorse.com
  – Discusses how modern farriery has improved outcomes in navicular management.
• Shockwave Therapy Research – AAEP Conference
  (Dr. F. Gremillet, 2004) – Abstract showing 81% success rate in navicular cases using ESWT.

Related articles:

• If Your Horse has Thrush Can You Still Ride it?
• Horseshoes: Why Horses Need Them Plus Facts, Uses, and Types

We hope that the blog is informative, looking forward to reading your thoughts in the comments.