Slight lameness in horse that has had neurectomy

[MissCapitalSplash]

Last fall I purchased a lovely AQHA gelding for flat work only and light AQHA showing. I HAD HIM VETTED. I had some concerns about him tripping and being reluctant to pick up his feet. I asked the vet a minimum of 6 times if he had been nerved as I would NOT buy him if that was the case. She was adamant that he wasn't. She noted two bumps on the lateral aspect of both pasterns which she said was normal. I asked if we could clip them and look for scars. She said that was ridiculous. Horse was completely unresponsive to hoof testers, even on frog. She attributed this to him having good feet. Xrays were ok. After her reassuring me there was no possible way he'd had a neurectomy, I purchased him.She attributed the tripping to poor shoeing and long toes, which he has. About 3 weeks after having him he began being slightly off up front on occasion. Drug test came back negative. I decided to dig back in his AQHA record and call all his previous owners. It was a crazy search but I finally found the trainer that had him the longest and the first thing he said was "That horse had a neurectomy in 2002 by Ohio state." ACK!!! He said he had navicular syndrome and was sound after having the procedure. Now I am fuming because I'd have never bought him had I known this, as I said to the vet. And of course reselling is OUT of the question.
The lameness resolved with correct shoeing (actually barefoot) until last week.

Last week he began being off up front again. He is NOT in hard work, he gets a light hack maybe 4 times a month in good footing.
I gave him some bute and rest.
I was clipping him a few days ago and sure enough, after clipping his white socks with a #10 blade, there are prominent scars on both lateral aspects over those "bumps" she said were normal.

Live and Learn I guess.

Now what do I do for him? The lameness is subtle, worse on a tight circle. Is it a wash?
I've been reading about this and it seems they can get small tumors at the site?
And a repeat neurectomy is never done, right?
What is odd to me is his xrays were supposedly clean.

I'm so disappointed. I LOVE this horse. I wanted to show him at an AQHA show on April 18, but it's not going to happen now.
He has the sweetest, most lovely personality and is definitely here to stay, but I'm so frustrated with this.

Can anyone offer advice on managing a horse that has had a neurectomy? I have no experience with this.

[goodhors]

You could have him redone. As you have seen, done in 2002, he was sound for several years with it. That is pretty long, and was useful during that time as well. Older nerving methods often did not last that long.

We got 6 months on our horse, before nerves regrew. It was a while ago, probably still using older nerving methods when they did her. Ours was a partial, so she knew where her foot was, less likely to be trippy that way. We turned her into a companion horse for a friend after lameness came back. Did not repeat the surgery. She stayed healthy, limping but did move around in pasture well.

Otherwise you are stuck with the lame horse. Next time you will need to go with a better check-over, ignore the Vet's more casual attitude on that part, if you use the same one for PPE. Vets are human too, work within the boundaries of their experience. Maybe she had not done many nerved horses before. You were the worried one, should have pursued the lump/scars that bothered you, further. Would only have taken a few minutes to clip the ankle.

You live and learn from experiences. You will look harder the next time you wonder. This is an experience. What you decide to do about horse, is going to be another experience you will learn from. Good luck with the horse and your choices.

[Lora]

I would have to say something to the vet - not that it is really going to do any good but

[mroades]

Now that they are doing lots of MRI's...it seems as if navic xrays can mean nothing. he probably has long term damage to his DDFT where it attaches. I have had them do well in pour in rubber.

BTW I had the same thing happen back in the 80's...vet made a big fuss over how hoof tester negative this horse was....6 months later when he started adding strides and tripping...yeah, found the scars.

[Fharoah]

If you have the money I would cosider an MRI

[yellowbritches]

Get an MRI and see what is going on in the rest of the foot, not just the x-rays. He may have little in the way of bony changes, but it might all be in the bursa, etc. You might be able to get him sound again by injecting the navicular bursa IF it is inflamed. The lameness might also be somewhere else...just because he's got a lot of other body parts that could be bothering him...maybe he needs his hocks injected or to be chiropracted or any number of things. I'd find a VERY good lameness vet and have a good thorough lameness exam done, and make sure that the vet knows he was nerved and when (can't imagine you wouldn't tell them that).

[asterix]

Just wanted to add that if you don't have insurance, you can start by going to a VERY good lameness vet, as yb said, and getting good films and ultrasound of the foot.
We found my horse's inflamed navicular bursa via ultrasound at a very experienced lameness clinic. We injected it and the horse improved dramatically and is now back in work. The vet said, next stop, MRI, but let's do this first and see if it does the trick.

But in any event, do get a work up. If there is something major going on in there you need to know.

[vxf111]

I am assuming we've narrowed down the lameness to the front feet, yes?

I would try to get your hands on the vet records from the prior nerving. I know that's unlikely. You're between a rock and a hard place because those records are old and probably unavailable. He might have done something between then and now that caused damage to the DDFT. You sure DON'T want to nerve on top of DDFT damage. But if there's no DDFT damage-- then nerving is on the list of possible ways to handle the issue.

Asterix suggested ultrasound. You can do that, but my vet (amazing lameness expert) feels he doesn't have great success with the ultrasound in the foot. it's certainly cheaper than an MRI but if he doesn't have success with it, I don't hold out hope that most vets would. New Bolton didn't think it was useful for imaging the foot in a similar situation. Also telling. I am glad asterix had success but if it was me and cost was a factor, I wouldn't waste the money.

If you can afford it, I think the gold standard method would be to get an MRI now and check out the DDFT. If that doesn't show anything, then inject the navicular bursa (or other areas that X-rays show to be problematic or where he blocks out sound). If that doesn't give you relief, you can nerve him again. It sounds like he did quite well, for a decent stretch, with the nerving. Depending on the severity of the underlying condition and what your plans are (and how flexible you can be about what you do with him/how you care for him) that might give you good results. I would get a really experienced vet to do the surgery.

I don't think, personally, that I'd nerve without doing the MRI first. Seems to risky. So if you can't afford that, I'd do x-rays and block, and then inject any areas that are problematic and cross fingers that works. Maybe it will? Maybe not, since I presume the old owner tried that before nerving him originally. Tough situation.

I would be VERY angry at the vet. I wonder if failure to discover the nerving breached the standard of care. I don't know. How visible/apparent are the lumps from the nerving?

[Watermark Farm]

Your horse had a neurectomy done in 2002 --- maybe he's regenerated those nerves.

I had a bi-lateral neurectomy done on my horse 18 months ago.
Surgeon told me to expect 2-5 years (sometimes less, sometimes forever) out of it.
It can be re-done --- not considered a big deal. The clinic I went to (Pioneer in CA) does tons of neurectomies. They said they have done several horses 3 times.

Get thee to a good lameness specialist and discuss your horse's situation and options and what else might be making him uncomfortable.

Good luck. PM me if you need to chat. Nerving my horse was a last ditch effort to make him pasture sound due to terrible lameness (horrid sidebone) and my only regret is waiting so long to finally do it. It was $1500 out the door for both feet done under general anesthesia in a hospital.

BTW, just food for thought....my horse was only 95% sound after the neurectomy. This was as good as he'd blocked. We assumed this was as good as we'd get. After the rehab, a bodyworker discovered that my horse had a shoulder injury (muscle) that was making him very sore. The injury had occured during the 2 years my horse was so terribly lame and stumbling/shuffling badly. A few sessions and my horse was 100% sound. So remember that lameness originates from other parts than feet! Even the surgeon I worked with poo-pooed this at first, but upon seeing how sound my horse went once the shoulder injury was resolved, but we all learned a good lesson from this. While you are looking at weight bearing lameness, don't overlook swinging leg lameness!

[x]

Yes, you can have a neurectomy re-done.
By the way, another way to check for nerving on a horse; take a ball point pen, or similar, and poke the area right above the heel of the horse, and see if the horse reacts/moves his foot. If the horse feels it, horse will most likely move the foot. If there is no feeling, the horse may have been nerved.

[Dune]

Sue the vet.:mad:

[BornToRide]

Not sure what state his hooves are in at this point, but his best bet for long term hoof health at this point is allowing the hooves to heal barefoot. You can always use boots if he needs some addition protection. For now I would stay away from shoes, as they can restrict decontraction, especially if a horse has a tendency to grow more upright hooves to begin with.

Neurectomy have a poor prognosis if the incorrect hoof form that causes the problem is never addressed to begin with and it sounds like it was not in this case.

Most navicular horses have the following in common:

Heel contraction
Incorrect toe loading that also fosters heel contraction
Long toes and heels that contribute to tripping, tow loading and heel contractionFind yourself a good trimmer who will support the hooves to open up and become more normal and correctly balanced, in other words ergonomically correct, so the horse will start to heel land as he should at all times.

Most likely this poor guy was shod at the age of two before the hooves were fully mature and in addition trimmed and shod poorly, which probably led to this condition.

Can you get copies of the x-rays? Do you have recent pictures of the front hooves you could share?

Best wishes!

[FatPalomino]

Most likely this poor guy was shod at the age of two before the hooves were fully mature and in addition trimmed and shod poorly, which probably led to this condition.


Or his parents could have had tiny little QH feet and had navicular, too!!!! These guys are not bred for survival and soundness... many are bred to stand around and look pretty, some are bred to go very slow....

A horse that has already had a Neurectomy probably has severe navicular disease. Of course, the long term prognosis is poor. It doesn't stop, or slow, the degeneration, just alleviates the pain.

I'd second the idea of having a good work up, then doing a 2nd neurectomy is that's the area of pain and corrective shoeing isn't able to sound up the horse. I wonder how old the OP's horse is?

I know 2 horses that had neurectomy's, and both stayed sound for years. They could have been the exception. They were still sound last time I knew them. One was sound for 5 or 7 years post-surgery, and died of other causes in his 20's. I'll nerve my navicular horse when the time comes that corrective shoeing doesn't help him anymore, and it is a last resort.

This is why more and more vets do not want to go anywhere near a pre-purchase. Sounds like your horse had heel sensation (if the nerves have regenerated), which would lead a vet to believe the horse has feeling there... and is not nerved.

[BornToRide]

Or his parents could have had tiny little QH feet and had navicular, too!!!! These guys are not bred for survival and soundness... many are bred to stand around and look pretty, some are bred to go very slow.... Yes, but that not not prevent anyone to at least try to do the right thing and support the horse as best as possible with correct trimming, rather than just accepting it as a possible fact.

There's always room for improvement and even Pete Ramey says that navicular is no longer an issue for him - the horses all improve once they are trimmed that the start to properly heel land as they should.

Per the owner's description, this horse already has bad hoof form. Even a horse that tends to grow narrow can be trimmed to correctly land heel first.

I would definitely NOT recommend a second neurectomy unless addressing the biomechanically incorrect the hoof form was at least thoroughly tried! Only then, if this did not yield any improvements, would I ever consider a second neurectomy! Please note that nerves can and will generally grow back .

[FatPalomino]

Yes, but that not not prevent anyone to at least try to do the right thing and support the horse as best as possible with correct trimming, rather than just accepting it as a possible fact.

Possible fact? There is plenty of research showing the genetic link to navcicular- look it up.

There's always room for improvement and even Pete Ramey says that navicular is no longer an issue for him - the horses all improve once they are trimmed that the start to properly heel land as they should.

So I can say I am the queen of Pop Music, and because you can't hear me, it's true?

Per the owner's description, this horse already has bad hoof form.
Under the care of a barefoot trimmer.

[BornToRide]

Quote:
Per the owner's description, this horse already has bad hoof form.
Under the care of a barefoot trimmer.
Nice try - no, from years of misguided trimming and shoeing by others, not the current trimmer.

[Patty Stiller]

I Would NEVER recommend a second neurectomy. I have seen fatal consequences to a few horses as a direct result of neurectomies. (disconnected deep flexor tendons, hoof abscesses so bad they sloughed the foot, you get the idea) disasters from even

IMO 99.9 percent of neurectomies are not needed, and those that are are salvage cases to get a broodmare to the weaning of her foal or something, pasture pets only. They are usually done because the root cause of the "navicular" issues were not addressed correctly in the first place. (most often long toes, and/or under run heels and other types of hoof imbalances)


I would start by treating him as if he had never been nerved in the first place. Radio graphs, to see if there is actual bone disease, INTERNAL hoof balance assessment, from the radiographs and then proper shoeing with careful balancing of ALL the internal structures and easing breakover in all directions.
Often barefoot is not enough. But regular shoeing is usually wrong, too.