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MMEventing
Nov. 1, 2009, 07:04 PM
I've got a friend whose vet is recommending that they nerve her daughters event horse (lower level event horse) for navicular issues. The vet told them that 6 horses ran this past rolex that were nerved, but I've never heard of any that were. What is everybody elses thoughts, concerns, ideas, etc. on it??

CookiePony
Nov. 1, 2009, 07:08 PM
I haven't either. Have they done an MRI? Do they know exactly what is wrong?

MMEventing
Nov. 1, 2009, 07:12 PM
From what I've been told, the horse had navicular change in x-rays. He's been chronically lame in his front end, they have done all of the corrective shoeing as well. And he just recently came up with suspensory issues that they saw on an ultrasound. But I don't think they have done an MRI.

HorsesinHaiti
Nov. 1, 2009, 07:13 PM
What! And who is this vet that he would know who has been nerved?

Somehow I doubt that many people would want to run a nerved, navicular horse at a 4*. Is is even allowed in the rules?

Beam Me Up
Nov. 1, 2009, 07:15 PM
I had always heard that it was a huge no-no to jump nerved horses (for safety reasons I thought they were mostly flatwork in a nice even ring after that).

Maybe the procedure has advanced?

MMEventing
Nov. 1, 2009, 07:16 PM
That is what my thoughts were. But I thought maybe I was uneducated in the whole nerving process now, if it has advanced. So thought I would see what everybody elses ideas were.

CookiePony
Nov. 1, 2009, 07:25 PM
MRIs are expensive, so many people don't have the option to do them. But, according to this article (https://www.thehorse.com/ViewArticle.aspx?ID=12800), MRIs give a lot more information that can indicate how a case should be treated:

In earlier years, a diagnosis of navicular disease was often considered career-ending for a horse. Chronic lameness was typical, in spite of therapeutic shoeing, medication, etc., and sometimes the only option to help the horse travel sound was a neurectomy (the cutting of nerves leading to the foot), which meant he would no longer feel pain (or anything else) in the foot. Today we realize that what we earlier called navicular disease (the horse showing palmar--toward the back of the foot--foot pain, positive to hoof testers over the navicular area, and going sound after a posterior digital nerve block) includes a host of different problems within the foot, some of which are unrelated to the navicular bone and/or bursa (the fluid-filled sac that cushions the navicular bone against the pressure of the deep digital flexor tendon). The term navicular syndrome or palmar foot pain is now used instead.
Some cases of navicular syndrome have a good prognosis for healing and full recovery, if given time and proper treatment.

lstevenson
Nov. 1, 2009, 07:46 PM
What! And who is this vet that he would know who has been nerved?

Somehow I doubt that many people would want to run a nerved, navicular horse at a 4*. Is is even allowed in the rules?


Oh you would be suprised. There are definitely some top level horses out there (and some very well known Rolex horses as a matter of fact ;)) that have been low nerved (back half of the foot only).

Couture TB
Nov. 1, 2009, 07:52 PM
I would never jump a horse that was nerved. But I did know a guy that did that and played polo on the mare. I always thought you could not compete a nerved horse.

vbunny
Nov. 1, 2009, 08:03 PM
Oh you would be surprised. There are definitely some top level horses out there (and some very well known Rolex horses as a matter of fact ) that have been low nerved (back half of the foot only).

Ditto above statement. have been for years.

lucretia
Nov. 1, 2009, 08:05 PM
it is against FEI rules i believe but it is very difficult to prove short of sticking needles in horses feet and it certainly goes on.

Bobthehorse
Nov. 1, 2009, 08:19 PM
Navicular is a degenerative problem, nerving will take the pain away but the horse wills till deteriorate, especially if its being jumped and galloped. So, you gain a couple years competing, but the horse likely loses some years of its life as competing will only cause the horse to deteriorate faster. Seems incredibly irresponsible and selfish to me.

The horse has navicular and suspensory issues, when are these people going to realize its not designed for its job and retire the poor thing?

Ajierene
Nov. 1, 2009, 09:41 PM
There was a horse at my barn in high school that was nerved. He was raced after that, if I remember correctly (not saying that's the best thing to do). He would also jump the four foot paddock fences routinely (he really believed that whole 'grass is greener on the other side' adage).

He became a school horse and we were NOT allowed to jump him more than an 18" crossrail. It did not have as much to do with repeated concussion on the horse's feet and a lot to do with the fact that the horse cannot feel his feet. There was concern for the horse, and if he were not nerved he may have been jumped more, with proper care, but my trainer at the time would not risk and accident due to the horse not realizing where his feet were. That is very likely in jumping. Tripping is much more likely as well as not quite knowing where his feet are over a jump until to late.

I would NEVER do it over any solid jump more than a log on the ground.

Duramax
Nov. 1, 2009, 10:12 PM
My guy was just recently diagnosed with navicular (as well as sidebone, and pedal osteitis :rolleyes: ). The very well respected vet from Southern Pines asked me what I wanted the horse's career to be, and I told him I just wanted him to be able to compete at novice and he suggested we do a partial neurectomy. My horse has not been in work for over a year because of the lameness and is not even 9 years old- shoeing changes and NSAIDS haven't made him comfortable so I'm seriously considering it. He is uncomfortable just walking around in the pasture so if it makes his quality of life better than I'm all for it. :uhoh:

lizajane09
Nov. 1, 2009, 10:28 PM
The extent of the nerving makes a very big difference in what the horse can do after the procedure. Thus why there are some who can go around Rolex and some who can't walk across the pasture without tripping over their own feet. Finding out at what point exactly the vet intends to nerve this horse is definitely important in determining what he may be capable of doing in the future.

Also, navicular syndrome is not necessarily degenerative. As explained in an earlier post, navicular syndrome just means that the horse has pain in a specific part of his foot and that the pain goes away when the horse is blocked there. If the problem is because his navicular bone is degenerating? Then yes, likely to progress over time and become worse. However, there are also instances in which navicular syndrome is stemming from other underlying issues that may not get progressively worse with time if they are handled correctly.

yellowbritches
Nov. 1, 2009, 10:58 PM
Without going into too much detail, a horse very close to me was nerved a couple of years ago. He had suffered on and off for a few years with front end issues and EVERYTHING you could do he had done (special shoeing, coffin injections, navicular bursa injections, Tildren, etc, etc, etc). Every diagnostic tool available was used on him to monitor the extent of his issues (including MRI). The horse is much loved and is also a savage beast when not in work and charming when he is (this was actually a big factor in the decision. If he didn't make it so apparent that he liked to have a job, he might have been retired). When it became apparent the horse was not going to stay comfortable with less invasive procedures, it was decided (after much discussion with the vets, much debate, much reseach, etc) to nerve him. He has been happily jumping around training level and his vets feel that if he wants to do some prelim he should be able to. He is still monitored carefully with regular visits with the vets and careful shoeing (his angles have to be carefully dealt with and he MUST have pads).

The procedure has come VERY far. There was a point when the idea of jumping a nerved horse was just scary. However, they are able to be so accurate with what they do now that it is quite safe (this horse DEFINITELY can feel his legs and feet). The biggest worry is them stepping on something because they won't necessarily feel pain in their soles (hence, the pads).

All that being said, nerving should be a last ditch effort. Every avenue should be exhausted, in my book. The very best vets you can use should be consulted, and you need to be VERY sure what your horses issues are. A BIG thing that was stressed prior to this horse's surgery was that he could have NO soft tissue issues in his feet (lesions or tears or inflammation of things like DDFT etc). They really did not want to do it if those types of things were in a compromised state, since having a big issue with those can be very bad. I think the procedure is VERY useful and worth its weight in gold, but I really, really think it needs to be after everything else you can possibly do has been tried. There's a lot of stuff to do to before you get to that point.

Eventer55
Nov. 2, 2009, 07:54 AM
Why are you not trying Isoxsuprine? It's an old drug, but was extremly effective for a horse I used for CTR and endurance. We caught it in the early stages, changed her shoeing and did a treatment of isox. She competed for years and very succesfully.

Badger
Nov. 2, 2009, 08:21 AM
That is an excellent and accurate post, yellowbritches.

Ltc4h
Nov. 2, 2009, 08:43 AM
You need to give him stall rest and deal with the suspensory first.
The suspensory runs across the navicular, the pain is probably not solely the navic.
If they nerve him and don't treat the suspensory they will in all likely hood blow that ligament, as he won't feel the need to protect the leg, hence traveling lame.
In all reality how many performance horse don't x-ray bad.

HorsesinHaiti
Nov. 2, 2009, 08:47 AM
Thanks Amanda! That approach to nerving makes complete sense. Glad to see the technique has advanced.

deltawave
Nov. 2, 2009, 09:01 AM
I think there are differences depending on where the horse is nerved, aren't there? Or is that old-fashioned thinking?

I was under the impression that the so-called "low" nerving didn't leave the horse with any impaired sensation except maybe an isolated spot on the heel, whereas "high" nerving left the foot with decreased sensation.

For a lower level horse I don't think it's anathema to consider nerving if it doesn't leave the horse not knowing where its feet are. The burden, of course, is then on the owner/rider to be extra vigilant and make sure the horse isn't tearing itself up by continuing to compete.

AKB
Nov. 2, 2009, 09:30 AM
I agree with Yellowbritches that the owner should get a good workup and consider all alternative treatments before nerving. We have a 21 year old mostly retired horse with long standing navicular disease. Our vet, a board certified surgeon, is recommending nerving him if we cannot keep him comfortable any other way. So far, we have done navicular bursa injections of steroid, IRAP, regional perfusions of Tildren, special shoeing, barefoot trims, and other treatments. At this point, he is comfortable. If we can't keep him comfortable, we will consider nerving/neurectomy. In our horse's case, because he also has heaves, we would do the nerving as a standing procedure instead of putting him under anesthesia. A neurectomy often does not last forever. Many times, some fibers grow back, necessitating repeat surgery.

Bobthehorse
Nov. 2, 2009, 10:02 AM
In all reality how many performance horse don't x-ray bad.

Most older jumping horses will xray with nav changes, but there are degrees, and slight changes often dont cause any pain and never will.

I dunno, I guess Im of the general opinion that if a horse isnt staying sound in work, it shouldnt be doing that work, and taking the pain away wont really change the fact that the horse is clearly not built for the stress of what its doing.

Gry2Yng
Nov. 2, 2009, 10:11 AM
I dunno, I guess Im of the general opinion that if a horse isnt staying sound in work, it shouldnt be doing that work, and taking the pain away wont really change the fact that the horse is clearly not built for the stress of what its doing.

:) Just because a horse is not staying sound in work does not mean that they aren't built for the work. Management has as much of a role as "built". Bad shoeing. Poor saddle fit. Poor nutrition. Turnout schedule. Plenty of "unsound" horses have been pulled out of one management program and put in another to work hard and perform well.

purplnurpl
Nov. 2, 2009, 10:28 AM
I've got a friend whose vet is recommending that they nerve her daughters event horse (lower level event horse) for navicular issues. The vet told them that 6 horses ran this past rolex that were nerved, but I've never heard of any that were. What is everybody else's thoughts, concerns, ideas, etc. on it??

Yes people run nerved horses. I and do believe, though I do not know, that there may have been horses run Rolex that were nerved. Everthing is on the down low though.

My good friend had a ** horse that was nerved in a front foot.
The horse broke his navicular bone--and sesmoid? It all healed but he was still off so they nerved the back half of his foot. He ran fine and never had an issue.

Before you nerve hit the MRI. Then make sure the vet blocks the exact spot that he will nerve.
I was thinking about doing this to Boomer when he was still not fully diagnosed. I asked them to block the area that would be nerved. It did no good. I then put him in the MRI and we found something TOTALLY DIFFERENT.

BEFORE YOU NERVE DISH OUT THE MONEY FOR AN MRI. Nerving is something you don't want to mistakenly do. It's a last resort.

TampaBayEquine
Nov. 2, 2009, 01:40 PM
Palmar digital neurectomy is performed at the back/sides of the pastern. There are 2 branches of the PDN that travel down into the foot- one is lateral and one is medial . The palmar digital nerve is cut and approx 1" segments are removed. This reduces sensation to the heels/structures within the back half-ish of the foot and part of the sole/digital cushion etc.

To determine exactly how much improvement in lameness you will get from a neurectomy you must nerve block AT THE SAME LEVEL.

The nerve endings typically grow back in 1-2 years and lameness will also return. There is a risk of neuroma formation at the cut ends esp if there is insufficient rest period after surgery .

MMEventing
Nov. 2, 2009, 07:04 PM
Why are you not trying Isoxsuprine? It's an old drug, but was extremly effective for a horse I used for CTR and endurance. We caught it in the early stages, changed her shoeing and did a treatment of isox. She competed for years and very succesfully.

They have tried Isox, didn't help a whole lot.

In my opinion they need to just make the horse a w/t beginner horse. But, it's not my student and not at my barn, so I can't say a whole lot. But the horse is for a 12yo who has never really competed above starter. SO my worry is that, although a rolex rider will be able to tell the exact second the horse isn't feeling right. A 12yo inexperienced rider will not.

But I agree with all of the other posters that they need to go through every other option first....

JumpingBug
Nov. 2, 2009, 07:30 PM
I would not jump a nerved eventer. Have jumped nerved hunter jumpers (lower level) and seen a few lesson horses who were much happier after being nerved. Often younger horses are stricken and sadly it runs in some lines for sure from mother to foal and so on and so forth.

The problem with nerving is:

1. the nerves can grow back
2. sometimes in a painful mass, so you have a miserable horse
3. the nerved horse must be watched, pulse in feet taken, feet watched like hawks because the horse may not be able to tell you something is really wrong with them.
4. Cross country requires a lot of terrain issues which is NOT great for navicular horses to begin with. If I had a XC horse who had navicular I would find him a job in the ring where the concussion would be kinder.
5. some horses show a incredible improvement after nerving while others become clods who trip all over the place.
6. remember just because you have killed nerves there is a PROBLEM in the foot. Many a horse has fractured the navicular bone when continued on in work after being nerved as it is a fragile hole riddled bone after all.

ISOX does not work on all horses and in fact we have not had that much success with it.

I would also not just go by X-rays alone and have a MRI done down there as sometimes a horse just happens to have a ugly navicular bone and something like a medial collateral ligament is to blame or other issues with coffin bone. I find a lot of people get the UM YEA IT'S navicular from vets when owners do not want to really work something up due to $$$ and it becomes a blanket diagnosis from many vets.

More than a few of us have even owned the horse with navicular on a xray who has never been off, just weird I tell you and then you have others with a few tiny channels be cripples!

thatseventing
Nov. 2, 2009, 08:24 PM
I have a horse that we nerved,(he's 8) because all the special shoeing, drugs, leaving off for a year, didn't work, so our vet suggested nerving...I did not like the idea, cause I am of the old school where you nerve a horse, they are a pasture ornament or a lower hunter that can jump 2'..after research, as someone else had said, it is a different procedure, and only nerving the back part of the hoof. He is happy as a clam, and sound too....The highest this horse will go is training...so that is fine...yes there is a chance that the nerve will regrow...but im hoping that it will last for a few years...I have not had any problems with tripping or clumsyness or anything, this horse is light on his feet....

JenEM
Nov. 2, 2009, 08:55 PM
I'll join those recommending an MRI before making a decision. My hopeful event horse came up lame suddenly this fall with something inside her foot that resolved to a low block. Vets who treated her said that this was the sort of thing that a few years ago would have fallen under the blanket diagnosis of "navicular" and been done with it. An MRI was able to tell us exactly what was going on inside there (a bruised coffin bone) and gave us a plan on how to treat what's really going on, and fix the actual problem. Well worth the expense, and reimbursable through insurance.

Find a good vet who knows feet and have them get x-rays and an MRI. See what's really going on inside the foot with the bones and the soft tissue (especially since it seems there's already something going on with the suspensory).

Watermark Farm
Nov. 2, 2009, 09:03 PM
I have owned two nerved horses, both nerved only after several years of intense effort failed.

Horse#1 had a bi-lateral low neurectomy and was evented and rallied for many years at BN and N by me and several Pony Clubbers. This horse was nerved at age 8 and died at age 27 still sound, only 2 days after his last show. We never had to re-nerve him.

Horse#2 also had a bi-lateral low neurectomy and was only as sound post-neurectomy (1/5) as he had been with a low block. I did this so he could retire comfortably in pasture. That's an important thing to remember, that your horse won't nerve any better than he blocks.

Low nerving results in loss of sensation in the rear of the foot. You have to diligently pick feet 1-2 x/daily and watch for injury. I found that both horses around 8 weeks post surgery had some regeneration of skin nerves; they could feel a pin prick on their nerved heels. Surgeon said this was normal. Proper layup period reduced the risk of neuromas. The best neurectomies are done in a hospital setting by someone who does tons of them. I was told to expect 2-5 years on average before nerves re-grew. Some horses never re-grow, some in one year.

It's a last last last resort, nerving, and there is much to be aware of when you make this decision. But for some horses (like my two) it can be a wonderful thing that allows them to retire comfortably or work at the lower levels.

I agree with others....exhaust all diagnostic methods first!