🐴 Navicular Lameness (Heel Pain) in Horses: Updated Vet Care in 2025 💉🦶

By Dr Duncan Houston BVSc

Navicular lameness, historically called navicular disease, is one of the most common sources of chronic front limb pain in performance horses. But in 2025, we now know the term “navicular disease” can be misleading, as heel pain often involves more than just the navicular bone. Today’s approach involves precise diagnosis and newer treatment options—like bisphosphonate injections—that can offer relief when used appropriately. 🧠🐎

🧩 What Is Heel Pain (Navicular Syndrome)?

“Navicular syndrome” was once thought to be a degenerative bone condition. But modern imaging shows the pain may originate from soft tissues around the bone—like ligaments, the deep digital flexor tendon, or the navicular bursa. 🦴🧬

That’s why most vets now prefer the term heel pain. This reflects the broader set of structures involved and shifts the focus from bone alone. 👣

🔍 Diagnosis: Where Heel Pain Begins

Diagnosis begins with:

• 📉 Observing gait and performance issues
• 💉 Diagnostic nerve blocks to isolate pain to the heel
• 📸 Radiographs to look for navicular bone changes
• 🧲 MRI for full assessment of soft tissues and subtle lesions

Dr Duncan Houston emphasizes that a complete exam—including hoof tester evaluation, flexion tests, and gait analysis—is essential before jumping into treatment. 🔎

💊 Bisphosphonate Drugs: Osphos & Tildren

When bone involvement is suspected, bisphosphonates are often used to slow bone resorption. These drugs work by inhibiting osteoclasts—the cells that break down bone. 🧪

Approved Equine Bisphosphonates:

• 💉 Osphos (clodronate) – administered intramuscularly
• 💉 Tildren (tiludronate) – administered intravenously

These are commonly used when radiographs show bone loss or degenerative changes in the navicular bone. But if soft tissues are the true pain source, bisphosphonates may have limited benefit. 🧠💡

📈 Effectiveness of Osphos in 2025

According to recent reports, Osphos may improve symptoms in up to 70% of horses with confirmed bone involvement. 🧾

Benefits may include:

• ✅ Reduced heel pain and improved comfort
• 🏇 Return to light work within weeks
• 🔁 Duration of relief often lasts several months

Osphos may also provide mild anti-inflammatory effects, though this is still debated. 🧬

🧠 Key Considerations for Treatment

While Osphos can be effective, it is not a one-size-fits-all solution. Consider the following:

• ⚠️ It should only be used if bone involvement is confirmed
• 🧪 MRI or radiographs help determine suitability
• ❌ Do not use in horses under 4 years, pregnant mares, or breeding stock

Also, Osphos is not a replacement for therapeutic shoeing, exercise control, or joint injections—it’s part of a comprehensive treatment plan. 📋

⚠️ Side Effects of Bisphosphonates

While generally safe, potential side effects include:

• 💥 Mild colic symptoms post-injection
• 🥱 Lethargy or reduced appetite
• 📍 Injection site reactions
• ⚠️ Risk of kidney damage, especially when combined with NSAIDs

Dr Duncan Houston recommends avoiding NSAIDs (like Bute) when administering Osphos. Walking the horse after injection helps reduce colic symptoms. 🐾💉

🛠️ Other Heel Pain Therapies

A full navicular lameness protocol often includes:

• 🧼 Corrective shoeing for heel support
• 💉 Coffin joint injections (steroids, hyaluronic acid)
• 🧬 Regenerative therapies (IRAP, PRP)
• 🔄 Exercise modification and soft footing

When bone is not the primary source of pain, these treatments may be more effective than Osphos alone. 🧠📉

📲 When to Contact AskAVet.com

Navicular lameness can be confusing and emotionally exhausting for horse owners. If your horse has heel pain or you're unsure whether Osphos is right, visit AskAVet.com or use the Ask A Vet App. 📱🧠

Dr Duncan Houston and the team can review X-rays, MRI results, treatment options, and hoof balance strategies. Get second opinions or real-time lameness support—all from your phone. 🐎💬

🏁 Final Thoughts

Heel pain in horses—formerly known as navicular disease—is a complex condition requiring modern tools and individualized care. In 2025, treatments like Osphos offer hope when used correctly and alongside other proven methods. 💉🧲

When managed as a multifactorial problem—not just a bone issue—many horses can return to comfortable, active lives. 🐴❤️

Need expert lameness support? Visit AskAVet.com and make informed decisions for your horse’s comfort and career 🐎🩺