🐴 Palmar Foot Pain in Horses: Understanding, Diagnosis & Smart Shoeing in 2025 🦶🔧

By Dr Duncan Houston BVSc

When horse owners hear “navicular disease,” they often think of a degenerative issue in the navicular bone. But today, we understand that the pain doesn’t always come from the bone itself—instead, it often involves ligaments, tendons, and soft tissues in the back of the foot. In 2025, this condition is more accurately called palmar foot pain. In this article, I’ll explain what causes this syndrome, how it affects different breeds, and what you need to know before making changes to your horse’s shoeing. 🧠🐎

🔍 What Is Palmar Foot Pain?

Palmar foot pain refers to discomfort originating from the palmar (rear) region of the foot. This area includes:

• 🛶 Navicular bone
• 🦴 Collateral ligaments
• 🧵 Deep digital flexor tendon
• 🦶 Digital cushion and supporting structures

While navicular bone damage can be part of the syndrome, many horses experience pain in this region without significant navicular bone changes on radiographs. That’s why the term navicular disease is no longer sufficient. 🎯

👣 Common Signs of Palmar Foot Pain

Palmar foot pain may present subtly or severely. Watch for:

• 🐾 Short, choppy strides—especially in the front feet
• 🔁 Reluctance to turn tightly or circle
• 🐢 Decreased performance or “not quite right” movement
• 📉 Discomfort on hard surfaces
• 👟 Pain response when using hoof testers over the heel

If the condition is chronic, horses may develop compensatory musculoskeletal problems elsewhere. 🧠⚠️

🧬 Risk Factors and Breed Tendencies

Some breeds are more prone to palmar foot pain, especially:

• 🏇 Thoroughbreds – often have naturally low or crushed heels
• 🤠 Quarter Horses – used in intense athletic sports
• 🎩 Warmbloods – with large bodies and smaller feet

Conformation issues—like long toes and low heels—also increase the risk by altering weight distribution and stressing the palmar structures. 📏⚖️

🔧 Shoeing and Heel Elevation: Double-Edged Sword

Therapeutic shoeing is a common response to palmar foot pain, especially the use of heel wedges. These are designed to:

• 📈 Raise the angle of the hoof
• 🛑 Reduce tension on the deep digital flexor tendon
• 💤 Decrease pressure on the navicular region

Initially, horses may feel better and perform better. However, there’s a catch. 🧠💥

⚠️ The Problem with Crushed Heels

In horses with already compromised heel structures (like crushed or underrun heels), lifting the heel further can cause long-term damage:

• 🧱 Weakens the heel base further
• 📉 Causes the digital cushion to atrophy
• 🌀 Changes the biomechanics of the hoof capsule

Dr Duncan Houston cautions: while wedges may offer temporary relief, they can worsen structural integrity if used without a long-term hoof rehabilitation plan. 📉⛔

🛠️ Balanced Shoeing Strategy

Smart hoof management for palmar foot pain includes:

• 📏 Evaluating the natural angle and balance of the foot
• 🧲 Using shoes or pads that support the frog and digital cushion
• 🔧 Avoiding long-term wedge use unless absolutely necessary
• 👣 Promoting heel-first landings to rebuild the back of the foot

Work closely with a vet-farrier team experienced in biomechanics to develop a custom plan based on imaging, gait evaluation, and conformation. 🔍🧰

📸 Diagnostics: Don’t Just Guess

Before any treatment or shoeing changes, proper diagnostics are critical:

• 📉 Nerve blocks to isolate the pain
• 📸 Radiographs to evaluate bone structures
• 🧲 MRI for assessing soft tissues around the navicular region

Even if navicular radiographs look normal, soft tissue structures like the suspensory ligaments and bursa may still be inflamed or damaged. MRI helps reveal the true source. 🧪🧠

📋 Treatment Options for Palmar Foot Pain

Treatment varies by underlying cause but often includes:

• 💉 Joint or bursal injections (e.g., corticosteroids)
• 🧬 Regenerative medicine (PRP, IRAP)
• 🛠️ Therapeutic trimming and shoeing adjustments
• 🚶 Controlled exercise and turnout for circulation

In advanced cases, navicular bursal injections or surgical interventions may be considered. 🏥

📲 Ask A Vet for Expert Hoof Pain Support

If your horse shows signs of heel pain or navicular issues, don’t wait. Visit AskAVet.com or download the Ask A Vet App. 🧠📱

Dr Duncan Houston and the team can review X-rays, hoof balance, and gait videos to provide real-time advice on shoeing, diagnostics, and long-term rehab strategies. 🐴💬

🏁 Final Thoughts

Palmar foot pain in horses is more than navicular disease—it’s a multifaceted syndrome requiring thoughtful diagnosis and management. In 2025, we now understand that while therapeutic shoeing can help, it must be used judiciously, especially in horses with compromised heel structures. 🎯

Smart diagnostics, balanced hoof care, and individualized treatment plans are the key to lasting comfort and performance. Visit AskAVet.com to take the next step in hoof health 🐎🦶