🐎 Palmar Foot Pain Treatment: Using Tildren Safely & Effectively in 2025 💉🦴

By Dr Duncan Houston BVSc

Palmar foot pain—often confused with or linked to navicular disease—continues to be one of the most misunderstood causes of equine lameness. In 2025, we know that the back (palmar) region of the horse’s foot involves more than just the navicular bone. As such, treatment must be tailored to the specific structures causing pain. One such treatment is the use of Tildren—a bisphosphonate drug that can help under the right conditions. 🧠🐴

🧩 What Is Tildren?

Tildren (tiludronate disodium) is a bisphosphonate drug approved for use in horses. It was originally developed for treating osteoporosis in humans, but it has shown effectiveness in managing bone resorption in equine navicular syndrome. 🧪

Its primary mechanism of action:

• 🔬 Inhibits osteoclast activity (cells that break down bone)
• 💉 Reduces bone turnover and resorption
• 🧠 May offer anti-inflammatory benefits in some cases

🎯 When Is Tildren Appropriate?

Dr Duncan Houston emphasizes that Tildren is not a cure-all for heel pain. It is specifically designed to treat bone-related causes of lameness. If the pain is originating from soft tissue—like ligaments, tendons, or the navicular bursa—Tildren will not be effective. 🚫

That’s why proper diagnosis is essential before using this drug. 💡

Recommended Diagnostic Steps:

• 📸 Radiographs to assess navicular bone condition
• 🩻 Ultrasound to evaluate soft tissue structures
• 🧲 MRI for comprehensive imaging of both bone and soft tissue

Only once navicular bone involvement is confirmed should Tildren be considered. 🔍

💉 How Is Tildren Administered?

The drug is typically given via slow intravenous infusion over a 30-minute period. This allows the active ingredient to bind to bone tissue, where it is slowly released over time. 🕒💊

Typical protocol includes:

• 🛑 Withholding feed prior to administration
• 💉 Pre-treatment with flunixin (Banamine) to reduce risk of colic
• 📅 Expect benefits to last for several weeks to months

Tildren’s slow elimination from bone gives it a long duration of action, although multiple treatments are rarely needed in a short period. ⏳

⚠️ Potential Side Effects and Risks

While Tildren is generally well tolerated, there are some potential side effects to be aware of:

• 💥 Mild, transient colic symptoms post-administration
• 🧪 Temporary decrease in blood calcium levels
• 🚫 Avoid use in horses under 4 years or breeding stock

Most adverse effects can be managed by walking the horse post-treatment and using premedication as advised by your vet. 🐎🩺

⚖️ Comparing Tildren to Other Treatments

Tildren is just one part of a larger treatment toolbox for heel pain. Other strategies include:

• 🔧 Therapeutic shoeing for heel support
• 💉 Joint or navicular bursal injections
• 🧬 Regenerative therapies (e.g., PRP, IRAP)
• 🚶 Exercise modification and turnout management

In horses where bone resorption is the clear cause of pain, Tildren can complement these strategies to improve comfort and performance. 🎯

🧠 Why Diagnosis Matters More Than Ever

In the past, horses with vague heel pain were often lumped into the “navicular” category and treated uniformly. But in 2025, we know that precise diagnosis—ideally with advanced imaging—is the key to successful treatment. 🧬

Using Tildren without confirming navicular bone involvement is not only ineffective but can delay appropriate care for other structures. 🧠📉

📲 Consult with AskAVet.com

If your horse is dealing with chronic heel pain or you’re considering Tildren treatment, reach out to AskAVet.com or use the Ask A Vet App. 📱🐴

Dr Duncan Houston and the Ask A Vet team can help review diagnostics, advise on medication use, and build a holistic treatment plan tailored to your horse’s needs. 🧠💬

🏁 Final Thoughts

Tildren can be a valuable tool in treating palmar foot pain—but only when the source of pain is bone-related. In 2025, thanks to better diagnostics and a deeper understanding of equine foot anatomy, vets can make smarter treatment choices for improved outcomes. 🧲💉

Before using Tildren, always confirm the diagnosis and work closely with your vet. For real-time lameness support and medication advice, visit AskAVet.com 🐎🩺