Navicular Rehabilitation Study at Auburn

 Debra R. Taylor DVM, MS, DACVIM (Auburn University College of Veterinary Medicine) is preparing to lead a study using barefoot trimming, environmental stimulation, and padded hoof boot therapy to test the theory that focusing on caudal foot development can bring both physical change and long-term comfort to horses diagnosed with navicular syndrome and/or caudal foot pain. If you own a horse diagnosed with chronic heel pain (with or without diagnosed navicular bone pathology), and would like to be included in the study, please contact Dr. Taylor at the vet school. Boarding is available at nearby farms.

For a summary of the methods we use for horses with heel pain and/or laminitis, read: Link to Hoof Rehab Protocol

Summary of Study

Criteria: Horse must have a clinical diagnosis of forelimb foot pain prior to consideration for the trial. Clinical diagnosis of foot pain is defined as, lameness of one or both forelimbs that is “blocked out” with a palmar digital nerve block.

DAY 0 (or within one week prior to day 0)

• Radiographs - Navicular series – 5 views per foot, to be obtained as per standard AULAC Radiology protocol.
• Photographs of feet – 5 specific angles, ruler in view, to be analyzed by computer software analysis.
• Hoof impressions – The front feet of each horse will be wrapped with dental  impression material to create forms to be later filled with plaster of paris to create an exact replica of the hoof.
• Kinematic gait analysis –To prepare the horse for two-dimensional video analysis, circular retroreflective markers will be placed on the skin over the moveable joints of the fore and hind limbs as well as on the hoof capsule. Hemispherical markers will mark the center of rotation of the distal interphalangeal joint, the toe, on midline, and halfway between the heel bulbs and the ground bearing surface of the heels. Each horse will be videotaped at the walk and trot over a level asphalt surface at a constant velocity and at a speed comfortable for the horse. The videotape of each horse will be subjected to kinematic analysis using the Peak Performance Motus motion analysis software package.  Linear and angular kinematic measurements will be analyzed for stride length, stride position in relation to the trunk and landing pattern (toe first, flat or heel first). 

Treatment:  The horse will then be evaluated and trimmed by either Pete Ramey, AHA Certified Trimmer or his apprentice, Jennifer Bowman,.  A trimming, diet and exercise protocol will be tailored to the specific needs of each horse.  Link to Hoof Rehab Protocol

• Rehab protocol will include:
  • Management of central sulcus thrush if present
    • Antibiotic and antifungal ointment to sulcus, applied daily
    • Introduction of pea gravel to stabling environment
  • Trimming and booting ( Easyboot Gloves see www.easycareinc.com)  to encourage a comfortable heel first landing
  • Variable thickness and densities of boot insoles to maximize frog stimulation
  • Dietary Management
  • Initially pasture rest may be prescribed between trims until heel first landing is achieved
  • After heel first landing is achieved, exercise in hoof boots will be prescribed – exercise log to be kept by owner
  • Repeat trimming on 3 week schedule initially then 6 week interval for 6 – 12 months
  • Return visit the AULAC for post-rehabilitation data collection.  Data to include all of the same procedures as pre-rehabilitation evaluation.

More detailed version of the study parameters found in the Client Consent Form

Below are pictures of Cash. He was donated to Auburn University; a classic "navicular horse". He has severe lameness in the back of both front feet and always impacts the ground toe-first. He spends much of the day standing with both feet in a feed bucket; when he does move it is with great pain and effort. All of his known problems are in the front feet; he blocks out completely sound at the PDN. Dr. Taylor, Ivy and Pete have begun treatment on him out of their own pockets. The hope is to properly document a few cases like Cash, and then use the information gathered to seek funding from traditional research grant sources.

Here is Cash, marked up for the kinematic gait analysis. With his movement downloaded into the computer, the smallest changes in impact, stride length and limb position can be detected and documented. Each horse's movement will be recorded and analyzed pre trim, post trim and in hoof boots at the beginning, at 6 months and at 12 months. Below: Data is gathered at the trot while barefoot and booted with Easycare Glue-ons and 6mm Comfort pads. (Athletic Tape/friction application)

Can the lateral cartilages, digital cushions, frog corium and frog of an adult horse gain strength and mass through barefoot trimming, environmental stimulation and therapeutic boot/pad use? If so, can this increased strength and mass actually increase the soundness, usability and longevity of a horse in this advanced condition? Can we document and publish a proven protocol for rehabilitating horses with chronic heel pain and general weakness or sensitivity in the back of the foot?

We need financial help. Dr. Taylor, Ivy and Pete have paid for Cash's preliminary work and are donating his farrier and veterinary care (and Cash has become Dr. Taylor's lunchtime running partner for boot/pad therapy). But we are lacking the $5,000 needed to pay for pre and post treatment MRI's and CT's. Most farriers and veterinarians were taught that the mass of the lateral cartilages and digital cushions cannot be increased through stimulation- that the strength and condition of these structures are genetically coded. Hopefully enough money can be raised from private donations to use CT and MRI to measure the changes in lateral cartilage and digital cushion volume pre and post treatment in each horse that comes into the rehabilitation program. We have already shown these changes in volume many times, but documented them only with lateral radiographs and photos. Heel width, frog volume, radiographic increases in 'palmar process to heel' dimensions, and increases in soundness are not enough. It is critical that we document the actual volume changes of the internal structures and submit the study to peer review. See PowerPoint presentation of our summer '09 cadaver study- establishing a method of measuring LC and DC volume for live horses.

We know we can develop the back of the foot into a more comfortable, larger, stronger structure, but it must be scientifically documented on numerous horses before it will be accepted by the veterinary community. As stated earlier, we probably need to document a few cases on our own before we could hope to receive funding from traditional sources. So we are asking you for donations- to help with Cash's documentation and hopefully 1-2 additional horses.

If you are willing to help, please send a donation. 100% of the proceeds will be used for this research (actually more; farrier and veterinary services will continue to be donated regardless of available funding) Checks should be made payable to the Auburn University Foundation and sent to:

Auburn University Office of Development 317 South College Street Auburn, AL 36849.

Please specify on the check and in an attached letter that the money is to be used for either Dr. Taylor/Ramey Heel Pain Study or Dr. Taylor/Ramey Laminitis Study

On behalf of Cash, and the countless other horses you may help- Thank you!