If your horse is showing signs of lameness, you may wonder: Did she step on a rock? Is something caught in her hoof? While many cases of equine lameness are minor and treatable, persistent or unexplained lameness—especially in the heel area—may be an early sign of Navicular disease, also referred to as Navicular syndrome. It’s classified as a syndrome because it presents with consistent clinical signs, such as heel pain and positive response to regional nerve blocks, but doesn’t always involve the same specific structures or pathology in every horse.

This condition affects the navicular bone and surrounding structures within the hoof, often leading to chronic pain and reduced performance. Early recognition and diagnosis of Navicular syndrome are crucial for implementing effective treatment and improving your horse’s long-term comfort and mobility. Learn what signs to watch for and how to manage this common cause of lameness in performance and pleasure horses.

What is Equine Navicular Syndrome?

Navicular disease is a common cause of forelimb lameness in middle-aged horses. It often degenerates and causes inflammation of the various structures in the hoof. This is known as “Navicular syndrome.” The condition leads to a gradual deterioration of the navicular bone and its surrounding tissues. This results in persistent pain and discomfort.

Also known as podotrochlosis, navicular syndrome in horses affects the structures within the hoof and tendons, as listed below :

• Navicular bone, a small, boat-shaped bone that acts as a shock absorber during movement.
• Navicular bursa, located between the navicular bone and the DDFT (deep digital flexor tendon).This sac contains fluid that enables the DDFT to glide past the navicular bone
• Collateral sesamoid ligaments
• Deep digital flexor tendon, which connects to the muscle above the knee, runs along the back of the fetlock and over the navicular bone, and then inserts into the coffin bone.

American Quarter horses, Thoroughbreds, and warmblood breeds are the most commonly affected breeds. Warmblood horses are often used in equestrian competition and have Thoroughbred, Arabian and draft horse bloodlines. The athletic performance of the horse impacts the amount of stress being put on the hoof. Simply put,  the higher the level of performance, the higher the level of hoof stress. It’s most commonly diagnosed in horses that are 4 to 15 years old.

What are the Signs of Navicular Disease in Horses?

The most obvious symptom, of course, is lameness. This typically gets worse over time and often shows up when your horse is working on hard surfaces or turning in tight circles. As one observes the navicular horse move, one may observe that he lands toe first (instead of heel first) to avoid the heel pain associated with the disease. In fact, when your farrier watches your horse move, he may be the first to pinpoint this! Skilled farriery goes a long way to keeping any horse sound but is vital in a horse that has less than perfect confirmation or feet. Most often, it affects one hoof worse than the other, although it’s relatively common for both feet to succumb.

Other symptoms include:

• Shortened stride
• Difficulty in walking, such as stumbling
• Heel pain, or pain when the fetlock is flexed
• Points front foot or continually shifts while at rest
• Horse is slower than usual, reluctant to work
• Slight head bob when trotting
• Sensitivity across the frog or in the heel
• Lameness on lungeing in a circle (inside front leg) at a trot and also avoids taking the correct lead in a canter
• Farrier detects soreness across heels with hoof tester

Common Causes of Navicular Disease in Horses

The causes of navicular disease in horses can be complex and multifactorial, making early diagnosis and management critical. While pinpointing a single source is often difficult, several risk factors frequently contribute to the development and progression of navicular syndrome.

• Poor hoof conformation: Horses with narrow, upright feet, contracted heels, and small frogs are at higher risk. A mismatch between small hooves and a heavier body type can concentrate excessive force on the hoof, increasing the likelihood of navicular issues.
• Inadequate hoof care: Improper trimming or shoeing—such as using shoes that are too small or misaligned—can place uneven pressure on the navicular bone. Additional concerns include underrun heels, mismatched hoof angles, and sheared heels, all of which can intensify structural stress. Classic long toe/low heel conformation.
• Excessive impact on the hoof: Repetitive work on hard ground or heavy training regimens may place undue strain on the heel and coffin joint, contributing to chronic inflammation and degeneration.
• Genetic factors: Certain breeds, such as Warmbloods, may have a genetic predisposition to navicular syndrome, making them more vulnerable to developing this condition over time.
• Nutritional imbalances: Poor nutrition can affect hoof health and bone integrity, contributing to the onset of navicular problems.
• Lack of proper exercise: Inactivity can reduce blood flow and weaken the supportive structures within the hoof, increasing the risk of navicular damage.

Understanding the underlying triggers of navicular disease in horses helps guide effective prevention and treatment strategies. Early intervention and a proactive approach to equine hoof care are essential for maintaining long-term soundness and comfort.

How to Tell if it’s Navicular Syndrome

Diagnosing navicular disease in horses involves a thorough examination by a veterinarian. An equine veterinarian will conduct a physical examination, evaluate the extent of the lameness, and put together a picture of the horse’s history and lifestyle. This will provide them with a more complete clinical representation. Furthermore, an assessment of  the feet and shoeing, together with the way in which the horse moves will be key. Likewise, the performance of  flexion tests and nerve blocks will pay their part in the evaluation.

Into the bargain, diagnostic imaging can be a real boon in telling whether navicular disease is the culprit in your horse’s lameness. Your vet may opt to use X-rays, MRW scans, ultrasonography or other imaging techniques which provide valuable information for treatment planning. The use of MRI encompasses diagnosis of damage to soft tissue structures such as tendons and ligaments. In addition, vets can also see a buildup of fluid in the navicular bursa and distal interphalangeal joint via MRI. These types of findings indicate inflammation. Furthermore, an MRI can identify changes in bone offering greater potential than an X-ray.

Navicular Disease Treatment Options for Horses

While there is currently no cure for navicular disease in horses, the primary goals of treatment are to relieve pain, reduce inflammation, and slow disease progression. A multimodal approach is often the most effective way to manage this degenerative condition and maintain your horse’s comfort and performance.

Rest and Activity Modification

Although rest alone will not cure equine navicular syndrome, limiting physical activity during flare-ups can significantly reduce discomfort and prevent further damage to the navicular apparatus.

Therapeutic Hoof Care

Corrective trimming and therapeutic shoeing play a critical role in horse hoof care. A skilled farrier can design custom shoes that relieve pressure on the navicular bone and the deep digital flexor tendon (DDFT) while improving overall hoof balance. Proper hoof alignment can dramatically enhance your horse’s comfort and mobility.

Anti-Inflammatory Medications

Administering NSAIDs for horses, such as Phenylbutazone Powder, is a common method of managing pain and inflammation. In some cases, corticosteroid or hyaluronic acid injections—may be applied directly to the affected area for localized relief. Equioxx® Tablets can also be used for the control of pain and inflammation.

Bisphosphonates

Drugs such as Osphos®, part of the bisphosphonate class, are used to reduce bone resorption and provide longer-term navicular disease treatment benefits, especially in chronic cases.

Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) is a non-invasive option that stimulates healing in both soft and hard tissue. Many equine veterinarians use this to reduce lameness and improve overall function.

Alternative and Regenerative Therapies

Complementary treatments such as acupuncture, chiropractic care, and stem cell therapy may provide added support by enhancing circulation, reducing tension, and promoting tissue regeneration in horses suffering from navicular disease.

Hoof and Joint Supplements

Nutritional support is also key. When managing navicular disease in horses, targeted supplements can play a supportive role in maintaining comfort and mobility. Steadfast offers comprehensive support for equine joint, tendon, and ligament health. Products like Comfort Quik are designed to promote normal comfort levels, which is essential for horses coping with chronic pain. For joint health and mobility, Chondrogen EQ and Conquer offer advanced support through ingredients that help maintain cartilage integrity and reduce inflammation. Additionally, Sore No More topical solutions may be beneficial for addressing muscle discomfort—particularly in horses that are compensating for hoof pain with altered posture or movement. These supplements and supportive therapies can be part of a comprehensive approach to managing navicular syndrome alongside veterinary care and hoof management.

Surgical Treatments for Navicular Disease

More invasive (surgical) treatments are usually only attempted in severe cases. They include:

• Navicular bursoscopy to debride dorsal tears of the DDFT or flexor cortex erosions on the navicular bone. This can also break down adhesions within the proximal aspect of the navicular bursa.
• Neurectomy of the palmar digital nerves. This means cutting the nerves that affect the foot, so your horse does not feel the condition as it worsens. This is done only in cases where other medical management techniques have not worked. But it’s not always permanent and there are risks involved.

Effective treatment for navicular disease in horses involves a comprehensive care plan tailored to your horse’s specific needs. Partnering with your veterinarian and farrier is essential to preserving your horse’s comfort, performance, and quality of life.

Management and Prognosis for Navicular Disease

No matter how you treat the painful symptoms, navicular syndrome tends to progress and get worse. This means you’ll need to provide lifelong treatment to your horse, and, unfortunately, some horses don’t respond positively. Eventually, navicular syndrome may develop into arthritis, heightened lameness and other health issues. And using anti-inflammatory medications over a long period of time can cause kidney or gastrointestinal issues.

However, medical advances are continually occurring. The future holds promise for improved options in treating this condition. And there are other things within your control that can help.

For instance, make sure your horse gets regular, controlled exercise and conditioning. This helps maintain her overall health, hoof function and joint mobility. Exercise brings good blood flow to the feet and blood flow brings nourishment with it.  However, don’t overdo it. Overexertion is not good either for a horse with navicular syndrome.

Diet also plays a key role. Feed a balanced diet rich in essential nutrients. Supplements such as Steadfast provides both joint and tendon/ligament support. Talk with your vet to get his or her input on these dietary changes.

Conclusion: Supporting a Horse with Navicular Syndrome

The prognosis for horses with navicular syndrome largely depends on the severity of the condition and the effectiveness of the treatment plan. While some horses experience only mild symptoms and maintain long-term soundness, others may progress more rapidly and suffer from chronic discomfort that impacts their quality of life.

However, with a proactive and informed approach, many horses can continue to live comfortably—and even enjoy athletic careers. The most successful outcomes often involve:

• Consistent veterinary care tailored to the individual horse
• A comprehensive pain management strategy, including medications, therapies, and nutritional support
• Ongoing hoof care and farrier involvement to maintain optimal hoof alignment and reduce strain

By working closely with your veterinarian and farrier, you can help your horse manage navicular disease and lead a fulfilling, active life despite the diagnosis. If you need help finding the right support for your horse, call us at 800.786.4751.