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The Holistic View
In my not so conventional practice
of Applied Equine Podiatry, we seldom
use the term “navicular disease”.
Taking a more holistic approach, we
embrace several principles, theorems,
and philosophies. At its foundation is
the belief that structure plus function
equals performance (S+F=P). We also
know that a horse has an innate ability
to heal himself, provided the environment
is conducive to healing.5
What does this mean to the treatment
of the condition defined as navicular
disease? First, we have to understand
that in coming to a point where a single
disease is defined, as is often the case
in conventional veterinary medicine, we
have narrowed our focus, and become
reactive. As new research provides
evidence that there are multiple causes
for the clinical manifestations of the
lameness associated with navicular disease,
it is only logical that a series of events
have led to the condition observed.
As theorized, changes in normal biomechanics
of joint movement may lead to
inflammation of the soft tissues of the
navicular apparatus, but the question is:
what is normal biomechanics of joint
movement of the navicular apparatus?
To answer this question, you must
subscribe to a specific model of foot
function. We subscribe to a model that
defines the Internal Arch Apparatus.
Understanding the
Internal Arch Apparatus
 The Internal Arch Apparatus is responsible
for both energy utilization and
energy dissipation within the foot, and is
comprised of the coffin bone, navicular
bone, distal articulating surface of the
short pastern, all connective tissues
(ligaments, tendons, fascia), the digital
cushion, and all corium (inner layer of
foot, containing nerves and blood
vessels). In short, the Internal Arch
Apparatus constitutes all structures
of the foot, without the hoof capsule.
Applied Equine Podiatry recognizes
that true foot function sees all structures
working in concert to provide performance.
Because this model includes
the navicular apparatus as part
of the whole, a manifestation of pain
within the navicular apparatus would
indicate a loss of structure and/or function
of the Internal Arch Apparatus.
Taking things a step further, it is
understood that the coria (corium) of
the Internal Arch Apparatus produce
the hoof capsule. It is often said of
the foot that the outside is a mirror
image of the inside. If one subscribes to
this belief, it is only natural that one would become reactive,
being held slave to the foot’s internal conformation. I teach
and follow the premise that “everything on the inside is a mirror
image of that on the outside.” Is this semantics? Hardly– with an understanding that the internal structure’s health is
the result of external stimulus, we become empowered.
Where am I going with this? I am saying that true navicular
disease (lameness due to bone change) is only apparent following
a long series of recurring events. In this chain of events,
soft tissue is the first to undergo change in response to an
environmental alteration (balance change, increased vibration,
friction and/or pressure), followed by changes to the horn.
Before any modifications to the bone become apparent, the
hoof capsule will show deformity (flare, excessive wear or
growth). As the horse reacts to pain, he changes the way he
loads the foot, and deformity appears. The deformity can be
minimal, but it will occur.
On rare occasions, a horse may show an acute-onset unilateral
(affecting one limb) lameness, which leads to a diagnosis of
navicular disease. It is my belief that short of a catastrophic insult
(injury), pronounced unilateral lameness is more often the result of
chronic loss of structure (fallen arch) and proper foot function.
How is it Treated?
Conventionally, whether the diagnosis is disease or syndrome,
most veterinarians will recommend corrective shoeing. Most
commonly, this means an egg-bar shoe (said to give added
support to the heel), accompanied by a rolled or rocker
toe, wedge pads when needed to correct hoof pastern angle, and impression material for cushioning.
But other shoeing protocols are used
too. Conventionally speaking, corrective
shoeing, regardless of the shoe used, is
dependent on the horse’s hoof-pastern
angle. If the horse already had a wellconformed
foot, little will be achieved
with corrective shoeing in the advanced
stages of the disease.
In addition, vets may recommend nonsteroidal
anti-inflammatory medications
to control foot pain, as well as phenylbutazone
(bute), but not all horses with
navicular pain respond to phenylbutazone.
Medications to increase blood supply
have also been prescribed. As a last
resort, your vet may perform a surgical
procedure known as a neurectomy. This
procedure severs the nerve supplying
the back of the foot but the results are
often temporary.
How Does Applied
Equine Podiatry Differ?
 When presented with a horse diagnosed
with navicular disease, it is imperative to
evaluate the foot structure. As I do not
subscribe to the conventional definition
of a well-conformed foot, I assess the
foot with an eye on the health of the
Internal Arch Apparatus. I have found
that navicular pain results from a loss of
those structures that help in maintaining
proper biomechanical function of the
joint, and in the positioning of the
coffin bone in its relation to the joint
and the distal limb. These structures
include not only the distal sesamoidean
ligaments and tendons, but also the
lateral cartilage and digital cushion.
Where conventional thinking focuses on
the stress exerted by the deep digital
flexor tendon on the navicular bursa, and
reacts to reduce this stress by reducing
break-over or increasing foot angle, I
find myself more concerned with heel
placement and the effect it has on the biomechanics
of joint movement, circulation,
and neurological function. Where are the
heels in relationship to the center axis of
the joint? No shoe can alter the position
of heels in relationship to this center axis,
but it does alter the forces acting on the
joint. This may temporarily reduce pain,
but it’s seldom successful in stopping the
progression of the disease.
This conventional approach ignores
the importance of the Internal Arch
Apparatus and the role it plays in
energy utilization. The key to treating
navicular pain is to consider the whole.
Simply trimming the heels to get them
to the widest part of the frog, or reducing
break-over, does not address the
underlying cause of the pain – the loss
of structure causing undue stress on
the supporting structures of the joint.
Instead we provide the correct stimulus
that will ultimately result in reducing the
stresses associated with the progression
of the disease process, and help restore
sound structure and proper function.
I have found that pain management
is essential during this time, and that
pain can effectively be managed homeopathically
and by the use of closed cell
foam pads as a rehabilitative strategy.
Over the past eight years, I have worked
on many horses diagnosed with navicular
syndrome/disease, and most had weak
structure to the caudal (back) aspect
of the foot. But with correct trimming
to achieve balance of the hoof capsule
to that of the Internal Arch Apparatus,
the appropriate application of stimulus
(exercise/pressure) to aid in the return
of correct structure, and sound pain
management practices, I was able to
eliminate the condition.
For more information on Applied
Equine Podiatry, please visit
www.appliedequinepodiatry.org
1. Pool RR, Meagher DM, Stover SM, Pathophysiology
of navicular disease, Vet Clin North Am Equine Pract
1989; 5: 109-129
2. Ross MW, Dyson SJ, Lameness in the Horse,
Philadelphia, 2003 Saunders
3. Leach DH, Treatment and pathogenesis of navicular
disease in horses, Equine Vet J 1993; 57: 415-421
4. Thompson KN, Rooney JR, et al, Considerations on
the pathogenesis of navicular disease, J Equine Vet Sci
1991; 11: 4-8
5. La Pierre, KC, The Chosen Road, Achieving High
Performance Through Applied Equine Podiatry, Dover,
Naked Greyhound Press, 2003
KC LaPierre has been a practicing
farrier for over 23 years and is
considered one of the foremost experts
on the equine foot. He developed the
Internal Arch Theory in 2004 and
travels the world teaching horse owners,
veterinarians and farriers about Applied
Equine Podiatry. KC is also a published
author and illustrator and has
consulted to a number of top trainers.
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Published in the January/February 2008 issue of Equine Wellness Magazine |
