Navicular Bursar

Once a diagnosis of a problem with the navicular bone, the deep digital flexor tendon or one of the other soft tissue structures associated with the navicular bone is made, one of the treatment options is to inject the navicular bursar with cortisone as an anti-inflammatory. The navicular bursar is the fluid filled pouch between the navicular bone and the deep digital flexor tendon.

The procedure involves injecting with a long needle between the heel bulbs, through the deep digital flexor tendon and into the navicular bursar. This is best carried out under x-ray guidance. First of all a radiograph is taken of the foot with a marker that shows up on the image, to identify the exact location of the navicular bone within the hoof, a mark is made on the hoof wall with a marker pen to be used as an aiming marker for the needle advancement. Often a nerve block will be placed at the palmar digital site to totally desensitise the heel region of the foot, sometimes just the location of the injection site is desensitised with local anaesthetic.

Once the injection site is desensitised the heel region is meticulous cleaned and then aseptically prepped. A 10cm spinal needle with a stylet is placed through the skin between the heel bulbs and advanced towards the navicular bone, roughly parallel with the ground, using the marker on the hoof wall as a guide to the angle of approach. As the needle is advanced it is possible to gently feel it contact the back of the navicular bone. At this point a second radiograph is taken to make sure the needle placement is correct. If the needle is in the right place behind the navicular bone and through the deep digital flexor tendon, then the stylet is removed from the needle and the cortisone is injected into the bursar. Mixed in with the cortisone is a radiopaque substance which shows up on x-rays, a third x-ray is taken to demonstrate filling of the drug within the pouch at the back of the navicular bone and therefore the drug within the navicular bursar, after the needle has been removed.

Following injection the heel region is bandaged to keep it clean for 24 hours. The patient is kept box rested also for the first day after the injection, then hand walked for a further 2 days, followed by an ascending exercise program dependent on what the actual diagnosis was.

It is important that this procedure is carried out as aseptically as possible as to avoid the introduction of infection into the navicular bursar. It is also important to be as accurate as possible with the needle placement, if we know from the series of images obtained that the needle was correctly positioned and that the cortisone was injected into the navicular bursar, then we know if the horse does not become sound it was not due to inaccurate drug placement and that a different treatment option is required.

Navicular bursar medication is only one treatment option available to us for the treatment of navicular disease syndrome. This technique should be used in conjunction with other medications such as Tildren (Equidronate), aspirin, isoxoprine, etc. Probably the most important aspect of treatment is the farriery and obtaining a correct and appropriate foot balance.

Dr. E.A.Lyall, BVetMed, CertEM (StudMed), MRCVS

New Born Foal Facts!

  • Suck Reflex should be present within 5-10 minutes of birth
  • Trying to stand within 30 minutes
  • Standing within approximately 60 minutes
  • Suckling within 2-3 hours (If not by 4 hours -call the vet!)
  • The best time for colostrum absorption is the first 12 hours
  • Should suck 5-7 times an hour
  • Will consume 10-15% of their bodyweight in milk in the first 24 hours.
  • This increases to 20-25% by a few days of age.
  • Meconium should be passed within the first 6 hours of life.
  • First urination is 6 hours for colts and 10-12 hours for fillies.
  • The umbilical stump should shrivel up within 24 hours.
  • Vet check at 12-18 hours of age

Foaling The Mare

Foaling the Mare
Most mares foal without complication, however it is important that they are monitored regularly as the foaling becomes imminent.  Mares prefer to foal when all is quiet, as such it is important that the checks do not disturb them.  The stable can be fitted with a low wattage light bulb that can be left on.  Small cameras are available so that foaling mares can be observed from a distance and sweat alarms can be used to indicate an imminent labour.  There are alarms that can be stitched into the vulva which call your mobile phone when the water bag is pushed through the vulva at the onset of labour.  In high-risk mares with complications, the milk secretions can be monitored to more accurately identify when labour is likely to begin. 

The mare herself will start to show signs impending foaling.  These may occur several weeks before foaling or may start much closer.  The signs include development of the udder, swelling in front of the udder, slackening of the pelvic ligaments resulting in hollowing and softening of the quarters, lengthening and relaxation of the vulva, changes in temperament and the production of wax on the teats.  The “waxing-up” of the mare is one of the last signs to occur. 

During the last month of pregnancy the udder produces the first milk, colostrum, this is rich in antibodies that protect the foal from infection.  Prior to foaling some mares drip or run milk and as a result lose the valuable colostrum, once lost it is not replaced.  If this occurs 200ml volumes can be milked from the mare and frozen, this stored colostrum can be thawed in warm water (not microwaved) and bottle-fed to the foal in the first 6 hours after foaling.

While a mare is foaling it is better to minimise interference and to only respond when there is a problem.  There are three stages of labour.  The first stage is when the foal is getting into the correct position to be born, this may take several hours.  During this time the mare may become restless, sweat, look at her flanks and get up and down.  The second stage of labour begins with the passing and breaking of the white water bag, it ends with the complete birth of the foal.  Ideally mares should foal lying down.  The second stage of labour involves the forceful uterine and abdominal contractions required to give birth to the foal, typically the mare will be lying on her side. The average length of the second stage is 17 minutes, if after this length of time when forceful expulsive efforts have been made and the foal has not been produced veterinary assistance should be sought. The third stage of labour involves the passing of the placenta.  Once the mare stands after foaling the placenta should be knotted at the level of the hocks to prevent the mare from standing on it.  The placenta is usually passed within one hour, if it is not passed within three hours veterinary assistance will be required.  The placenta should be kept for your vet to examine.

Most mares will foal without any complications.  The normal presentation is that of a diving posture where the two front feet and the head come together, so the first part of the foal to be seen will be a hoof, usually followed by a second hoof a little further back.  The soles of these hooves should be facing the ground, if they are facing upwards the foal is either rotated or it is breach and coming back feet first which is very unusual.  A rotated foal will end up in the correct orientation as the mare gets up and down, so let her do this.  The leg with the foot which is a little further back will have a flexed elbow, the elbow may catch on the brim of the pelvis, if the mare appears to be making little progress getting the foal out, then between the mare’s contractions grip the pastern on the shorter leg and pull the limb to the same length as the more forward hoof, this will extend the elbow and prevent it catching on the pelvis.  Once this is corrected often the foal will come away easily.

As well as two front legs there should be a nose, this should be at about the level of the foal’s mid canon on the forelimbs.  Once the nose is out of the vulva it is worth just clearing the membranes from the nostrils.  If little progress is being made by the mare a little traction can be put on the foal to help it out, the direction of pull should be down towards the mares hocks due to the shape of the birth canal and the posture of the foal.  Grasp the pastern regions and pull gently, particularly between the mare’s contractions to prevent the foal slipping back into the uterus, let the contractions push the foal out, just help her.  Once the foal gets it’s chest and then pelvis through the mare’s vulva it will come away very easily.  Ideally the foals back legs should be left in the birth canal and the mare allowed to lye quietly to regain her strength, in this position the foal will still remain attached to the placenta via the umbilical cord, during the time it lies here blood from the placenta will be retained by the foal.  The placenta should break at the natural weak point next to the foal’s abdomen when the mare stands up.  As the foal is lying there make sure the nostrils are clean, sit it on it’s chest with it’s front legs wide apart in front of it and rub it’s chest with straw to stimulate breathing.

If at any stage in the birth process there are concerns about the foals presentation or it’s viability then seek veterinary assistance immediately.

Respiratory Conditions

Diseases and Disorder of Youngstock – Respiratory Conditions
(By Ed Lyall, BVetMed, CertEM (StudMed), MRCVS)

Young horses are like children where they have quite naïve immune systems meaning they can pick up viral and bacterial infections much easier that an adult horse. Many of these manifest themselves when the antibodies, derived from the mothers colostrum, start to disappear from the foal’s blood stream. The most common infections are respiratory infections; it is not unusual to see paddocks full of weanlings with crusty snotty noses on stud farms, they are usually caused by viruses.

There is little treatment for respiratory viruses in horses other than supportive care, ideally the youngsters affected should have their temperature monitored and non-steroidal anti-inflammatory drugs such as bute can be given to bring the temperature down to normal.

Any foal with a snotty nose and a high temperature should be monitored for the development of swollen painful glands under the jaw and around the base of the ear. If such swellings are present, tests should be performed to rule out strangles, the bacterial respiratory infection caused by Streptococcus equi. Young horses often have slightly enlarged glands where their immune system is learning to deal with all the pathogens that the horse is being exposed to on a daily basis. The difference is that strangles causes abscesses with the glands that are very painful to palpate. Any horse, and its contact companions, that are suspiciously looking as though it has strangles should be isolated until the results of the appropriate tests are through.

Rhodococcus equi is a bacterial disease that causes abscessation in the lungs of young foals. It is derived from inhaled environmental bugs and can affect multiple foals on the same property, typically from two months of age. Foals will be found to be dull and lethargic with reasonably high temperatures, severe cases will be breathing difficulty; blood samples will show elevation of white cell counts and more importantly elevation of fibrinogen levels.

The diagnosis is confirmed by ultrasound scanning the chest to find evidence of the abscesses. Treatment is with appropriate long term antibiotics.

Caring for the Young Horse

Caring for the Young Horse


It is important to monitor worm egg counts and to appropriately treat with anthelmintics. Young, growing horses are more susceptible to intestinal parasites than adult horses as the immune system is responsible for keeping worm burdens down in the bowel. They are also more likely to have colic due to the presence of tapeworm in the bowel, and these cases can require surgery to correct because the tapeworms cause the bowel to contract in an uncoordinated fashion.

Small red worms, cyathostomes, can cause very bad diarrhoea, typically in the autumn when the larvae go into hibernation in the bowel wall, the encysted larvae emerge from hibernation and leave the bowel wall, causing a lot of trauma to the tissue.  Diarrhoea caused by worms can be very difficult to treat and can result in a rapid debilitating loss of condition in young horses.

Teeth can become very sharp, and problems with milk teeth/caps, are commonly seen. Poor conditions and difficulty chewing would indicate that an examination of the mouth and a quick rasping session would be appropriate.

As young horses are developing it is important to keep a close eye on their limbs to make sure they are developing properly. Hard ground and rapid growth rate can cause various problems. Boxy feet can develop quickly and can easily be missed if the animal is turned out in long grass. The deep digital flexor tendon is effectively too tight, pulling the foal up on to the tip of its toe, which is then worn away, resulting in a boxy conformation. Many of these cases can be corrected with some remedial work by the farrier, heel trimming and applying a toe extension. Some require surgery in conjunction with farriery, to cut the check ligament of the deep digital flexor tendon, or in extreme cases the deep digital flexor tendon itself can be cut. Even after surgery these youngsters will have a normal athletic career.

The most common cause of lameness in young horses is foot abscesses, however, it is important to look at lame youngsters and make sure they do not have swollen joints, so that problems to do with health and limbs can be picked up and dealt with at an early stage.

A preventative health care programme should include regular and appropriate worming, vaccination against influenza and tetanus, regular assessment of the limbs and feet with the farrier and monitoring of weight, body condition and growth rate. Most of the feed companies have nutritionists to advise on feeding of young stock, and your vet will assist in the assessment of the limbs if you feel there is a problem.

Coping with Sweet Itch

Coping with SweetItch


(By Pauline Williams, BSc, MSc,MA,VetMB, Cert EM (Int Med), MRCVS)


Sweet itch is a skin condition caused by an allergic reaction to midge bites (primarily Culicoides spp). It is also known as insect bite hypersensitivity or summer seasonal recurrent dermatitis, and can affect horses, ponies and donkeys all over the world according to the distribution of midges.

All animals are bitten by midges but only those that are allergic to the bites show clinical signs. There are different species of Culicoides which feed at different sites; some at the mane and withers, others at the tail and or belly and legs. The animal may be allergic to one or more species and therefore they may show signs on one area only, such as the tail or all over the body in severe cases.

Clinical Signs

Affected animals show varying degrees of pruritis (itchiness) which leads to self-trauma due to rubbing. The most common sites affected are the mane and tail but sometimes only the belly is affected and in severe cases the animal may show signs of all over the body including the legs. Rubbing leads to alopecia (hair loss), ulcers and bleeding with secondary crusts (scabs) and infection. Many of these changes are reversible out of season when there are much fewer midges. However in more chronic cases the skin can become hyper pigmented (blackened) and thickened with ridges, especially along the mane. Severely affected animals may lose weight due to chronic irritation and show behavioural changes from tail swishing, rolling, and rubbing the belly on the ground to being unrideable at the peak midge feeding times of the day (dusk and dawn).

If you are buying a pony that is said to be managed successfully by one of the different treatment options, you should be aware that a change in location may either improve or exacerbate the condition to a point that it is no longer manageable. Sweet itch sufferers may also deteriorate with age.

When buying a pony in the winter out of the midge season, in severe cases the thickening on the neck and tail head may still be evident. However, it is often difficult to detect animals which show milder signs or those that have been managed effectively through the summer. Often there is evidence of different hair length, particularly at the tail head, but it is important to ask the owners to declare if the pony suffers from the condition. At present, there is no reliable blood test or other allergy test to detect sweet itch sufferers out of season, but research is on-going.

Identifying Joint Disease

 Identifying Joint Disease

Joint pain can be mild to severe; even mild joint pain that is unnoticeable in terms of lameness to the rider can be performance limiting. A sore joint may stop a show jumper landing on the correct lead after the fence or it may cause the horse to roll unnecessary poles of higher fences. A dressage horse may show asymmetry of limb action during complex dressage movements. Polo ponies may find it difficult to stop and turn sharply and race horses with joint pain may be slower than their expected potential. Joint pain is as a result of joint inflammation, so left untreated some inflamed joints will settle down with rest. Some chronically inflamed joints go on to become osteoarthritic. Early identification of joint inflammation and appropriate treatment can reduce the chances of chronic joint pain and therefore poor performance and lameness issues.


Often riders will call and say they think there is a problem with a horse, and I now look at higher level competition horses on a regular basis to monitor for joint pain. The first thing is to ask the rider to describe the problems they think they are having. I then palpate the horse’s limbs for obvious filling of the joints, as in most cases an inflamed joint will have an effusion, which is where the inflamed lining of the joint produces an excess amount of fluid. Some effused joints can be identified by visual inspection as the joint bulges. In some instances, particularly with the fetlock joint, it is possible to feel a palpable thickening of the joint capsule. Some joints will feel warm to the touch.


The next step is to trot the horse up on a firm flat surface and see how it moves. One of the advantages of regular checks is the vet gets to know what it normal for the horse and is then able to spot subtle gait changes. Flexion tests are a valuable way of identifying a problem with a joint, most inflamed joints will result in lameness after flexion test. The horse will then be evaluated under saddle, on the lunge in a school and on a hard surface. The rider will be asked to demonstrate the problems they are having, this may be during complex dressage movements or jumping obstacles.


Often it is possible to identify a specific joint causing the problem by clinical examination, but a lot of the time it is necessary to anaesthetise or block sequentially joints on the limb in question. Once a joint is blocked the horse is put back in the situation that demonstrated the lameness the best, i.e. on the lunge, on the hard or flexion test. Often there is little for the vet to visually see and the response to blocking must be assessed by the rider.

Joint Disease Treatment

Joint Disease Treatment

Once the problem joint has been identified, the next step is to formulate a treatment plan. The first option is usually to medicate the joint with corticosteroids in combination with hyaluronic acid. There is often bad press given to the use of corticosteroids in horses, but the doses that are regarded as protective to the cartilage in the joint pose little risk of much talked about side effect of laminitis. Inappropriate use of corticosteroids in terms of dose rate and injecting too many joints at one time may result in problems but using corticosteroids would be regarded as routine by myself and many other vets. Corticosteroids cannot be used near the time of competition or the horse will come up positive on a drug test. As such we obey a withdrawal period, which depends on which drug is used. This means that horses that have repeated problems with joints and need medication to help also need a treatment plan worked out based on their competition schedule.

Arthroscopic surgery is an option for chronically diseased joints and is often carried out outside the competition season to allow time for recovery after the surgery. Shockwave can be a very valuable tool for treating some joints such as the flat weight bearing joint of the hocks, where chronic inflammation is called spavin. It is not completely clear how shockwave works, however it does have a desensitizing effect as well as stimulating blood flow by sending acoustic shockwaves through the tissue. Shockwave can also be a useful treatment for ligamentous problems around the joints.

When I am evaluating a horse with a joint problem an assessment of the foot balance is also made, and any findings are discussed with the yard farrier. Often, altering the shoeing will alleviate pain from within a joint, this is often the case with the hind feet and hock pain. It is also worth involving the physiotherapist in the treatment plan, as horses with chronic joint pain will have upper limb and back stiffness issues. The use of glucosamine based food supplements is a useful adjunct to the management of all sports horses, regardless of whether they have joint problems or not.

The key to managing a competition horse in terms of performance is not to wait until the horse is showing signs of lameness, but to identify subtle problems that can be affecting their performance and act before they become a bigger issue.

Laminitic Horse

Caring for the Laminitic Horse

(By Ed Lyall, BVetMed, CertEM (StudMed), MRCVS)

Laminitis is a painful condition involving inflammation of the laminae. In severe cases the laminae become inflamed all around the hoof resulting in uniform separation, when the limb is loaded the whole pedal  bone then ‘sinks’ within the hoof. The prognosis following rotation is much worse; radiographs are useful to identify what had actually happened.


There are several reasons why laminitis occurs and it is important to identify the cause so treatment can be carried out accordingly;

1. Equine metabolic syndrome (EMS) which is effectively a form of insulin resistance.
2. Cushing’s disease which many older horses and ponies are now diagnosed with.
3. Some form of sepsis or infection that result in the release of toxins within the body, such as colitis, colic surgery or retention of a portion of the placenta after foaling. Grain overload also falls into this category as the change in diet results in abnormal toxin producing bacteria colonising the gut.
4. Excessive loading of one limb due to injury to the opposite limb. 
5. Excessive exercise on hard ground.

Clinical Signs

Laminitis affects the front limbs more commonly that the back limbs, but one foot can be affected or even just the hind feet. The typical signs of laminitis include;

1. Abnormal stance – usually with the weight rocked back onto the heels and toes out in front off-loading the weight from the more painful toe region.
2. Often cases look very awkward on their hindlimbs, but this is a result of more load being taken by the back end.
3. Walk is reluctant with a toe slapping gait, where the heel is loaded before the toe. There will often be stiff, stilted gait when turning sharply on a hard surface.
4. Often soft footing will be favoured by the patient. Severe cases will lie down and be reluctant to get up.
5. From a clinical point of view the hoof capsule may be hot with a strong pulse palpable in the palmar digital arteries at the back of the fetlock and there will be a pain response on hoof tester pressure in the toe region.

If laminitis is suspected, the first thing to do is make sure there is a deep soft bed, administer pain killers in the form of phenylbutazone if available and then contact a vet for assistance. Laminitis is in many cases an emergency.


This will comprise of the following:

1. Removal of shoes, shortening the toe to reduce the rotating effect of the deep digital flexor tendon.
2. Some form of frog support will then need to be applied, and this is to off load the weight from the painful hoof wall. 
3. If we know there has been a toxic episode then icing the feet can reduce the blood supply and prevent further toxins from reaching and damaging the laminae further.
4. Over the years many products have been tried to affect blood flow to the laminae, such as ACP and an ointment form of trinitroglycerine.
5. Phenylbutazone or a derivative is the main pain relief used.
6. Appropriate levels of exercise depending on response to therapy, initially strict rest, then more comfortable turn out in a small paddock may be allowed.
7. Once the initial laminitic incident is under control, then there are a multitude of types of shoes that can be applied to the feet from egg and heart bar shoes, reverse shoes, four point shoes with rails to clogs. The clogs have saved many horses’ lives recently and again are my favoured transition from strap on pads to more normal shoes.