Question: How do I treat high ringbone and navicular in the left front of my 16-year-old gelding? I used osphos about six months ago and injections of steroids into the bursa and navicular joint. My horse is also receiving 57 mg. of Equioxx daily and is shod with natural balance shoes. The ringbone flares up from time to to time making him unrideable. I have tried to work him very light 2- 3 times a week.
Answer: It looks like you are off to a good start with management of your horse’s pain. Ringbone is a progressive arthritic disease of the pastern that can be difficult to manage. Keeping the shoeing balanced is very important and some radiographs to look at the balance of the foot would be helpful. Most of the options for management I have listed below will cross over to management of navicular disease. If the Osphos is helping manage the navicular disease, I would continue to use it. Natural Balance shoes are a good choice, but there are some other options if those are no longer working as well as they used to. Denoix shoes by Grand Circuit are worth looking into. Perhaps your farrier and veterinarian can look at the shoeing together and see if there might be something to change in the angles, medial/lateral balance or type of shoe.
You can try adding in some oral supplements. For oral supplementation, look for joint supplements (chondroitin sulfate, glucosamine) that are backed by research. The manufacturers of these products will usually publish the independent research on their websites. I have had good results using Cosequin ASU, but there are many other options. I have had good success with adding in MSM, Boswellia, Fatty Acids (chia seed or flax seed) and antioxidants to the daily diet in addition to a joint supplement. Make sure to use reputable manufactures for supplements.
There are systemic injectable joint medications such as pentosan polysulfate, glycosaminoglycans and hyaluronic acid (intravenous) that may be helpful in management of your horse’s pain. You can utilize hot and cold therapy as needed. During periods of cold weather or when your horse seems particularly stiff, you can apply heat to the joint prior to work. Similarly, you can apply 10” of ice or cold hosing after work to help decrease inflammation in the joint, if you feel like the joint becomes inflamed after work. You may find that your horse responds better to either heat or cold. Either one is a safe, simple and easy therapeutic to utilize. There are topical products you can use to help control pain and inflammation. Examples are: Surpass, Arnica gel, Traumeel gel or Sore No More. Acupuncture can be helpful for long term management of arthritic pain and is another option to consider. Extracorporeal shockwave therapy can be helpful for pain management in these horses if you have that modality available to you. Some of my clients have reported success using the magnetic bell boots on these horses while they are stalled. Additionally, it is important to use heavy bell boots while your horse is worked and during turn out. This prevents him from accidentally hitting himself with his shoe and further exacerbating the pastern arthritis.
You may have to use a stronger NSAID like banamine or phenylbutazone during periods of flare up and place him back on the Equioxx once things quiet down. Movement is good for joint health, so keeping up with the light work as he can tolerate is wonderful. If you have not already tried biologicals in the joint, IRAP or Pro-Stride would be options. These biologicals, that are made from the horses own blood and injected into the joint, use the body’s own anti-inflammatory mediators to quiet down joint inflammation.
Eventually, with high ringbone, the pastern joint may fuse, when this happens the motion in the joint decreases and most horses are much more comfortable. Should all else fail, you can have the joint fused through either a special joint injection or surgery. If you decide to go this route you should have a consultation with an equine surgeon prior to the procedure so that you can learn about possible complications and prognosis. Good luck with your horse and I hope you can continue to keep him comfortable and enjoy him!
Courtesy of AAEP
Answered by Terri Van Wambeke, DVM, Oregon City, Oregon