When David Ramey left veterinary school in the early 1980s, the approach to navicular disease was more simplistic than today.

After a physical exam, a vet would often perform an anesthetic block over the palmar digital nerves at the back of the pastern. Next, the veterinarian would take an X-ray of the limping horse’s foot. If the veterinarian felt that the X-rays showed “changes” from normal, navicular syndrome was often diagnosed, based on the “abnormal” X-ray.

Treatment typically included the farrier shoeing the horse and the vet administering various medications. If treatment failed, ultimately the palmar digital nerves would be cut (“nerving” the horse).

Over time, as veterinarians began to look more critically at disease of the horse’s hoof, they realized that their understanding of navicular syndrome, and conditions of the horse’s hoof, was more complicated than they initially believed. Although research has revealed more about navicular disease, it is still a complicated issue. Advances in imaging, anesthetics and diagnostic techniques have really changed how we should look at the issue.

A Working Definition

Terminology usage is an indicator to the complexity of navicular disease. “It’s been called navicular, navicular disease or navicular syndrome, or more broadly, you’re starting to hear about caudal heel pain,” says the equine veterinarian from Calabasas, Calif. “Whenever you have terminology that isn’t really specific, you can be pretty sure that people don’t have a firm idea of what’s going on.”

But as most people familiar with equine anatomy know, the issue doesn’t only involve…