Is It Really Navicular? With Dr. David Ramey - The Humble Hoof

0:00Welcome to the Humble Huff Podcast. My name is Alicia Harlov. This is a podcast for both horse owners and hoof care professionals offering discussions into various philosophies on the health of the hoof and soundness of your horse. Please check us out on Facebook or at the HumbleHuff.com. If you've listened to this podcast for any amount of time you probably know that I got into hoof care because of my nevicular diagnosed gilding Vinny. You may be wondering what is nevicular? Well, in the past, nevicular was considered a disease of the nevicular bone in the hoof, which sits the back half of the hoof and it was thought that if you had nevicular bone changes on radiographs, the horse might have a degenerative disease which would cause pain and lameness and eventually cause the horse to be retired or euthanized. That diagnosis sent me on an absolute rabbit hole and I did what most people do when

1:01they have a situation that they don't know what to deal with and I went to Google. One of the first places I found was Rockley Farm in England and I saw instances where horses were diagnosed with nevicular disease and given a poor prognosis and they went back to work. As I went through a checklist to grow healthier hoofs for Vinny and get him more comfortable, I came across a blog post by Dr. David Rainey called The Persistence of Memory or what do you mean I don't have to give my horse isoxic green for his nevicular. This post was what I was looking for to get hope for a nevicular diagnosis and it's what I've referenced countless times since I first found it probably almost ten years ago. It's been shared continuously in my nevicular Facebook group and it's something that I reference often. So when I was at the AAP convention in December 2025 and I saw that Dr. David Rainey had a booth and it just happened to be right next to the booth for the hoof care

2:04organization I'm a part of progressive hoof care practitioners. I knew I had to meet him chat with him and ask if you would be in the podcast to talk about nevicular. Dr. Rainey was super gracious and lending me his time to chat about this diagnosis and what it means for these horses. So why don't we start and you can tell us a little bit about your journey into veterinary medicine and how you became interested in in nevicular. Well my journey into veterinary medicine was just a journey of love. I had an opportunity to work around them. I rode horses when I was a little boy but I had an opportunity to work around them one summer and I decided to completely change my career path just because I wanted to be around horses and so I of course got into veterinary school and at the time as now in nevicular disease was you know commonly discussed topic and so it became sort of inevitable that I would have to learn about nevicular disease and deal with it from a clinical standpoint. But as I dealt with it in a clinical

3:06standpoint it also became pretty quickly clear that a lot of what we thought we knew just didn't seem to add up with the clinical presentation and so that then spurred my interest into really following doing some research and investigation on my own and it's been quite an interesting journey and quite instructive as to how medicine in general progresses. Yeah and I think you know we talked a little bit about this at AADP in December where you know nevicular became a passion of mine because I had a horse that was diagnosed with nevicular and your blog post about it I think was called the persistence of memory was something that I was one of the first things I found when I was googling nevicular and trying to figure out what it all meant for my own horse and sort of sent me into my own little rabbit hole so I mean I could talk about that forever and I know my listeners have heard about that a lot so that's not I don't want to talk about me but I wanted to ask you a little bit about some of those things that I found through reading your blog so can you

4:09tell us a little bit about the past you know traditional approach to a nevicular diagnosis and why it might be flawed in some cases. Well there's I mean first there's no question that some horses do develop disease of the nevicular bone and so the question is not whether horses get nevicular disease but are we able to properly diagnose it. Now the the trap that we and I you know using we talking about veterinarians fell into was thinking that this was a relatively straightforward diagnosis way back in the 1970s it was postulated that horses with heel pain got heel pain because of a defect or somehow a lack of circulation in the area and so there were articles published about horses getting warfriend which is actually rat poison it's an anti

5:12coagulant keeps blood from clotting and horses got this medication and it was really quite a pain because you know once you start interflearing with your ability to clot their blood then you have to follow their coagulation times but the fact is that some horses appeared to get better after they would started on this medication which brings up one of the real bugaboo's that we deal with in medicine which is the idea that just because one thing comes after the other the second thing caused the first thing so initially we had this idea that you know the horses had pain in the nevicular bone and you gave them nanicoagulant and many of them would get better the way that we made the diagnosis was we shot anesthetic in the back of the foot and we thought we were being very precise by taking putting that anesthetic over nerves and went right to the nevicular bone and so the combination was seeing a lame horse

6:14putting anesthetic over the nerves and then taking x-rays of the vehicular bone which when we determined that they didn't look like they should admit that the horse had nevicular disease led to actually a fairly and disturbingly easy diagnosis and treatment plan that was followed for hope goodness a good 15 20 years things got tricky after that it really started coming of a a flurry of investigation because whereas we had a relatively easy diagnosis which we'd see a horse in pain and then we could eliminate the pain by pomegranicetic or the nerves going to the heels and then we take x-rays and if we determine the x-rays weren't short on quote I heal we could make a diagnosis of nevicular Z and then we had an anicoagulant to give because it was supposed to be from a circulatory problem it was relatively straight forward but

7:20then we started looking deeper as we in medicine often do and found out there were just a whole lot of holes in mystery now I will mention because warfern was such a pain to deal with people came up with the idea that they would give isosocrine divorces and that idea came out in early 1980s and there was even a study showing it horses that had been diagnosed with the big disease just better when they were an isosocrine and so people would with cell dozens and dozens of bottles of isosocrine for variety of things for the circulation but I digress I think the first thing we started to realize it was a x-rays in the nuclear bone are not really diagnostic for nevicular disease I mean in severe cases they can't be but we used to talk all the time about what we're

8:21described loosely as changes in the nevicular bones that is to say we had an appearance that we thought was normal and we would take x-rays and we'd say well that doesn't agree with our perceptions what normal is therefore it's abnormal therefore the first has a vehicular disease starting in the 1980s with surveys again Europe and then even a study that I presented in the early 1990s it became pretty quickly clear that there's a whole variety of appearances of the nevicular bone that can be considered within the range of normal and one of the things that I routinely tell people is that normal is not a thing it's sort of a it's sort of a space I use the example of people being either pinned in toe to or standing out with their toes or being straight none of those people are limping their feet are in different positions they're

9:24all normal within a range of normal nevicular bones are like that too some of them can have a little holes in them more or less and in the absence of any lameness or signs of pain they're pretty well meaningless none the less people persist in describing horses is perhaps being pre-nevicular but there's no basis for such a diagnosis at any rate by the time the 1990s came around it was pretty clear that just taking x-rays of a horse's nevicular bone didn't really tell us anything in the absence of any clinical information well things got all a little murkier yet when we started to understand that the anesthetic that we're putting in the horse's foot was not nearly as precise as we would have liked it to be so whereas people talked about putting anesthetic

10:24directly over the nerves and then blocking out the nevicular bone it turns out as anybody who's studied anatomy should understand that there's a lot more in the horse's foot than the nevicular bone and putting anesthetic over nerves that are going down to the foot as the potential in in reality it does it has a potential to block out and it actually blocks out way more than the nevicular bone we couldn't see any of that in the early 1990s but I stood frankly to see horses who would block out they would have x-rays of a certain they look a certain way they'd be on medicine and then but within a few months so horses would be better which kind of goes against the idea that the nerve block just absolutely specifically targeted in the vehicular bone there had to be something else going on the third thing was that not too long after that we started investigating isoxypren and found that it's

11:25actually not well absorbed by the horse and most of it that is absorbed is removed very quickly so even if it did have a therapeutic effect I saw from probably can't work then you throw that on to post-mortem studies that were done down at Texas A&M showing them the vehicular disease is not a circulatory problem the fact that we kind of could determine a horse had pain coming from its foot but other than that you really weren't sure what was going on but a lot of those horses would get better nonetheless ideas changed slowly so a lot of people still persisted with ideas of pre-nevicular x-rays to tell you if your horse was going to develop nevicular disease or spurious diagnoses based on poor diagnostic criteria and things went along sort of merkely until we came up with MRI in MRI has shown us that well there's a

12:28whole bunch of stuff that can go wrong in the foot so what we have now is at least in in my own practice is a situation where I very rarely make a diagnosis in the vehicular disease certainly horses get foot problems quite regularly but I think it's super important for the horse community to understand that you shouldn't rush into a diagnosis of the vehicular disease because number one it's not as common as we formally believed number two it's it's a horse generally does that genuinely does have nevicular disease it's usually a pretty bad diagnosis and third since most of them don't if you're patient a lot of those horses get better anyway yeah and I'll say I mean I I have most of the horses that come to my property have an evicular diagnosis and most of them I mean knock on wood they do pretty well with with a very basic approach to just getting them to move in a healthier way

13:31and getting stronger feet but I will say that you know I I have an evicular Facebook group that has been it's you know coming on 11 years old and we have tens of thousands of members in there and a lot of them still have horses that are on isoxoprene or that got diagnosed just from radiographs or some that were diagnosed without even radiographs you know I've had people that joined the group and say oh my vet says my horse has nevicular and you know they don't have any radiographs it's just that they blocked to the caudal hoof and it's interesting to me because you mentioned that in the 90s that it was fairly known that radiographs were not maybe the best way to diagnosis is that something that maybe it's just not as public knowledge as it should be in terms of this being more of an intricate or or more involved diagnosis as opposed to one that's just looking at the nevicular bone I can't I have a hard time explaining it there's a one of my one of my favorite things is by a writer for the Baltimore son in the late 19th century named H. L.

14:35Magnet and he said for every complex problem there is a solution that is simple easy and wrong and and and and naviguars like that because the nevicular bone is in a very complex area of anatomy where there are tendons and ligaments on their joints in there there there are a whole bunch of structures all of which can be injured and affected and if one jumps on a diagnosis of nevicular disease one essentially ignores all the other potential problems it could be in there and when you're making when you're working in medicine and then you diagnosis you want to try to keep your possibilities open as long as possible unless you can absolutely say for sure that you know what you got and that's why when I hit sear stories like yours about you know horses being diagnosed as nevicular based on having a heel block or a horse is being diagnosed as nevicular without x-rays it just it makes me wonder too because

15:39certainly we've come a long way as a veterinary community where we should know better than that but it goes back to mink and you you have an area where things are very complex and people like easy solutions doctors like easy diagnoses and treatments and saying listen guys this is this is really not something that we should just jump into it makes it more complicated and more difficult people just don't like that I say they like being able to just have an answer yeah James area at the English veterinarian who wrote the all creatures great and small series of books in the 1970s was told by his employer that it doesn't matter what the animal has just make sure you call it something because people want to give it a name and so if you give you know the horse with lameness that you can eliminate by putting an aesthetic in its foot it's not just you know you said cuddle but it's been shown that the

16:39heel block can take out the joint of the foot itself the coffin joint in some horses so it becomes really complex and but I think people like being able to say oh your horse has this you need to do this it makes it a sad and unfortunate diagnosis it's kind of an easy diagnosis to sort of conceptualize and understand and I just you know it's just but it's not right it's not right because unfortunately I think it takes away from people the idea that maybe their horse can get better it takes away you know people saying well I'd like to buy this nice horse and he says well based on the x-rays he might develop the vehicular disease in the future I mean it takes away a lot of the the opportunity to own good horses I guess is the best way to say it yeah we don't know as much as we think it's much more complex than we thought it was 30 years ago but the word still hasn't gotten out nearly as widely as I think it

17:44needs to get out great and and so my next question might be a little bit of a tricky one to answer but given what we know now and in terms of like all the that you're saying about diagnosis and radiographs how much stock should we put into a horse that or into the vehicular bone changes on a sound horse like if you know so many like I pre-purchase exam right now is like the standard it's now become the thing that we all do I didn't do pre-purchase exams when I got my first horse but you know it's now like you rarely do people buy a horse without one and if a horse is sound and moving well and they have an evicular bone changes is that something that should like we should pause or or should that affect a purchase or or how much you know wait should we put into those I'm not much we don't we don't have the information that suggests that a certain characteristic of an evicular bone indicates that there will be

18:45lameness at some point in the future if you ride your horse enough you can pretty much guarantee at some point the future is going to be lame but that's just because you know they're doing athletic activities something to be heard but the idea that in taking pre-purchase examinations of the vehicular bone we can somehow predict how that horse is going to do down the road is just it's just a fallacy but you know when people get into doing pre-purchase exams there are liability questions and that that come up and people don't want to be on the hook for a bad decision so it's a lot easier to turn a good horse down and go look for another one than it is to take the quote unquote chance that this horse might be have a problem down the road yeah and so I guess is another difficult question in the sense of I know that you can't answer this with a hundred percent certainty but so when we see those navicular changes on radiographs and some of them I'm sure our actual changes are damaged does that necessarily equate to pain no I mean if at the point of

19:50pain the horse is going to be limping right and so I'm sorry I'm going to rephrase that so like if we have a horse that's lame well I think what you're trying to say if you have a horse it's lame and he has navicular changes what do you do that yes yeah and the answer is wait because you know as a as a former really good client of mine you say when you take X-rays of horse at a point in time and you call them changes their changes from what because you never had X-rays to see how the horse looked before so how do you know their changes from anything how do you know how how come why don't those just normal for that horse you know a fractured bone is a change from normal but we all know the great difference between a normal you know X-ray of your shin bone and a broken X-ray of your shin bone those are two completely different things but navicular bone X-rays aren't like that they're not that easy and so you know if

20:52you see a horse that is lame and you can identify the lane is being in the foot and you take X-rays and you see that the navicular bones don't look like the picture perfect X-rays the only thing that you can say based on that exam is that the horse is lame somewhere in the foot you don't know that that X-ray is anything other than that horse's normal X-ray unless there's some sort of a severe abnormality they can see yeah I mean so that's another question I had kind of bouncing off of this is that outside of like looking at a by-part type or tri-part type navicular bone is there anything you see on a navicular bone graph where you're like oh that's bad that definitely hurts yeah you can see like cis and navicular bone sometimes you can see the bone changing and like spurring and so when you when you see second advanced secondary changes you can be pretty confident for those are significant but if

21:55you don't see those changes if you don't see those secondary changes it's it's pretty tough to hang your hand on anything yeah so in terms of you know you're talking about if you have a horse that has lameness that blocks the foot the you know basically what you can say with certainty is that pain is coming from the foot like what issues might be diagnosed as navicular disease that are actually something else well the big thing that we've come to understand since the advent of MRI is how many soft tissue injuries occur in the foot so the deplexer tendon for example comes down the back of the leg turns over the navicular bone and inserts into the bottom of the coffin bone that's a real high stress point and they can have little tears can occur down there much as if we're in the upper leg it would be something that we might refer to as a bow tendon it's an area that's very difficult to image without MRI but if an

22:56injury to it that deplexer tendon occurs down there they'll block out with a heel block they'll look fine and eventually they'll heal there are the m-car ligament in the the vehicular bone attaches the base of the navicular bone to the coffin bone there are suspensory ligaments of the navicular bone even the joint of the foot the coffin joint gets back around that area and inflammation in the coffin joint can extend into the tissues surrounding the navicular bone still there's just there's there's there's a whole bunch of different tissues that can get injured down in the foot and all of them will block out to anesthetic injected over the nerves that go down the back of the hamster but the prognosis for a soft tissue injury a ligament injury or tendon injury is much different than if you have deterioration of

23:56the navicular bone which is essentially a you know a very sad diagnosis because it means horses are gonna get better right yeah and I can't tell you how many times I have I mean I've had clients and I've had members in my Facebook group I've had horses here on the property where the owners had thought that they were destined for retirement or euthanasia and you know we tried to approach all of them as if they have a soft tissue injury because it's not I never regret going too slow and rehab I do regret going too fast and I see a lot of those horses become pretty comfortable and I think you know that's something that I've always tried you know over the last 10 years and not saying that there aren't cases that won't get better but in the sense of I've always tried to give hope to owners that their horse may be able to get more comfortable whether that's you know some of them just want a happy retirement and some of them want to just hack and some of them want to be able to do more and I'm just trying to get the word out more that that's not necessarily a career ending or life

24:56ending diagnosis depending on how they came to it I guess and that's something that I found really encouraging about everything that you put out about it or that I've read that you put out about it is a similar approach of like you know trying to make sure that we give the horse more of a benefit of the doubt that there might be something that can get them better yeah I mean I won't even begin to try to make that diagnosis until the horse hasn't responded to any therapy for like six months yeah I just I just say look the problems in the foot if you want to do more accurate imaging you know we that's now available to us we you know we have in mind we have pet scans coming out so there is more accurate imaging that will help you know but the fact that the matter is that most of these soft tissue injuries are just going to take time and if as you say give them plenty of time and just your patient with them a lot of these sources come right on the longest one that I can remember so far as I

25:56had a horse who blocked in the heel it didn't diagnose he came to me as a second opinion so I told him we just have to wait it out they waited 18 months but the horse came south yeah and it's funny because I went to England shortly after my horse's diagnosed because there was a a facility out there that worked a lot with horses with you know coddle hoof pain and they a lot of them will just turn out their horses for like a year and just I mean that's obviously kind of scary to do to think okay we're just gonna ignore it but and then I'm not saying I'm not putting this out there to tell people to do that I'm just saying a lot of them do that and a lot of their horses come up sound it's just like they just let them sit and then see how they do obviously that's a little I tend to be a little more proactive than that but it kind of points to what you're saying is time can can answer a lot of questions too but that's what we used to do right or just lame turning out come back and look at him next year I mean you know prior to all of the knowledge that we accumulated that was a

26:59dream and in the fact that matter is that it worked on a lot of horses yeah I'm not saying it's the best thing for every horse and there's certainly you know downsides to turning horses how with ligament injuries and that sort of stuff you know I think that controlled and supervised rehabilitation is generally a better idea than just kicking them out in the back 40 but you know the fact is we we keep finding out that we don't know as much as we think we did and so under such circumstances I always think it's probably a good idea to be a little careful and proceed a little cautious and have a little optimism and you know it's clear that they said what we used to think was wrong yeah and I don't know if it was your I'm trying to remember if it was your blog or if it was somewhere else that I read that a lot of horses get better whether we do something or not you know whether you know all we do all the therapies and and

27:59try to do every single injection and you know treatment plan it kind of you know gave me a little bit of a a perspective of those cases that we do everything for and they seem like they don't get better versus the cases that we do nothing and they seem to get better oh yeah whether well you know it's from a human perspective it's hard to see a horse with an injury and not want to do something but the this is a question I asked an article a few years back do you want to do something or do you want to do something that does something yeah and so much of what we do and that goes in terms of you know many of the machines many of the supplements even some of the medications so much of what we do is just doing something but while we're doing that something time passes and the healing goes on and so we we tend to feel good and give ourselves a lot of you know pets on the back for for our good intentions but whether they

29:02actually do anything or not is a is a whole different question and you know for horse owners where the cost of care is is certainly a reasonable issue I think it's always a good thing to keep in mind that just because you do something doesn't mean the something you're doing is doing and the only thing is guaranteed is the cost and again for people that are looking at trying to keep their horses within the means of a budget sometimes it's better discontent as I tell people there's the phrase don't just stand there do something well the phrase works in reverse too you can say don't just do something sometimes just stand there and and it'll be and it'll be fine so I just there's because it's such a a word that diagnosis is laid with so many negative ideas and consequences and because it's not something that we can be

30:04super confident with I just think that it would be who horse owners to kind of step back and if you don't find anything that's immediately damning say well let's just give this a little time let's do let's be a little conservative and give you know take it easy and let him rest and relax and see how it comes long yeah and I have you know I have a wrap-up question but I was wondering because I've read a few your blog posts on bisfossinates I was wondering if you wanted to touch on those or talk about them or oh bisfossinates yeah I'm not I am so bisfossinates have been shown to be safe in horses mostly they you know you don't want there's colic associated after giving them there's you don't you don't want to put them in a renal failure and give them lots of bisfossinates along with non-stroidal drugs because they all go through the kidneys and in race horses I think 10 years ago it was felt that giving

31:09bisfossinates routinely to young race horses actually was associated with catastrophic fractures but if you if you look at the initial research on them it's not really very promising when you go through and parse it and I wrote an article about that second thing is that the bisfossinates that are being used in horses are really old drugs they're they're several generations away from the more effective drugs that are being used in people for the treatment of like post mental pausal bone loss I just the again it's a it's a simple solution but you know to well your horse has a little change and he blocks out so instead of rushing for the ice oxen we're rushing for the osfoss and I just think that it doesn't it doesn't make medical sense it makes kind of emotional sense that you you know understand you have a horse that you're worried about and you have a drug that has been approved for use in the

32:12vicular disease but again if you look at the research behind it it's not that impressive nor would you expect it to be because the vicular disease is a deterioration of the bone and this medication is not going to stop that even in its most optimistic interpretations it might you know it might help decrease pain coming from the bone but I certainly am not I haven't been impressed with it clinically and I you know I can't I bet I don't give a bottle a year this is not a it's a kind of thing that has you know a list of side effects that are you know it could be a bit scary and I'm not really impressed with the with the research so I just don't use it much I will say listen if you want to find out what it is go spend some money on some diagnostics you know get some imaging done and then you have a much better idea what you're dealing with and

33:14if not just give it some time and see how things will come along and most of the time you know there's the there's the old old saw about time healing all wounds what doesn't heal all them but sure gets a lot of them yeah and I mean that's that's even a great point of advice for owners and and that was sort of my gonna be my last question was do you have any last advice for an owner of a horse that was recently diagnosed with an ovicular in terms of you know what they should and I think this whole episode kind of talks about how they should approach it but anything else that you can tell them as last advice for for what they should do after that diagnosis well a lot of it you know to me a lot of it just depends on how comfortable you are with uncertainty yeah I'm personally really uncomfortable with uncertainty I don't believe you have a lot of control over a lot of stuff so I'm okay if somebody says look you know I I can block your horse in the foot look I've taken some x-rays I don't see any horrible here so why don't we give it some time and see what happens well there's

34:17uncertainty with that right so if you don't like uncertainty then try to pursue the most accurate diagnosis you can come up with which is advanced imaging it's also the most expensive diagnosis that you can come up with but if you've got the money and you don't like uncertainty I completely recommend that you do that you may find that you have to wait it out anyway which is fine but if you're okay with uncertainty and you get a diagnosis like this that you know there's a lot of uncertainty in the diagnosis I just will we'll just see how it goes and you know because the horse isn't going to be sulking doors are going to just go along do the best you can anyway and you know feed it and enjoy it in other ways you know and spend time with your horse and then check it every month of students see how things are going and you might be happily surprised down the road that things are getting better yeah absolutely is there anything that we didn't touch upon that you feels important before we

35:20wrap up is there something that I didn't ask about that you'd want to talk about or you know I think the big thing is that we're it's to understand we're all trying the best that we can yeah and we don't have all of the answers to everything in the vehicular a diagnosis of new vehicular disease not like a diagnosis is seeing that your horse has a cut on the side of his cheek you know when you see a horse with a cut on the side of his cheek you know you got to go and clean it and nestetize it maybe today the horse a little bit so it up and most you know what to do right it's an obvious problem this isn't an obvious problem and when the horse does have a severe case of vehicular disease it's a problem that you probably can't do much about anyway much like arthritis if you have a severe case of arthritis there we don't have a cure for that and in many ways vehicular disease is like arthritis it's a generation of the bone we don't

36:22have a cure for that so in my mind the the best thing to do is to keep things in perspective understand that the diagnostic and treatment processes are full of flaws they're the best we can do now and if you like your horse give it in a time give them a chance it's and again it's not a diagnosis to make me make quickly and it's not even a diagnosis it can be maybe very precisely in many cases so I mean I guess the last thing is there any I didn't say I'd say for your listeners if your horse gets a diagnosis of new vehicular disease don't despair just just kind of go well let's look let's see what we need to see and maybe give it a little time and maybe look a little deeper but just because somebody tells you something right off the bat doesn't mean you have to just you know feel like your horses are wrecked and desad for the rest of your life

37:22yeah and I personally want to thank you because honestly I can't even imagine the thousands and thousands of people you've given hope to just with your blog and your a vehicular book and it's something that I would definitely have not kept pursuing you know helping my horse I don't think if it weren't for those so thank you so much for allowing your knowledge to be put out there to to share with others and I really appreciate that and I'm sure there are so many others who do as well oh thank you I mean the whole reason I got into that school is try to help horses and I just you know that's kind of all I want to do so if I can if I can help some people in any way shape or form and help some horses that just nice me happy yeah absolutely well it's so nice I'm so glad that I was able to meet you last month and and that you agreed to chat with me and I really appreciate your time today despite your already long morning and thank you again this is great oh you bet I'm happy to help you at any time thanks for your efforts to help people and help horses too and it's a absolute

38:23honor to be on with you and thanks for inviting me of course all right we'll talk you soon bye I always say that I'm slightly more hoof obsessed than the average person and chances are if you're listening to a hoof care podcast you are too so we should probably be friends feel free to find me on Facebook or email me at the humble hoof at gmail.com