Equine Navicular Syndrome Case Study: How Physiotherapy-Led Farriery Changes Helped Kenny Become Sound Again

A case study showing how a coordinated approach between physiotherapy, veterinary care, and remedial farriery reversed a horse's decline from navicular syndrome and impar ligament desmitis.

If you're researching equine navicular syndrome, impar ligament injury, or how remedial farriery can affect recovery, this case study follows the real rehabilitation journey of Kenny, an Irish Sport Horse gelding, from diagnosis through to a full veterinary clearance to return to work.

At a Glance

Patient	Kenny, Irish Sport Horse gelding, 7–8 years old
Diagnosis	Irregular navicular bone conformation, impar ligament desmitis, adhesions of the proximal navicular bursa (right fore)
Presenting signs	Right fore lameness, back pain, behavioural changes under saddle
Timeline	March 2026 – September 2026
Outcome	Sound on hard ground, soft ground, and on the circle; cleared to resume ridden work
Key intervention	Physiotherapy-led recommendation to change remedial farriery approach

What Is Navicular Syndrome (and Why Diagnosis Alone Isn't Always Enough)

Navicular syndrome refers to pain and dysfunction associated with the navicular bone, navicular bursa, and the surrounding soft tissue structures in the horse's foot, including the impar ligament, which anchors the navicular bone to the coffin bone. It's one of the more common causes of chronic forelimb lameness in sport horses, and getting an accurate diagnosis via nerve blocks, X-ray, and MRI is only the first step.

What Kenny's case demonstrates clearly is that correct diagnosis and correct medical treatment don't guarantee recovery if the shoeing strategy doesn't suit the individual horse. This is where physiotherapy assessment, working alongside the vet and farrier, becomes critical.

Case Timeline

March 2026 — Diagnosis

Kenny presented lame on the right fore with pain on palpation of his back. A positive nerve block localised the issue to the coffin/navicular region. Radiographs were unremarkable, but MRI revealed:

•      Increased signal in the distal navicular bone

•      Impar ligament desmitis

•      Adhesions in the proximal navicular bursa

He was treated with intra-bursal medication and back mesotherapy, and fitted with a deep wedge shoe using frog plate and heel support pads.

Late March 2026 — Initial Physiotherapy Assessment

RPM Equine Physiotherapy's first full-body assessment identified marked compensatory patterns consistent with chronic right fore pain: camped-under front limbs, an elevated croup, sacroiliac prominence, and widespread muscular hypertonicity — more pronounced on the left side, reflecting a horse offloading his painful limb. Behaviourally, Kenny had become touch-sensitive and inconsistent in his ridden contact, which was in fact the original trigger for veterinary investigation.

April 2026 — The Setback

Despite ongoing veterinary and physiotherapy input, Kenny deteriorated. On the morning of a reshoeing, he was found to have active inflammation in the impar ligament and scored 2/10 lame at trot. At this point, his prognosis looked poor enough that euthanasia was being discussed as a realistic possibility.

Physiotherapy-Led Farriery Recommendation

Repeated reassessment pointed to a specific problem: the remedial shoeing strategy itself was not supporting Kenny's foot. The original pad/packing configuration, while a common approach to navicular cases, was not resolving, and may have been contributing to, his ongoing lameness and soft tissue inflammation.

Based on this clinical picture, RPM Equine Physiotherapy recommended a change of farrier and a different remedial shoeing philosophy: moving to a wedge pad with a softer gel packing, rather than the original deep support pad.

June–August 2026 — Steady, Documented Progress

Every farriery cycle from this point showed visible improvement — a more balanced hoof capsule, improved limb alignment, and progressively better findings on physiotherapy reassessment (reduced hypertonicity, improved range of motion, more symmetrical loading).

September 2026 — Sound

Follow-up X-rays and a full veterinary lameness assessment confirmed Kenny sound on hard ground, soft ground, and on the circle — a complete clinical turnaround from the March diagnosis. He has since been cleared to begin a structured return to ridden work.

Before & After: Hoof and Radiographic Changes

Why This Case Matters: The Role of Physiotherapy in Farriery Decisions

Kenny's case is a clear example of why physiotherapy assessment should be part of the wider veterinary and farriery team, not an afterthought once medical treatment has been completed. Key takeaways:

•      A correct diagnosis is not the same as a correct management plan. Kenny's underlying pathology was accurately identified from the outset — the issue was in how it was being managed at the foot.

•      Ongoing reassessment catches what a single snapshot misses. It was the pattern of compensation and lack of progress across repeated physio sessions — not any single appointment — that flagged the shoeing as a limiting factor.

•      Coordinated care changes outcomes. The recovery only began once vet, physiotherapist, and farrier were working from the same picture and willing to change course.

•      "Not improving" is information. When a horse isn't responding to an appropriate medical plan, it's worth asking whether every other part of their management — shoeing, saddle fit, workload — is genuinely supporting that treatment.

Frequently Asked Questions

What is impar ligament desmitis in horses?

Impar ligament desmitis is inflammation or damage to the distal sesamoidean impar ligament, which attaches the navicular bone to the coffin (pedal) bone. It's often seen alongside navicular syndrome and can contribute to chronic forelimb lameness.

Can remedial farriery affect navicular syndrome recovery?

Yes. The type of shoe, pad, and heel support used can significantly influence loading through the navicular apparatus. An approach that suits one horse's conformation and pathology may not suit another, which is why individualised, reassessed farriery, ideally informed by physiotherapy and veterinary findings, matters.

How long does navicular syndrome rehabilitation take?

It varies widely by horse and severity, but Kenny's case — from diagnosis to a full soundness clearance — took approximately six months of coordinated veterinary, physiotherapy, and farriery management.

Is navicular syndrome career-ending for a horse?

Not necessarily. With an accurate diagnosis and management plan tailored to the individual horse — including, where needed, changes to farriery — many horses go on to return to work, as Kenny's case shows.

About This Case Study

This case study was compiled by RPM Equine Physiotherapy from veterinary records, physiotherapy assessment notes, and farriery documentation, with the owner's permission, to share what coordinated, responsive care can achieve — even when a case initially looks like it's heading in the wrong direction.

If your horse has a diagnosed foot or limb issue that isn't resolving as expected, physiotherapy assessment can help identify whether management factors — including farriery — may be part of the picture.

Get in touch with RPM Equine Physiotherapy to discuss your horse →