Navicular bursa: puncture

Septic bursitis

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  • Cause : traumatic penetration of navicular bursa usually via a solar penetration    →   infection within bursa   →   direct damage to navicular bone, deep digital flexor tendon.
  • Signs : severe lameness  [Musculoskeletal: gait evaluation]  , puncture wound evident on frog or sole, draining wound above the heel.
  • f:\websites\\Site\Images\tempimage\iln01041.jpgFig.1 f:\websites\\Site\Images\tempimage\iln01041.jpg
    Diagnosis : foot paring    , plain and positive contrast radiography    , centesis of the navicular bursa with cytology and culture/sensitivity of samples, intrasynovial anesthesia    of the navicular and/or distal interphalangeal joint may result in gait improvement, post mortem   (Fig. 1)  .
  • Differential:
  • Treatment : surgical drainage and removal of infected and necrotic debris.
  • Prognosis : depends on extent of infection and duration before effective treatment:
    • Fair if confined to bursa.
    • Guarded if navicular bone and deep digital flexor tendon involved.

Print off the Owner Factsheet on Penetrating foot injuries    to give to your client.


Differential diagnosis


Clinical signs

  • Forelimb/hindlimb, single limb lameness with reluctance of the horse to put the heel of the foot to the ground.
  • Palpable swelling/pain between the bulbs of the heel and the ungual cartilages.
  • Pain on digit flexion  [Musculoskeletal: manipulative tests]  .
  • Farriery: tools - hoof testerFig.2 Farriery: tools - hoof tester
    Marked withdrawal response following hoof tester   (Fig. 2)  application over the frog.
  • Discharging solar lesion, commonly located in the mid-third of the frog, often in the sulcus; visible after foot cleaning/sole paring.



  • Guarded: if infection is confined to the bursa and treatment is initiated early.
  • Guarded to poor: if navicular bone and deep digital flexor tendon are involved.
  • Improves for: early and appropriate management; early return to exercise; endoscopic management.
  • Horses treated with surgery within 7 days of the puncture had significantly better outcomes than those that were delayed longer.
  • Hindlimb cases also had a better prognosis than forelimb.
  • Endoscopic treatment of navicular bursal penetration has been as high as 75% successful in complete return to soundness. In addition, concurrent infections of adjacent synovial structures can be treated at the same time.
  • Street-nail procedures involve radical surgery that may require second debridement and prolonged pain relief. Success rates after this procedure range between 18.4 and 31.6% for complete soundness.

Expected response to treatment

  • Resolution of lameness.

Reasons for treatment failure

  • Ongoing infection or inflammation.
  • Extensive damage to the navicular bone and flexor tendon cartilage.
  • Damage to surrounding soft tissue structure such as the DDFT which fails to heal.
  • Infection in other structures such as the DIP joint or digital sheath that is not detected.
  • Prolonged duration prior to treatment.
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