“No foot, no horse.” On this age-old adage, we can all agree. But what, specifically, is wrong in that foot? Traditionally, the hoof capsule and its contents have thwarted our best efforts to understand what is going on or what is going wrong in the foot.

Over the past 15 years, medical imaging has undergone remarkable advances that have im­pacted every aspect of equine prac­tice from colic management to lameness diagnosis and corrective farriery. For example, “navicular disease” was poorly understood, largely be­cause eval­uation of the foot was lim­ited to radiographs. Mo­dern di­ag­nostic imaging — in particular magnetic resonance imaging (MRI) and computed tomography (CT) — has dramatically increased our understanding of exactly what causes horses to be lame in the foot.

MRI and CT can be used to determine the structure (or structures) involved and the nature of the injury. This information can then direct a meaningful approach to corrective shoeing, medications, surgery and exercise/rehabilitation regimes.

In order to illustrate some of the util­ity of medical imaging and the new understanding of “navicular syndrome,” we will consider four different cases…