Understanding how Radiographs can help your horse's feet
- Marc Jerram
- Jul 27
- 7 min read
Introduction
Keeping your horse sound and comfortable depends a lot on the health and balance of their hooves. Whether your horse is an elite athlete or a happy hacker, good foot balance is essential for preventing injury, reducing stress on joints and tendons, which in turn help your horse move freely and comfortably. While many hoof problems can be spotted by an experienced farrier or vet just by looking at the foot, some issues are hidden inside the hoof where the eye can’t see. That’s where radiographs commonly known as X-rays come in.
X-rays allow us to see inside the hoof. They show the bones and internal structures that lie beneath the outer wall, sole, and frog. With this information, vets and farriers can work together to make smarter decisions about trimming and shoeing. In recent years, using X-rays as part of regular hoof care especially for horses with lameness or tricky feet has become much more common. In this article, we’ll explain how X-rays work, what they can tell us about your horse’s feet, and how they can be used to guide a hoof care plan.
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Why Foot Balance Matters
A well-balanced hoof allows the horse’s weight to be spread evenly across the foot and up through the legs. If a hoof is out of balance, it puts uneven strain on bones, tendons, joints, and soft tissues. Over time, this can cause soreness, abnormal hoof wear, and more serious problems like arthritis, tendon injuries, or navicular disease (Dyson and Murray, 2007).
You can think of hoof balance like the tyres on a car. If one tyre is worn or misaligned, the car won’t steer properly, and over time, it puts stress on other parts. Hooves are no different. A small imbalance can cause a big problem if left unaddressed.
Unfortunately, not all imbalances are visible from the outside. A hoof might look symmetrical but actually have uneven bone positioning or internal strain. That’s why X-rays are such a useful tool, they show what’s going on beneath the surface.
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What Are Radiographs (X-Rays)?
Radiographs, or X-rays, are images taken using low doses of radiation to show the inside of the horse’s foot. Don’t worry, this kind of radiation is very safe and is used all the time in both human and veterinary medicine. In horses, X-rays can be done with the horse standing up, and most don’t need sedation.
The images produced are black and white pictures showing the bones inside the hoof, including the coffin bone (also known as P3), the navicular bone, and the short pastern bone. By carefully looking at these images, a vet can measure angles and distances that reveal how the foot is aligned and how well-balanced it is (Fig.1)
Fig. 1 The variety of measures that can be obtained using diagnostic imagery.
The Main Views We Use
When taking X-rays of the foot, the vet will usually take them from different angles:
• The side view (called the lateromedial or LM view) shows how the bones are aligned from front to back. This is helpful for looking at toe length, heel height, and how the hoof lines up with the pastern above it.
• The front view (called the dorsopalmar or DP view) helps assess side-to-side balance. It shows whether the inside and outside of the hoof are symmetrical.
• Sometimes, a bottom-up view (called a solar view) is taken to check sole thickness or to look for gas pockets or abscesses.
These views provide a full picture of the hoof’s internal structure and help guide trimming and shoeing.
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What Can X-Rays Tell Us About Foot Balance?
Let’s look at some of the key things vets and farriers look for when using X-rays to assess a horse’s foot:
1. Hoof-Pastern Axis (HPA)
This describes how the front of the hoof lines up with the bones in the pastern. Ideally, the slope of the front of the hoof should match the slope of the pastern. If the hoof is too long in the toe or collapsed at the heel, this angle gets out of alignment. This is known as a "broken-back" hoof-pastern axis, and it puts extra strain on the deep digital flexor tendon and the navicular area (Clayton et al., 2011). X-rays help identify this and guide trimming to restore alignment (Fig. 2)
Fig. 2 X-ray showing well aligned hoof pastern axis.
2. Palmar Angle (PA)
This is the angle between the bottom of the coffin bone (P3) and the ground. A healthy front foot typically has a small positive angle, around 2 to 5 degrees. If this angle is too low or even negative—where the bone tilts backwards—it can cause pain, reduce shock absorption, and lead to issues like under-run heels or chronic laminitis (Kummer et al., 2006). Trimming and shoeing can then be adjusted to raise the heels and support the back of the foot (Fig. 3).
3. Mediolateral Balance
From the front view, X-rays can show whether the inside and outside of the hoof are bearing weight evenly. If one side of the hoof is lower, it creates uneven strain on joints and soft tissues, much like walking on a tilted shoe (Fig. 4). This is especially important in horses with crooked legs or uneven wear patterns (Weller et al., 2006).
4. Sole Depth
X-rays can also measure how thick the sole is. A thin sole—less than about 10–12 mm offers less protection to the coffin bone and increases the risk of bruising or lameness (Fig.5). If a horse has thin soles, trimming may need to be more conservative, and protective pads or supportive shoes may be recommended (Dyson, 2011).
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How Radiographs Guide Trimming and Shoeing
Once the X-rays are taken, the vet and farrier can sit down and look at the images together. By identifying what’s out of alignment, they can decide what needs to change in the trim or shoeing plan.
For example:
• If the toe is too long and the coffin bone is rotated, they may shorten the toe to reduce leverage.
• If the heels are collapsed, they might use a wedged frog support pad to bring the heel back into alignment.
• If the sole is thin, they may avoid trimming too much and use a shoe with more sole protection.
In horses with laminitis, X-rays are essential. They show how much the coffin bone has rotated or sunk and help monitor recovery over time (Fig. 6). The trimming plan will focus on taking pressure off the damaged areas and supporting the structures that remain (Pollitt, 2004).
Even in horses that are not lame, radiographs can help prevent problems. Early changes in the navicular bone or coffin joint can be spotted before they cause visible issues, allowing farriery adjustments to reduce stress and prevent worsening.
Working Together: Vet and Farrier Collaboration
The best results come when vets and farriers work as a team. The vet provides the medical and anatomical insight, while the farrier applies this information in a practical way during the trim and shoeing. Many farriers now routinely work from radiographs, especially for horses with hoof problems or irregular conformation.
Portable X-ray machines now make this process easier than ever. High-quality images can be taken at your yard, and the results are available immediately. In more complex cases, follow-up X-rays can be taken every few weeks or months to track progress and make small adjustments as needed.
Limitations and Considerations
While radiographs are incredibly useful, they do have some limitations. They provide a flat, two-dimensional image of a three-dimensional foot. That means they can’t show everything, and interpretation requires skill. Positioning is also critical—if the X-ray is taken at the wrong angle, it might give a misleading result (Butler et al., 2008).
Radiographs are most effective when used alongside other assessments, such as watching the horse move, feeling the limb and hoof, and understanding the horse’s history. They don’t replace the farrier’s eye—but they do provide valuable extra information.
Conclusion: A Smart Tool for Smarter Hoof Care
Radiographs are a powerful tool for understanding what’s going on inside your horse’s hoof. They reveal the positioning of the bones, show areas of imbalance, and guide precise, evidence-based decisions about trimming and shoeing. For horses with chronic lameness, poor conformation, or complex hoof problems, they’re essential. But even for healthy horses, occasional X-rays can be a great way to fine-tune hoof care and spot early issues.
By working closely with your vet and farrier, using X-rays as part of a regular hoof care routine, you can help your horse stay comfortable, sound, and performing at their best.
References
Butler, J.A., Colles, C.M., Dyson, S.J., Kold, S.E. and Poulos, P.W., 2008. Clinical Radiology of the Horse. 3rd ed. Oxford: Wiley-Blackwell.
Clayton, H.M., Schamhardt, H.C., Willemen, M.A. and Lanovaz, J.L., 2011. Kinematics and kinetics of the hoof and the relationships with the hoof-pastern axis. Equine Veterinary Journal, 43(3), pp.278–285.
Dyson, S., 2011. Diagnosis and management of common foot problems in the horse. Equine Veterinary Education, 23(4), pp.178–189.
Dyson, S.J. and Murray, R.C., 2007. Management of equine foot pain: clinical use of imaging and interpretation for farriery. Veterinary Clinics of North America: Equine Practice, 23(2), pp.417–446.
Kummer, M., Geyer, H., Imboden, I., Auer, J.A. and Lischer, C.J., 2006. The effect of hoof trimming on radiographic measurements of the front feet of normal Warmblood horses. Veterinary Journal, 172(1), pp.58–66.
O’Grady, S.E. and Morrison, S., 2004. Farriery for the chronic laminitic horse. Veterinary Clinics of North America: Equine Practice, 20(1), pp.135–148.
Pollitt, C.C., 2004. Equine laminitis: a revised pathophysiology. Veterinary Clinics of North America: Equine Practice, 20(2), pp.409–438.
Weller, R., Pfau, T., May, S.A. and Wilson, A.M., 2006. Variation in conformation in sound Thoroughbred racehorses: implications for locomotor biomechanics and susceptibility to injury. Equine Veterinary Journal, 38(S36), pp.616–621.
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