Foot balance X-rays in horses: when are they needed and what can they tell us?
Your horse's feet are the foundation of everything they do. Whether they're competing, hacking or simply enjoying retirement, healthy, well-balanced feet are essential for comfort, performance and long-term soundness.
While experienced vets and farriers can learn a great deal from examining the hoof externally, appearances don't always tell the full story. That's where foot balance X-rays (radiographs) become invaluable.
By looking inside the hoof capsule, we can assess how the internal structures relate to the hoof itself, helping us make informed decisions about trimming, shoeing and treatment.
What are foot balance X-rays?
Foot balance X-rays are a series of radiographs taken while your horse is standing comfortably on specially designed positioning blocks.
These images allow us to visualise the bones within the hoof, including the pedal bone (coffin bone), navicular bone and surrounding structures. They also enable precise measurements that simply aren't possible from the outside.
Rather than relying on guesswork, foot balance X-rays provide objective information that helps your veterinary surgeon and farrier work together to achieve the best outcome for your horse.
When might your horse benefit from foot balance X-rays?
Many owners assume X-rays are only required once a horse is obviously lame. In reality, they can be beneficial much earlier, helping identify subtle issues before they become more significant.
Your vet may recommend foot balance X-rays if your horse:
Has recurring or unexplained lameness
Feels "not quite right" under saddle
Has shortened or uneven strides
Frequently trips or stumbles
Is struggling to maintain performance
Has persistent foot soreness
Has poor hoof conformation or asymmetrical feet
Has suffered laminitis
Has navicular syndrome or heel pain
Is recovering from a foot injury
Requires remedial farriery
Is difficult to keep balanced between shoeing appointments
Performance horses can also benefit from baseline radiographs, particularly if they are competing regularly or undergoing corrective shoeing. Establishing what is normal for your horse can prove invaluable if problems arise later.
Signs you should speak to your vet
Some changes are so gradual that owners don't immediately recognise them as foot-related.
It's worth arranging an assessment if your horse:
Doesn't feel as willing to work as usual
Becomes stiff after exercise
Struggles on certain surfaces
Feels uneven on circles
Finds one rein more difficult than the other
Starts landing toe-first rather than heel-first
Frequently loses shoes
Has recurring abscesses or cracks
Shows reduced performance without an obvious cause
These signs don't necessarily mean there is a serious problem, but they do warrant further investigation to determine whether hoof balance could be contributing.
What can foot balance X-rays tell us?
One of the biggest advantages of radiography is that it reveals what's happening beneath the hoof wall.
Foot balance X-rays allow us to assess:
Pedal bone position
We can see exactly how the pedal bone sits within the hoof capsule and whether it is correctly aligned.
Hoof-pastern alignment
Ideally, the hoof and pastern should form a smooth, continuous line. Abnormal alignment can increase strain on tendons, ligaments and joints over time.
Heel height and toe length
Even relatively small differences can alter how your horse loads each limb and how efficiently they move.
Sole depth
Adequate sole depth helps protect the sensitive internal structures of the foot. Horses with thin soles may require different management or shoeing strategies.
Medial-lateral balance
Radiographs allow us to assess whether weight is being distributed evenly across both sides of the hoof, something that isn't always obvious externally.
Early signs of disease
X-rays may identify changes associated with conditions such as:
Laminitis
Navicular disease
Arthritis
Pedal bone abnormalities
Chronic hoof imbalance
Identifying these changes early allows treatment plans to be tailored before problems become more advanced.
How are foot balance X-rays performed?
Owners are often surprised at how straightforward the process is.
In most cases:
Your horse remains standing throughout.
The feet are cleaned thoroughly.
The horse stands on positioning blocks to ensure accurate images.
Digital X-rays are taken from several different angles.
Images are available immediately for assessment.
Most horses tolerate the procedure extremely well and sedation is often unnecessary unless the horse is particularly anxious or unable to stand quietly. Portable digital X-ray equipment also means these examinations can be carried out at your yard, reducing stress for both horse and owner.
Why working with your farrier matters
One of the greatest benefits of foot balance radiographs is the ability to work collaboratively.
By sharing the images with your farrier, both professionals have a clear understanding of the internal anatomy, allowing trimming and shoeing decisions to be based on precise measurements rather than external appearance alone.
This team approach is particularly valuable for horses with:
Chronic lameness
Laminitis
Navicular syndrome
Performance issues
Complex hoof conformation
Remedial shoeing requirements
The result is a more targeted treatment plan designed specifically for your horse's individual anatomy.
Early investigation often leads to better outcomes
Waiting until a horse becomes significantly lame can mean problems have already progressed.
If your horse simply doesn't feel quite right, seems uncomfortable or has recurring foot issues, foot balance X-rays may provide the missing piece of the puzzle.
By understanding what's happening inside the hoof, we can make more informed decisions, support your farrier with accurate information and help keep your horse comfortable, sound and performing at their best.
Foot balance X-rays as part of our mid-season performance checks
At Starling Equine Vets, we believe the best results come from taking a proactive, team-based approach to your horse’s health. That’s why foot balance x-Rays form an important part of our mid-season performance checks for many horses in regular work.
Our mid-season performance checks are carried out in collaboration with trusted equine professionals, including the team at Osteopath in Suffolk, and where appropriate, other members of your horse’s support team such as farriers, phyiotherapists, saddle fitters and trainers. By combining clinical examination, foot balance x-Rays and biomechanical assessment, we’re able to build a complete picture of your horse’s musculoskeletal health.
This approach means that if you your horse is compensating, developing asymmetries or showing subtle changes in movement, we can identify the likely cause and put a coordinated plan in place – whether than involves adjusting trimming or shoeing, targeted osteopathic treatment, changes to training or further veterinary investigation, every recommendation in based on objective findings and shared expertise.
For owners of competition horss, this integrated approach provides reassurance that every aspect of their horse’s performance and wellbeing is being monitored, helping to keep them comfortable, performing at their best and reducing the risk of minor issues developing into more significant injuries later in the season.
Concerned about your horse's feet?
If you've noticed subtle changes in your horse's movement or your farrier has suggested further investigation, our experienced equine veterinary team can advise whether foot balance X-rays are appropriate.
Working closely with your farrier, we'll help build a clear picture of your horse's hoof health and develop a treatment plan tailored to their individual needs.
Get in touch with our team if you’d like to discuss booking foot balance x-Rays or a mid-season check on 01473 970393 or office@starlingequinevets.co.uk.