FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
The Veterinary record2025; 198(4); e166-e175; doi: 10.1002/vetr.6024

Radiographic imaging of the entheses of the equine thoracic foot.

Abstract: An injury of a tendon or ligament of the equine foot is frequently a cause of lameness. The optimal radiographic projections delineating the entheses of five commonly injured tendons and ligaments of the foot should be described. Methods: The entheses of the collateral ligaments of the distal interphalangeal joint, the collateral sesamoidean ligaments of the navicular bone, the deep digital flexor tendon, the common digital extensor tendon and the distal sesamoidean impar ligament were isolated from a thoracic foot of three cadavers. Three standard radiographic projections (60-degree, dorsoproximal‒palmarodistal oblique [D60°PrPaDO] projection, lateromedial [LM] projection and dorsopalmar [DP] projection) were obtained of each foot, with the entheses of the selected tendons and ligaments identified with a marker. Results: The entheses of all structures analysed in this study were best identified on the D60°PrPaDO and LM projections. The insertion of the collateral ligaments of the distal interphalangeal joint was also easily identified on the DP projection. Conclusions: A limitation was the inability to distinguish between lateral and medial sides of the feet. Conclusions: The radiographic images of the foot created in this study can serve as a guide for identifying enthesopathies of the ligaments and tendons of the equine foot.
© 2025 The Author(s). Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.
Get Full Text
Publication Date: 2025-12-03 PubMed ID: 41334591PubMed Central: PMC12904081DOI: 10.1002/vetr.6024Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study aimed to identify the best radiographic views to visualize the attachment sites (entheses) of important tendons and ligaments in the horse’s front foot, which are often injured and cause lameness.
  • The research established that certain angled X-ray views provide optimal visualization of these structures, which can help in diagnosing foot injuries in horses.

Background and Objectives

  • Lameness in horses is often caused by injuries to tendons or ligaments in the foot.
  • The attachment sites of these tissues to the bone, called entheses, can show signs of damage or disease called enthesopathies.
  • Radiographic imaging (X-rays) is a common diagnostic tool used to assess bone and soft tissue injuries in veterinary medicine.
  • However, the best X-ray projections to clearly display the entheses of key tendons and ligaments in the equine thoracic (front) foot have not been clearly described before this study.
  • The study focused on five commonly injured structures in the equine foot:
    • Collateral ligaments of the distal interphalangeal joint
    • Collateral sesamoidean ligaments of the navicular bone
    • Deep digital flexor tendon
    • Common digital extensor tendon
    • Distal sesamoidean impar ligament

Methods

  • Cadaver limbs: Researchers used three thoracic horse feet from cadavers to perform the study.
  • Dissection: They isolated the entheses of the selected tendons and ligaments by physical dissection to identify their precise locations on the foot.
  • Radiographic projections: Each foot was imaged using three standard X-ray views:
    • 60-degree dorsoproximal–palmarodistal oblique (D60°PrPaDO) projection
    • Lateromedial (LM) projection (side view)
    • Dorsopalmar (DP) projection (front-to-back view)
  • Markers: Radiopaque markers were placed on the entheses to help identify these attachment sites clearly on the X-rays.

Results

  • The study found that the D60°PrPaDO and LM projections consistently provided the best visualization of all the entheses studied.
  • The DP projection was also effective specifically for visualizing the insertion sites of the collateral ligaments of the distal interphalangeal joint.
  • However, one limitation was that using these projections it was not possible to distinguish between the medial (inside) and lateral (outside) sides of the foot on the images.

Conclusions and Applications

  • The results provide practical guidance on which radiographic views to use for optimal imaging of tendon and ligament entheses in the equine thoracic foot.
  • This information can assist veterinarians in diagnosing enthesopathies (diseases of the tendon or ligament insertions) and related injuries, improving accuracy and treatment decisions.
  • Although the technique does not allow differentiation between medial and lateral sides, it still enhances the ability to identify abnormalities at the critical attachment sites of important foot structures.
  • The imaging method developed can serve as a reference for future clinical and research applications involving equine foot pathologies.

Cite This Article

APA
Honnas DH, Fiske-Jackson AR, Fulkerson CV, Wilhite DR. (2025). Radiographic imaging of the entheses of the equine thoracic foot. Vet Rec, 198(4), e166-e175. https://doi.org/10.1002/vetr.6024

Publication

The Veterinary record
ISSN: 2042-7670
NlmUniqueID: 0031164
Country: England
Language: English
Volume: 198
Issue: 4
Pages: e166-e175

Researcher Affiliations

Honnas, Donald Henre
  • Royal Veterinary College, London, UK.
  • Purdue University, West Lafayette, Indiana, USA.
  • Texas Equine Hospital, Bryan, Texas, USA.
Fiske-Jackson, Andrew R
  • Royal Veterinary College, London, UK.
Fulkerson, Caroline V
  • Purdue University, West Lafayette, Indiana, USA.
Wilhite, D Ray
  • Auburn University, Auburn, Alabama, USA.

MeSH Terms

  • Animals
  • Horses / anatomy & histology
  • Cadaver
  • Radiography / veterinary
  • Tendons / diagnostic imaging
  • Foot / diagnostic imaging
  • Foot / anatomy & histology
  • Forelimb / diagnostic imaging
  • Ligaments / diagnostic imaging

Conflict of Interest Statement

The authors declare they have no conflicts of interest.

References

This article includes 37 references
  1. Blunden A, Dyson S, Murray R, Schramme M. Histopathology in horses with chronic palmar foot pain and age‐matched controls. Part 1: Navicular bone and related structures.. Equine Vet J 2010;38(1):15‒22.
    pubmed: 16411581
  2. Seignour M, Pasquet H, Coudry V, Denoix J. Ultrasonographic diagnosis of injuries to the deep digital flexor tendon and associated structures in the equine foot (suprasesamoidean area).. Equine Vet Educ 2011;23(7):369‒376.
  3. Dyson S, Murray R. Magnetic resonance imaging evaluation of 264 horses with foot pain: the podotrochlear apparatus, deep digital flexor tendon and collateral ligaments of the distal interphalangeal joint.. Equine Vet J 2007;39(4):340‒343.
    pubmed: 17722726
  4. Aldrich E, Goodrich L, Monahan M, Conway J, Valdés‐Martínez A. Radiographic localisation of the entheses of the equine stifle.. Equine Vet J 2016;49(4):493‒500.
    pubmed: 27397866
  5. Smith A, Felstead C, Lawson J, Weller R. An innovative technique for displaying three dimensional radiographic anatomy of synovial structures in the equine distal limb.. Vet Radiol Ultrasound 2009;50(6):589‒594.
    pubmed: 19999341
  6. Whitton R, Buckley C, Donovan T, Wales A, Dennis R. The diagnosis of lameness associated with distal limb pathology in a horse: a comparison of radiography, computed tomography and magnetic resonance imaging.. Vet J 1998;155(3):223‒229.
    pubmed: 9638067
  7. Widmer W, Buckwalter K, Fessler J, Hill M, Van Sickle D, Ivancevich S. Use of radiography, computed tomography, and magnetic resonance imaging for evaluation of navicular syndrome in the horse.. Vet Radiol Ultrasound 2000;41:108‒116.
    pubmed: 10779069
  8. Sage A, Turner T. Ultrasonography of the soft tissue structures of the equine foot.. Equine Vet Educ 2010;14(4):221‒224.
  9. Zubrod C, Farnsworth K, Tucker R, Ragle C. Injury of the collateral ligaments of the distal interphalangeal joint diagnosed by magnetic resonance.. Vet Radiol Ultrasound 2005;46(1):11‒16.
    pubmed: 15693552
  10. Denoix J, Jacot S, Bousseau B, Perrot P. Ultrasonographic anatomy of the dorsal and abaxial aspects of the equine fetlock.. Equine Vet J 1996;28(1):54‒62.
    pubmed: 8565955
  11. Anderson J, Puchalski S, Larson R, Delco M, Snyder J. Injection of the insertion of the deep digital flexor tendon in horses using radiographic guidance.. Equine Vet Educ 2008;20(7):383‒388.
  12. Rantanen N. Principles of magnetic resonance, computed tomographic, ultrasonographic and scintigraphic imaging of the soft tissues of horses.. Proceedings of the Dubai Inter Equine Symposium 1996. p. 155–164.
  13. Park R, Nelson T, Hoopes P. Magnetic resonance imaging of the normal equine digit and metacarpophalangeal joint.. Vet Radiol 1987;28:105–116.
  14. Denoix J, Tapprest J, Mathieu D. Magnetic resonance imaging of the foot: will this revolutionise diagnosis?. Proceedings of the 38th British Equine Veterinary Association Congress, Equine Veterinary Journal Ltd. Newmarket 1999. p. 44‒45.
  15. Honnas C. The foot.. Equine surgery 1999. p. 779‒791.
  16. Rose P, Graham J, Moore I, Riley C. Imaging diagnosis—caudal cruciate ligament avulsion in a horse.. Vet Radiol Ultrasound 2001;42:414‒416.
    pubmed: 11678562
  17. Sanders‐Shamis M, Bukowiecki C, Biller D. Cruciate and collateral ligament failure in the equine stifle: seven cases (1975‒1985).. J Am Vet Med Assoc 1988;193:573‒576.
    pubmed: 3170336
  18. Dyson S, Ross M. Diagnosis and management of lameness in the horse.. St. Louis, MO: Elsevier/Saunders; 2011.
  19. Scutellari PN, Orzincolo C. Le entesopatie. Radiografia e xeroradiografia a confronto [Enthesopathies. Radiography and xeroradiography compared].. La Radiol Med 1988;75(1‒2):20–27.
    pubmed: 3279470
  20. Kannus P. Structure of the tendon connective tissue.. Scand J Med Sci Sports 2000;10(6):312–320.
    pubmed: 11085557
  21. Casillas JM, Jacobs CC, Manfredi JM. Radiographic localization of the attachments of soft tissue structures in the tarsal region of horses.. Am J Vet Res 2020;81(5):406415.
    pubmed: 32343182
  22. Butler J, Colles C, Dyson S, Kold S, Poulos P. Clinical radiology of the horse.. 3rd ed. Hoboken: John Wiley & Sons; 2011.
  23. Nickel R, Schummer A, Seiferle E. The Anatomy of the Domestic Animals.. New York, NY: Springer‐Verlag. 1986;1:198‒199.
  24. Dyson S, Murray R. Lameness and diagnostic imaging in the sports horse: recent advances related to the digit.. AAEP Proceedings/Unpublished Data 2007. p. 53.
  25. Kainer R. Clinical anatomy of the equine foot.. Vet Clin North Am Equine Pract 1989;5:1‒27.
    pubmed: 2650825
  26. Getty R. Equine syndesmology.. In: Getty R, editor. The anatomy of the domestic animals. Philadelphia: WB Saunders; 1975. p. 361‒362.
  27. Heitzmann A, Denoix J. Rupture of the distal sesamoidean impar ligament with proximal displacement of the distal sesamoid bone in a steeplechaser.. Equine Vet Educ 2007;19(3):117‒120.
  28. Dyson S, Pool R, Blunden T, Murray R. The distal sesamoidean impar ligament: comparison between its appearance on magnetic resonance imaging and histology of the axial third of the ligament.. Equine Vet J 2010;42(4):332‒339.
    pubmed: 20525052
  29. Stashak T. The foot.. In: Stashak TS , editor. Adams’ lameness in horses. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2002. p. 645‒733.
  30. Butler J, Colles C, Dyson S, Kold S, Poulos P. The foot.. In: Clinical radiology of the horse. 2nd ed. Oxford: Blackwell Science; 2000. p. 27‒83.
  31. Sisson S, Grossman J, Getty R. Sisson and Grossman's the anatomy of the domestic animals. Philadelphia: WB Saunders; 1976.
  32. Denoix J‐M. Functional anatomy of tendons and ligaments in the distal limbs (Manus and PES). Vet Clin North Am Equine Practice 1994;10(2):273–322.
    pubmed: 7987720
  33. Young AC, Dimock AN, Puchalski SM, Murphy B, Spriet M. Magnetic resonance and radiographic diagnosis of osseous resorption of the flexor surface of the distal phalanx in the horse. Equine Vet J 2012;44(S43):3–7.
    pubmed: 23447869
  34. Conway J, Goodrich L, Valdes‐Martinez A. How to radiographically localize the entheses of the equine stifle joint. Proc Am Ass Equine Practnrs 2012;58:388‒391.
  35. Denoix J. The equine distal limb: an atlas of clinical anatomy and comparative imaging. Manson Publication; 2002.
  36. Pasquini C, Spurgeon T, Pasquini S. Anatomy of domestic animals. Pilot Point, TX: Sudz Publishing; 2007.
  37. Axiak LA, Werpy NM. Injury to the collateral cartilage and collateral ligament of the distal interphalangeal joint. AAEP Proceedings 2025. Accessed 1 May 2025.

Citations

This article has been cited 0 times.
Subscribe to our newsletter
Join 99,850 horse owners like you who receive our email updates on horse health and nutrition.