18/05/2026
WHEN THE HOOF ISN'T THE WHOLE STORY
Most of what an HCP does begins with observation: eyes, hands, the way a horse moves, the way it stands, what the foot looks like from the outside and when picked out. Most of the time, that's enough.
Sometimes it isn't. And when an HCP suggests involving a vet for further investigation, it's usually because something observed in the foot isn't adding up โ or because what's happening in the foot is pointing toward something happening in the horse.
This is what that thinking looks like.
WHAT WE SEE THAT MAKES US THINK BEYOND THE FOOT
A horse whose hoof quality doesn't respond as expected to diet, management, and a consistent trim cycle. Poor horn that would reasonably be expected to improve, and isn't.
Recurring abscessation without a clear mechanical explanation. One abscess is common. Repeated abscessation in the same foot, or across multiple feet, is a different conversation.
A digital pulse that is persistently elevated without an obvious trim-related or pathology-based explanation. Warmth in the feet that comes and goes without a clear cause.
Chronic or repeated laminitis episodes, particularly where grass and diet management are already in place. A horse that keeps returning to the same problem.
An older horse showing muscle wastage, a long, patchy, or delayed coat change, increased drinking or urination, or weight loss without obvious cause. These are not hoof findings โ but they change what the hoof findings mean.
A horse with a cresty neck, regional fat deposits, or a body condition that doesn't shift despite appropriate management. Metabolic flags that often show up before a laminitis episode.
This isn't an exhaustive list. It's a snapshot of the kinds of observations that shift the conversation from the foot in isolation to the horse as a whole.
BLOODWORK โ WHAT'S BEING MEASURED AND WHY
ACTH โ adrenocorticotropic hormone. This is the primary screening test for PPID (pituitary pars intermedia dysfunction), sometimes called Cushing's disease โ a progressive condition of the pituitary gland that becomes increasingly common in horses over fifteen. PPID directly affects the foot through its relationship with insulin dysregulation and its impact on immune function, hoof quality, and laminitis risk.
Timing matters. ACTH rises naturally in all horses in late summer and autumn, and results must be interpreted against seasonally adjusted reference ranges. A horse showing clinical signs of PPID may warrant testing at any time of year. Early or mild PPID can be difficult to detect on basal ACTH alone, and a vet may recommend a TRH stimulation test for greater sensitivity.
Resting insulin. Hyperinsulinaemia โ chronically elevated insulin โ is now understood to be a primary driver of endocrinopathic laminitis, the most common form in the UK horse population. Resting insulin provides a baseline picture of insulin status. It isn't a perfect test โ false negatives are not uncommon, and a single sample can be influenced by recent feeding, stress, and pain โ but it's the practical first-line investigation. A vet may follow up with an oral sugar test if resting insulin is inconclusive but insulin dysregulation is still suspected.
Glucose. Resting blood glucose has limited diagnostic value in horses โ it is usually within the normal range even in horses with significant insulin dysregulation, and it is easily affected by stress and feeding. It is typically measured alongside insulin as part of a broader metabolic picture rather than as a standalone test.
Selenium and vitamin E. Both are essential for normal neuromuscular and immune function, and both are frequently deficient in UK horses on forage-based diets. Selenium deficiency affects multiple body systems and can contribute to poor overall condition, including hoof quality. Selenium is also toxic in excess, which makes testing before supplementing important. Vitamin E is the primary fat-soluble antioxidant in equine diets and is often low in horses on conserved forage, particularly through winter.
Liver enzymes โ specifically GGT, AST, and ALP. The liver plays a central role in mineral metabolism, detoxification, and protein processing. Where there's a history of ragwort exposure, access to other hepatotoxic plants, or unexplained weight loss and poor condition, liver function warrants investigation. Compromised liver function has downstream effects on nutrient processing that can affect hoof quality and overall health.
IMAGING โ WHAT IT SHOWS AND WHAT IT DOESN'T
Radiography is the most accessible and commonly used imaging tool for the foot, and it provides information that external assessment cannot. The lateral view โ taken from the side โ shows the position of the pedal bone within the hoof capsule: its angle relative to the ground, the depth of sole beneath it, the thickness of the dorsal wall, and any evidence of rotation or sinking in laminitic cases. The dorsopalmar view โ taken from front to back โ shows mediolateral balance, joint space symmetry, and any bony changes within the foot.
What radiography shows is bone and its relationship to the hoof capsule. What it does not show well is soft tissue โ the laminae, the digital cushion, the navicular bursa, the collateral ligaments. A foot can look reassuring on radiograph and still have significant soft tissue pathology.
Radiography is most useful when there's a question about pedal bone position, sole depth, or bony changes that external assessment cannot answer. It is also a baseline tool โ having images from a horse when it is well makes future comparison meaningful.
MRI and CT are referral-level investigations, not yard-side tools, and access and cost reflect that. MRI provides detailed soft tissue and early bone pathology information that radiography cannot โ it is the investigation of choice where navicular disease, collateral ligament injury, or deep digital flexor tendon pathology is suspected. CT provides excellent bony detail in three dimensions and is particularly useful where complex fractures or subtle bony changes are the question. Both require specialist facilities and significant restraint or anaesthesia protocols depending on the system used. When they are recommended, it is because the question being asked cannot be answered any other way.
A NOTE ON COLLABORATION
The investigations above sit within veterinary scope โ an HCP can observe the clinical picture that prompts the conversation, but the testing itself involves a vet. That relationship between observation and investigation is part of how good hoof care works in practice.
Other professionals โ farriers, vets, physios, equine dentists โ will have their own diagnostic triggers and referral pathways depending on what they are seeing. What investigations do you ask for, and what prompts you to ask for them? This thread is a useful place for that conversation.
