PET Imaging is Changing the Future of Equine Lameness Diagnosis
A Farrier’s Perspective on a Revolutionary Technology
For years, as farriers and hoof-care professionals, we have often found ourselves facing the same frustrating situation: a horse is lame, the owner is worried, the veterinarian performs radiographs and ultrasounds, yet nothing significant appears. The horse is clearly telling us something is wrong, but traditional imaging sometimes struggles to reveal the problem.
Today, that is beginning to change.
A relatively new technology called Positron Emission Tomography (PET) is revolutionizing the way veterinarians investigate lameness, particularly in the foot and fetlock regions. In my opinion, this is one of the most exciting developments we have seen in equine medicine in recent years.
Unlike radiographs, CT scans, or MRI, which primarily show anatomical structures, PET reveals something far more important: what is actually happening inside the tissues in real time. It allows veterinarians to see areas of increased metabolic activity, inflammation, stress remodeling, and abnormal bone turnover before structural damage becomes visible on conventional imaging.
This is particularly relevant for those of us working with feet every day.
As farriers, we constantly deal with horses that present subtle performance issues, intermittent lameness, unexplained discomfort, or hoof-related pathologies that can be difficult to localize accurately. PET offers the possibility of identifying active pathology at a much earlier stage, helping veterinarians and farriers make more informed decisions regarding trimming, shoeing, rehabilitation, and return-to-work programs.
One of the most impressive aspects of PET is its ability to detect microscopic bone changes before they become fractures. Bright “hot spots” on the scan indicate increased biological activity within the bone, often revealing stress injuries that are completely invisible on radiographs. In racing and high-performance horses, this capability has already proven invaluable for identifying areas at risk of catastrophic injury before disaster strikes.
But PET is not only about bone.
Using different tracers, the technology can also highlight tendon injuries, ligament lesions, inflammation, infection, and even laminitis. In fact, ongoing research suggests PET may become one of the most valuable tools available for understanding laminar pathology and monitoring treatment response in horses suffering from laminitis.
What makes this advancement even more remarkable is that modern equine PET no longer requires general anesthesia.
The latest generation of scanners, such as the MILE-PET system developed by LONGMILE Veterinary Imaging, allows horses to be scanned while standing under light sedation. The process is quick, safe, and remarkably efficient. A small amount of radiotracer is administered, the horse waits approximately thirty minutes, and imaging can then be completed in just a few minutes per region.
For many years, MRI represented the gold standard for advanced imaging of the equine foot. MRI remains an exceptional tool, but PET adds something unique: it shows whether a lesion is active. Two horses may have very similar MRI findings, yet one lesion may be actively progressing while the other is already healing. PET allows us to see that difference.
As a farrier, I find this aspect particularly fascinating.
How many times have we wondered whether a radiographic finding is clinically significant? How many times have we questioned whether a horse is truly improving or simply compensating? PET offers a completely different perspective because it evaluates function rather than just anatomy.
The technology is still relatively new, and access remains limited compared with radiography or ultrasound. However, the early results coming from institutions such as UC Davis are extremely promising. Studies have already demonstrated PET’s superiority over traditional bone scans in identifying certain fetlock injuries, particularly involving the sesamoid bones, and its ability to monitor healing over time.
For those of us whose work revolves around maintaining healthy feet and sound horses, PET represents far more than another diagnostic tool. It is a window into the biological processes occurring beneath the hoof capsule, allowing us to understand injuries earlier, treat them more effectively, and ultimately improve both welfare and performance.
The future of equine lameness diagnosis is not only about seeing structures.
It is about understanding how those structures function.
And right now, PET may be the closest thing we have to that future.