Does My Horse Have Pyramidal Hoof Disease?

Also known as “buttress foot,” this condition primarily affects horses with poor leg conformation in high-impact disciplines. A veterinary podiatry expert explains.

No account yet? Register


pyramidal hoof disease
As pyramidal disease worsens, the shape of the hoof changes significantly and becomes more narrow and square. | Photo: Courtesy Dr. Raul Bras

Q.I recently bought a young prospect who passed a fairly rigorous prepurchase exam (PPE). When she got home my farrier came to shoe her and told me he believes she has “pyramidal disease.” I’d never heard of this hoof condition before but have found a few references to it online. How do I know she has this condition, what causes it, why wouldn’t it have been included in the PPE, and what’s the long-term prognosis for her as a sport horse?

Via e-mail

A.Pyramidal disease is a form of osteoarthritis in horses which affects the coffin joint (low ringbone) or the pastern joint (high ringbone). Specifically, pyramidal disease is the fragmentation of the extensor process of the distal phalanx (coffin bone, or P3). It is thought to occur due to trauma, osteochondrosis, or presence of separate centers of ossification. Forelimbs are more commonly affected than hind limbs

Create a free account with to view this content. is home to thousands of free articles about horse health care. In order to access some of our exclusive free content, you must be signed into

Start your free account today!

Already have an account?
and continue reading.


No account yet? Register

Written by:

Raul Bras DVM, CJF, grew up in Puerto Rico where he showed and bred Paso Fino horses. He earned his undergraduate degree in animal science from Louisiana State University, graduated from Ross University Veterinary School in 2005, and completed his clinical year at Auburn University. In 2005, Bras completed a surgery internship at Rood & Riddle Equine Hospital, in Lexington, Kentucky. The following year he stayed on as an associate veterinarian in Rood & Riddle’s podiatry department, where he’s now a shareholder. Bras completed Cornell University’s farrier program in 2007 and became an American Farriers Association Certified Journeyman Farrier in 2010. In addition to providing his expertise in equine podiatry in Lexington, Bras travels throughout the United States and internationally to treat horses. He’s devoted to the betterment of the vet-farrier relationship. In 2015, he was inducted into the International Equine Veterinarian Hall of Fame.

Leave a Reply

Related Articles

Stay on top of the most recent Horse Health news with

FREE weekly newsletters from

Sponsored Content

Weekly Poll

sponsored by:

Where do you go to find information on pituitary pars intermedia dysfunction (PPID)? Select all that apply.
78 votes · 136 answers

Readers’ Most Popular

Sign In

Don’t have an account? Register for a FREE account here.

Need to update your account?

You need to be logged in to fill out this form

Create a free account with!