BackgroundSagittal groove disease of the proximal phalanx in equine athletes is commonly considered a bone stress injury. Repetitive hyperextension of the fetlock under high load is thought to contribute to its development. Concurrent changes are often reported in the dorsal sagittal ridge of the third metacarpus/metatarsus (MC3/MT3).ObjectivesTo describe the spectrum of associated osseous abnormalities that are present in the fetlock in a large group of horses diagnosed with sagittal groove disease on low‐field magnetic resonance imaging (MRI).Study designRetrospective, cross‐sectional.MethodsMRI images of horses diagnosed with sagittal groove disease at Equitom Equine Clinic between March 2014 and March 2023 were evaluated using semi‐quantitative grading schemes and a sagittal groove disease MRI classification system.ResultsMRIs of 132 limbs were evaluated, predominantly from warmbloods used for showjumping (n = 83) and dressage (n = 18). Osseous densification and bone oedema‐like signal grades were higher in the dorsal sagittal ridge than palmarly/plantarly (p < 0.001 and p < 0.05, respectively). Grades of both osseous densification and bone oedema‐like signal in the dorsal sagittal ridge did not significantly differ between the different sagittal groove disease MRI classifications (both p > 0.05).Main limitationsInclusion based on original MRI reports, absence of control group, small numbers within some grading groups hindering statistical analyses.ConclusionsFindings support the aetiological theories of chronic bone‐stress due to loaded fetlock hyperextension however the severity of osseous changes of the dorsal sagittal ridge does not appear to be associated with the severity of sagittal groove disease classification.