Although the equine distal phalanx and hoof lamellae are biomechanically and physiologically integrated, bony changes in the distal phalanx are poorly described in laminitis. The aims of this study were (1) to establish a laminitis grading scheme that can be applied to the wide spectrum of lesions seen in naturally occurring cases and (2) to measure and describe changes in the distal phalanx associated with laminitis using micro-computed tomography (micro-CT) and histology. Thirty-six laminitic and normal feet from 15 performance and nonperformance horses were evaluated. A laminitis grading scheme based on radiographic, gross, histopathologic, and temporal parameters was developed. Laminitis severity grades generated by this scheme correlated well with clinical severity and coincided with decreased distal phalanx bone volume and density as measured by micro-CT. Laminitic hoof wall changes included progressive ventral rotation and distal displacement of the distal phalanx with increased thickness of the stratum internumcorium tissues with lamellar wedge formation. Histologically, there was epidermal lamellar necrosis with basement membrane separation and dysplastic regeneration, including acanthosis and hyperkeratosis, corresponding to the lamellar wedge. The changes detected by micro-CT corresponded to microscopic findings in the bone, including osteoclastic osteolysis of trabecular and osteonal bone with medullary inflammation and fibrosis. Bone changes were identified in horses with mild/early stages of laminitis as well as severe/chronic stages. The authors conclude that distal phalangeal pathology is a quantifiable and significant component of laminitis pathology and may have important implications for early detection or therapeutic intervention of equine laminitis.Keywords horse, laminitis, distal phalanx, pathology, diagnostic imaging, micro-computed tomography, x-ray microtomography, osteolysis, osteopathologyThe structural integrity of the highly specialized and complex elements composing the equine foot-including the epidermal and dermal lamellae, bone, tendons, ligaments, and other connective tissues-is essential for suspension of the distal phalanx (DP) within the hoof capsule. The interface between the equine DP and inner hoof wall is unique in that the dorsal cortex of the DP is highly porous relative to the solar cortex or to the cortices of other bones in the appendicular skeleton.39 These porosities correspond to perforating vascular channels that extend from the medullary spaces of the DP to supply the overlying lamellar tissues. 30,39 Thus, the unique interface of this specialized musculoskeletal unit provides a direct microanatomic integration between bone and epidermal/dermal lamellar tissues.Laminitis is a disease affecting the epidermal and dermal lamellae of the inner hoof wall, which often progresses to a chronic phase. The chronic phase of laminitis is characterized by inadequate tissue healing and aberrant regenerative responses that result in lamellar hyperplasia and dysplasia,...