Magnetic Resonance Imaging for Diagnosing and Managing Deep Digital Flexor Tendinopathy in Equine Athletes: Insights, Advances, and Future Directions

Deep digital flexor tendinopathy is a significant cause of lameness and poor performance in equine athletes with substantial implications for their return to athletic performance. Magnetic resonance imaging (MRI) is increasingly integrated into the diagnostic workup of horses with foot pain and has revolutionized the diagnosis and management of these injuries. This review discusses the principles of MRI in the context of DDFT injury, comparing high-field and low-field systems, and highlighting the clinical relevance of technical parameters including field strength and sequence selection in achieving an accurate diagnosis and prognosis. It also evaluates the complementary role of computed tomography and ultrasonography in cases where MRI may not be feasible and discusses emerging imaging techniques, including PET-MRI and quantitative MRI. This paper underscores the importance of serial imaging to monitor lesion progression and guide rehabilitation, while identifying knowledge gaps and proposing future research directions. Ultimately, a multidisciplinary approach incorporating advanced imaging modalities and tailored rehabilitation is essential to improving clinical outcomes in horses with DDFT injuries.