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Magnetic resonance imaging (MRI) is increasingly integrated into the diagnostic workup of horses with foot pain and has revolutionised the diagnosis and management of these injuries. This review discusses the principles of MRI in the context of deep digital flexor tendon (DDFT) injury, comparing high\u2010field and low\u2010field systems and highlighting the clinical relevance of technical parameters, including field strength and sequence selection, in achieving an accurate diagnosis. This review also critically evaluates how different configurations and\/or imaging features of tendon lesions may impact patient prognosis, considers the complementary role of computed tomography and ultrasonography in cases where MRI may not be feasible, and discusses emerging imaging techniques including positron emission tomography (PET)\u2010MRI and quantitative MRI. Lastly, this review 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 and tailored rehabilitation is essential to improving clinical outcomes in horses with DDFT injuries.<\/jats:p>","DOI":"10.1111\/evj.14508","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T07:48:02Z","timestamp":1746172082000},"page":"1183-1203","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Magnetic resonance imaging for diagnosing and managing deep digital flexor tendinopathy in equine athletes: Insights, advances and future directions"],"prefix":"10.1111","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1270-0998","authenticated-orcid":false,"given":"Alexandra","family":"Scharf","sequence":"first","affiliation":[{"name":"Department of Clinical Studies, New Bolton Center University of Pennsylvania  Kennett Square Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9493-6026","authenticated-orcid":false,"given":"Elizabeth","family":"Acutt","sequence":"additional","affiliation":[{"name":"Department of Clinical Studies, New Bolton Center University of Pennsylvania  Kennett Square Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0857-9363","authenticated-orcid":false,"given":"Kathryn","family":"Bills","sequence":"additional","affiliation":[{"name":"Department of Clinical Studies, New Bolton Center University of Pennsylvania  Kennett Square Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4230-7831","authenticated-orcid":false,"given":"Natasha","family":"Werpy","sequence":"additional","affiliation":[{"name":"Equine Diagnostic Imaging, Inc.  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