Fifteen horses with flexural deformity of the metacarpophalangeal joint were evaluated and their conditions were designated as mild, moderate, or severe. Evaluations were made on the basis of clinical signs and lesions seen on radiography. Horses with mild deformities were treated with corrective trimming and shoeing; those with moderate deformities were treated with desmotomy of the accessory ligament of the deep digital flexor tendon and corrective shoeing. Desmotomies of the accessory ligaments of both deep and superficial digital flexor tendons were performed on horses severely affected, followed by corrective shoeing. In this long-term study, 4 horses with mild lesions and 4 horses with moderate lesions returned to useful work. None of the horses with severe disease responded enough to withstand strenuous athletic training.