Satisfactory investigations of the equine foot appear to be limited by the histomorphological complexity of internal hoof structures. Foot lameness is considered to be one of the most debilitating pathological disorders of the equine foot. In most species, foot lameness is traditionally linked to hoof deformity, and a set of molecular events have been defined in relation to the disease. So far, there is controversy regarding the incidence of foot lameness in horses, as it is unclear whether it is foot lameness that triggers hoof distortions or vice-versa. In order to develop a better understanding of foot lameness, we review both the healthy and lame foot anatomy, cell biology and vascularisation and using micro-computed tomography show new methods of visualising internal structures within the equine foot.