This was a gelding that was brought for veterinary and farrier examination. The gelding has minimal response to hoof testers over the medial and lateral aspect of the frog as well as minimal response to sole pressure. The owner had him examined by another vet who performed nerve blocks and determined that there was a positive response to a lower posterior nerve block making them suspicious of heel and foot pain. I performed radio graphs of this patient and found him to be moderately to severely unbalanced medial to laterally as can be seen on the left DP radio graph. The coffin joint spaces have a significant difference in measurement. The patient was trimmed and balanced and radio graphs were taken again for interest purposes and the coffin joint was re-balanced to almost the millimeter. The navicular radio graphs of this patient did reveal some mild sclerosis in the navicular bone which most likely could be attributed to years of improper hoof care causing abnormal stress in the caudal heel region resulted in chronic changes of the bone and the surrounding soft tissue. After examining this horse and working with Ian to balance the horses feet I do believe that there is a fair to good prognosis that this horse can go on to have a long sound career.