Summary Objective : A study was conducted to define the relationship between oriental channel imbalance and several categories of front foot lameness. Methods : 189 horses with forelimb lameness (at least Grade II/V) from a general equine practice in Virginia were examined by the author using traditional manual palpation of the acupuncture channels. The forelimb channels were evaluated on the basis of the reactivity of five acupoints: Large Intestine (LI) 18, Small Intestine (SI) 16, Triple Heater (TH) 15, Urinary Bladder (BL) 42, and Urinary Bladder (BL) 14. The patients were evaluated with western methods to establish an anatomical diagnosis of pain distal to the proximal interphalangeal joint. All horses with oriental channel imbalance (CD) were examined with intra-articular anesthetics injected into the distal interphalangeal (DIP) joint. The horses were examined and treated by a single observer. Chi Square analysis was used to assess different frequencies of oriental channel imbalance, with P Results : Oriental channel imbalance was significantly more frequent in cases of chronic heel lameness (CHL), acute heel lameness (AHL), and laminitis and less frequent in subsolar abscess. LI/LU imbalance was present in all categories that had oriental channel imbalance. CHL and AHL had a significantly increased frequency of Pericardium (PC) channel imbalance compared to laminitis, subsolar abscess and the general population. The diagnostic sensitivity but not the specificity for reactive acupoints was determined for lameness originating distal to the proximal interphalangeal joint. During the time of the study, more nonlame horses with channel imbalance referable to the DIP joint were examined than the total CHL and AHL horses with that pattern of imbalance. Conclusions : Lameness of the equine foot that involved purely extra-articular structures, such as subsolar abscess, was not associated with oriental channel imbalance. Painful foot conditions that were associated with traumatic intra-articular inflammation of the DIP joint were reflected by oriental channel imbalance. Subclinical traumatic joint inflammation in nonlame horses could be confirmed by intra-articular anesthesia.