Radiographic abnormalities (RAs) in the proximal interphalangeal (pastern) joint have several manifestations and can cause concern in young horses intended for racing. Our objective in this retrospective study was to describe the appearance and prevalence of pastern RAs in young Thoroughbreds and compare the racing outcomes of cases with sibling controls. All radiographic reports of young Thoroughbred racehorses born in 2003–2007 read by veterinarians in one Lexington, Kentucky, practice were searched for pastern RAs. Pastern RAs are described, and the 2- and 3-year-old racing records of affected horses are compared with siblings. Pastern RAs were detected in 1.3% of weanling and yearling Thoroughbred horses examined. Radiographic abnormalities detected included shallow (≤3 mm) indentations in joint contour, dorsal osteophytes or axial palmar and/or plantar enthesophytes (≥3 mm), osseous fragments, and subchondral lucencies (≥4 mm). Horses with fragments in the pastern joint tended to be less likely to start a race at 2 years of age. Horses with fragments and subchondral bone cysts in the distal first phalanx tended to be less likely to start a race at 2 or 3 years of age than control siblings. The importance of some pastern joint RAs to performance can be overemphasized; however, some RAs have a tendency to be associated with poorer racing outcomes than sibling controls and may be considered when reviewing the radiographs of young Thoroughbred racehorses.