Several different problems can lead to pain and lameness in the navicular/caudal heel area, including inflammation and injury of the supporting ligaments, problems in the flexor surface of the bone or flexor tendon itself in that area, and/or problems within the navicular bone itself (more on the specifics later). These problems are more common in the performance horse, and in general are the most common cause of "chronic" forelimb lameness in the horse.

Caudal heel pain has been diagnosed in most breeds of horses, but there does appear to be a breed predisposition, with Quarter Horses, Thoroughbreds, and warmbloods being diagnosed with the syndrome more frequently than others. Affected horses tend to be between the ages of seven and 14. Other common predisposing factors are conformation abnormalities of the hoof, including a broken forward or backward hoof axis, underrun heels, sheared heels, contracted heels, mismatched hoof angles, and disproportionally small feet.

Every day veterinarians across the country see hundreds of cases of laminitis, a painful disease that affects the feet of horses.  Laminitis results from the disrupted of blood flow to the sensitive and insensitive laminae within the foot, which secure the coffin bone to the hoof wall.  While the exact mechanism by which the feet are damaged remains a mystert, certain precipitating events can produce laminitis.  Although lamiitis occurs in the feet, the underlying cause is often a disturbance elsewhere in the horse's body.