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BACKGROUND Correct diagnosis and characterisation of deep digital flexor tendon (DDFT) lesions in equine athletes allows targeted treatment and improved prognostication. OBJECTIVES To assess the prevalence and character of pathological change within the DDFT in the pastern with concurrent tendon injury distally. It is hypothesised that tendon lesions in the pastern will be associated with tendinopathy within the hoof capsule. STUDY DESIGN Retrospective descriptive case series. METHODS Cases with DDFT lesions in the pastern and magnetic resonance imaging (MRI) or ultrasonography of the foot were evaluated retrospectively. Lesion location and type were recorded. Odds ratios were calculated to determine the associations between more distal tendinopathy and the presence of different DDFT lesion types in the pastern. RESULTS Thirty-four MRI scans of 33 horses and 64 ultrasonographic exams of 58 horses were analysed. Lesion location and type were recorded. Distal DDFT lesions were found in 75% (95%CI 66.0, 84.0) of total cases of pastern DDF tendinopathy and in 97% (95%CI 91.6, 100.0) of cases with core lesions of the DDFT in the pastern. A core lesion in the pastern was significantly more likely (OR = 20.7, 95%CI 2.2, 191.0, p = 0.008) to be associated with injury in the foot than other types of pastern lesion. MAIN LIMITATIONS MRIs of the foot were not obtained on all included limbs which did not allow for fully inclusive evaluation of DDFT lesions distal to the navicular bone. CONCLUSIONS DDFT pathological change in the pastern, particularly core lesions, is associated with additional tendinopathy within the hoof capsule. When a DDFT lesion is found in the pastern, further imaging of the tendon within the foot is indicated to direct appropriate treatment and improve prognostication.