Case records of 202 horses treated for laminitis were reviewed with the intent of determining the long-term outcome and correlating this with digital radiographic findings and with the degree of pain associated with the laminitis. At long-term follow-up 57 horses had returned to athletic soundness (Group 1), 20 horses were intermittently lame (Group 2), 19 horses had permanent severe lameness (Group 3), 97 were dead (Group 4), and 9 were lost to follow up. Using simple regression analysis, functional outcome did not correlate with the degree of rotation (R2= 0.004) or the presence of distal displacement (R2= 0.139). Functional outcome did correlate with the clinical grade of laminitis (R2= 0.504). Horses in Group 1 had significantly less distal phalangeal rotation (5.89 ± 6.48 degrees) than did horses in Group 2 (11.10 ± 8.19) and Group 3 (14.50 ± 10.80), but were not significantly different from Group 4 horses (7.49 ± 6.57). Of 96 surviving horses, 23 had evidence of distal displacement compared with 54 of 97 non-survivors. Based on these results, horses that develop distal displacement of the distal phalanx are more likely to die than are horses without distal displacement; however, the presence or absence of distal phalangeal displacement and the degree of distal phalangeal rotation cannot be used to predict the outcome of a horse with laminitis. Clinical assessment is a more reliable means of determining the final outcome and should be given precedence over radiographic findings.