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Medial, with respect to the horse, means towards the middle as you stand directly in front of the horse. Lateral is toward the sides. When we say medial - lateral balance of the foot we are comparing the length of the walls of the hoof on the medial (inside) and lateral sides. Medial - lateral balance is important because imbalances create abnormal pressure across some of the hardest working parts of the horses hoof and skeletal system. These imbalances can cause bruising and arthritis. This article provides images of proper alignment and explains how trimming and wear can effect medial - lateral balance of the hoof.