Observations indicate that distortion and/or loss of palmar soft tissue (PST) of the hoof can lead to common problematic hoof distortions and navicular syndrome. We are currently establishing parameters to enable monitoring of this important part of the hoof. Current evidence indicates that ROST shoes enable restoration of the PST, but we also need to determine what practices and devices provide similar benefits, and which are harmful. When PST volume becomes critically low, the heel walls contracts further creating a vicious cycle. The ischemia produced by unimpeded heel contraction and the mechanical consequences of the loss of digital cushion volume ultimately result in the spectrum of pathology found in navicular syndrome. In my opinion, navicular syndrome has likely been preventable in the majority of cases, and widely employed “therapeutic” shoeing practices with the goal of mechanically increasing HPA, may in fact unintentionally promote further heel contraction and compromise to the palmar soft tissues of the hoof, exacerbating the pathology further.