http://www.bendequine.com/documents/Physitis.pdf
Research has found several causes, the most important being
nutrition. Foals most commonly develop problems when they are fed excess nutrients
which allows for rapid growth.
Nutrient
deficiency (a.k.a. a-grocery-osis) can also cause problems.
A second cause is trauma to
or excessive weight bearing on a certain growth plate. Uneven weight bearing can be due
to angular limb deformities or flexural limb deformity. Infection is also a cause of
physitis (from an external wound or infection spread from the foal’s bloodstream).
“hay, oats, and water” is not necessarily a great diet. It’s very common to see physitis in fat babies - too much is still “unbalanced”. It’s also got a weight component in this case.
Just because nutrition is/can be a main source of this doesn’t mean it’s the only source. Of there there are noted genetic components and sometimes just a crap component that will never be figured out.