Lameness Exam & Scale – How Vets Diagnose Lame Horses

Updated July 10, 2023
Equine vet watching horse in exam after flexion tests.

Among the many things that a horse owner dreads is going out to the barn and seeing your horse not moving right. It can be as simple as an occasional irregular stride on the lunge line or as dramatic as head-bobbing, hip-hiking lameness or worse. In either case, the next step is contacting the veterinarian and scheduling a lameness exam.

Although there are some typical components to nearly every lameness exam—such as use of hoof testers and flexion tests – there is no one, standard “lameness exam” because every horse and every situation is different. For example, the tools and tests used for a horse who has taken some uneven steps competing at the highest levels of his sport may be very different from the way a vet approaches the diagnosis of a young horse that comes in from the pasture limping.

Keep reading to learn the components of a lameness exam and what you may expect after you’ve called the vet.

Components of a Lameness Examination

Medical History

Surprisingly, the first thing a vet will do when called out to examine a horse for lameness does not involve palpating the limbs or watching the horse jog — it is gathering a history. This means asking the owner, and possibly trainer or barn manager, questions about the problem and encouraging them to describe what they are seeing and feeling, including when it first started, how it has changed and if any treatment has already been given.

Visual Exam

Once the vet has these basic facts, the lameness exam itself can begin. Step one is a visual inspection at rest, before the horse is even asked to move. The vet is assessing conformation, balance and symmetry left to right as well as back to front, plus the horse’s overall posture and comfort level.

Hands-on Exam

Equine vet performing a physical exam on a horse

The next step is palpation or feeling the various body parts by hand. Don’t be surprised if the vet palpates the normal limb first then moves to the abnormal limb. This is because it is helpful to be able to compare one leg to the other and to know what it is supposed to feel like for that particular horse before trying to decide if the way a specific structure looks or feels is not normal.

Hoof Testers

Digital pulses (the intensity of the heart rate in the blood vessels of the lower limbs) may also be assessed. At this point, the vet may apply hoof testers to the feet, to determine if there’s any pain or discomfort when certain areas of the hoof are squeezed or pressed on. Armed with this preliminary data, it may now be time to observe the horse on the move.

Evaluating the Horse’s Movement

They will watch the horse in motion at the walk and trot, perhaps on both straight lines and circles, and on both hard and soft ground. Some veterinarians prefer to have the horse jog in-hand while others prefer to see the horse jog at the end of a lunge line. They may observe the horse from the back, front, or sides, taking note of any unnatural shifting of weight from one leg to another, irregular hoof placement, shortening of stride, head bobbing, or other signs of lameness.

Flexion Tests

vet flexing leg of horse during a pre-purchase exam

In this procedure, additional stress is placed on specific joints such as the knee, fetlock (ankle), stifle, and hock by holding one leg off the ground in a bent position for a minute or two then putting it down and immediately trotting the horse off. Flexion tests are helpful to localize soundness issues by temporarily accentuating pain. So, a horse that was a Grade 1 on the right front at first might demonstrate a Grade 2 or 3 lameness after the knee is flexed, indicating that may be where the problem is (see below for more information on grading a lameness).

Additional Diagnostic Tests

Nerve and Joint Blocks

Depending on the results so far, the vet may decide it is time to numb a limb, usually beginning at the bottom with the hoof and working up the leg.

Nerve blocks are performed by injecting topical anesthetic agents just under the skin and over the top of nerves. Within a few minutes, the structures served by these nerves become temporarily deadened and if pain was originating from that particular area of the leg, the horse may now jog out sound. However, if that area was NOT the source of the lameness, then the horse will jog the same as before and another area may then be blocked against pain.

Entire joints can be numbed with a joint block. This involves the anesthetic agent being sterilely injected into the joint itself and, after waiting for the agent to take effect, the horse is jogged to see if there is any difference in his way of going.

Diagnostic Imaging

ultrasound exam during horse pre purchase exam

The next service the vet may offer is imaging. Veterinarians have a wide array of visualization tools at their disposal to aid in the diagnosis of lameness. However, these modalities do not take the place of a thorough lameness exam, they are complementary to it.

Once a lameness has been localized to a specific area, the best tool for the job will be selected, such as radiographs (X-rays) for bones and joints or ultrasound for soft tissues like tendons and ligaments. Advanced imaging choices include nuclear scintigraphy (bone scan), magnetic resonance imaging (MRI), and computed tomography (CT).

Sometimes images of specific structures can be used to rule in a cause for lameness—such as an OCD cyst in the stifle or a core lesion in the suspensory—and sometimes images can be used to rule out a cause for lameness—such as properly aligned fibers in the superficial digital flexor tendon or pristine articular cartilage surfaces in the hock joint.

From a horse that feels uneven in the reins or won’t pick up a certain canter lead to a non-weight bearing lameness (an emergency), your vet is your best resource to get to the bottom of the issue quickly so that appropriate treatment can be started right away and you can get back to enjoying your horse!

Video on Equine Lameness Exams

Lameness Scale Grading System 

A lameness grading system has been developed by the American Association of Equine Practitioners (AAEP) to standardize the degree of a horse’s unsoundness:

  • 0: Lameness not perceptible under any circumstances.
  • 1: Lameness is difficult to observe and is not consistently apparent, regardless of circumstances (under saddle, circling, inclines, hard surface, etc.).
  • 2: Lameness is difficult to observe at a walk or when trotting in a straight line but consistently apparent under certain circumstances (weight-carrying, circling, inclines, hard surface, etc.).
  • 3: Lameness is consistently observable at a trot under all circumstances.
  • 4: Lameness is obvious at a walk.
  • 5: Lameness produces minimal weight bearing in motion and/or at rest or a complete inability to move.

Additional Horse Owner Resources

SmartPak strongly encourages you to consult your veterinarian regarding specific questions about your horse's health. This information is not intended to diagnose or treat any disease, and is purely educational.