Understanding the welfare and ethical debate around flexion tests in equine lameness evaluation, their diagnostic value, and more welfare-positive approaches to lameness workup.
Flexion tests occupy a contested welfare space in equine medicine. They cause acute pain during the procedure and their diagnostic value is limited by poor specificity — many sound horses show positive responses. Yet they remain standard practice in many equine lameness evaluations because they are quick, inexpensive, and familiar. The welfare-centered approach evaluates whether the information gained from flexion tests is proportionate to the welfare cost, and considers whether objective gait analysis, diagnostic analgesia, or imaging would provide better information with lower welfare impact. Pre-purchase examination use of flexion tests is particularly problematic given their poor specificity and the significant consequences — horse rejection — of positive results in this context.