The flexion test is widely used in equine pre-purchase examinations but raises both welfare and diagnostic validity concerns, prompting debate about its role in veterinary practice.
Flexion test welfare concerns arise from the forced positioning of limbs in extreme flexion for periods of up to 90 seconds, which causes tissue compression and discomfort particularly in horses with pre-existing joint pathology. The welfare cost would be justified if the diagnostic benefit were clear, but the poor specificity of the test - its tendency to produce positive results in both lame and sound horses - calls this justification into question. Modern diagnostic approaches using regional analgesia and advanced imaging provide more specific information with potentially less welfare compromise, though flexion tests continue to be widely used due to cost and practicality.