Buying a horse is a gamble since their condition and health is a moving target and there is no way to predict the future. There is, however, a way to take snapshot of the present and to evaluate the past: a pre-purchase exam — or PPE.

A PPE is a health exam performed by a vet when the buyer and usually the seller are both present. It is done to assess current soundness, to help determine the suitability of a horse for the buyer’s intended use and to help provide the buyer with the information they need to make an informed purchase decision. No horse is perfect and this is not a “pass/fail” exam but it can help you identify pre-existing conditions and decide whether or not it’s something you can live with. A PPE is not a guarantee of future soundness, ability or temperament; it provides just one set of data points for buyers.

Some buyers choose not to have a PPE done. The reasons vary: the horse might not be very expensive, they may have known or ridden the horse for a long time, they trust the seller, or they might feel they have enough experience to make their own decision. I have bought two horses without a PPE. One I had leased for a year before buying; the other I had fostered for six months. I did not regret either of those purchases but I had seen both of these horses in work over an extended period of time.

Every other horse I have bought (or tried to buy) I have vetted. As someone who must board my horse I want to make sure that I don’t buy a horse with a pre-existing condition that might cause long-term issues. It expensive enough to have a horse. Taking care of a lame horse is even more expensive and much less fun. After all, the initial purchase price is a drop in the bucket compared to the long-term costs of horse ownership.

While a very thorough PPE exam can be expensive, especially if you want x-rays of multiple joints from several angles, they don’t have to be that detailed. Several times I’ve stopped a PPE when the vet found something wrong during the basic physical exam — in my case it was a subtle lameness but it could also have been a problem like cribbing, muscle wastage indicating an old injury or incorrect training, or a conformational issue, such as long, sloping pasterns that might indicate the horse was not suited for a particular use. If the vet identifies inflammation or lameness early on I certainly am not going to pay to find out what has caused it! However, a physical exam may raise questions that are best answered by an x-ray and now that many vets have digital equipment you can see the results right away and choose how many views are necessary or required.

Flexion Tests

Flexion tests are one of the standard components of a PPE. In this test, the vet holds the joint under consideration in a firmly flexed position for a period (usually 1-3 minutes) and then immediately watching the horse move, usually at the trot, to detect any change in gait compared to that observed before performing the test. However, you need to be careful because it’s perfectly possible to make any horse look lame if the horse is flexed for too long. There isn’t a lot of agreement on how long a leg should be flexed, for example, which can make the results subjective.

David Ramey, DVM did a study using 50 horses belonging to his clients.

I took a lameness history of all of the horses in the study, and I watched them trot and lunge on hard ground, and I felt their legs for abnormal swellings or areas of soreness. If a client’s horse was lame, or showed some obvious physical abnormality, I didn’t use him – I just wanted to study sound horses. And then I did two tests – a “normal” (for me) flexion test, and a test that was as hard as I could flex the leg without the horse going up in the air and trying to kill me (for my study, I held the horse’s leg up in the air for 60 seconds, but there’s no agreement on the “proper” amount of time – which is another problem). I recorded the responses. In addition, I took X-rays all of the lower legs of the horses.

60 Days later, he examined the horses again. If an individual horse incurred some lameness in the 60-day period following the initial examination, the lameness was correlated with clinical, flexion test, and X-rays findings. The findings were sobering.

• I found that forelimb flexion tests couldn’t tell me anything about the future of a sound horse.  I could make every single horse lame with a hard enough flexion test, with the exception of one particularly annoying Arabian gelding who was always trying to bite me (no Arabian jokes, please).
• Horses that had “something” on their X-rays weren’t any more likely to be lame after a “normal” flexion test than horses that had “clean” X-rays.
• Horses that had positive “normal” flexion tests weren’t any more likely to be lame 60 days out, either (those horses that were lame mostly had things like hoof abscesses, which nobody could have predicted anyway).
• If you follow a groups of horses for 60 days, there’s a decent chance that a few of them might experience an episode of lameness.  Who knew?

While I don’t x-ray horses until they glow, generally when I’ve had a horse vetted I have the vet take x-rays of the hooves, ankles and hocks, even if it’s just a baseline that I can use for future comparisons. Occasionally, you find something unexpected. In one exam we discovered that the horse had previously fractured its coffin bone and that the break had healed oddly. While the horse was sound, I was looking for an eventer and my vet was concerned that this was a weakness that galloping and jumping over rough terrain might re-injure.

Sometimes that exam is unexpectedly good. I sat in on a PPE for an OTTB that had raced more than 60 times. The x-rays showed absolutely clean legs, indicating that his gelding was built to last. It was very reassuring to the girl who bought him.

Often exams shows characteristics of a horse that need to be evaluated in the overall context of its performance and use. I had a mare that had a very slight hitch in her gait when she wasn’t very fit. I had noticed it when I bought her and had quizzed the examining vet. He had considered it the result of weakness and thought it would improve. When I sold her, the buyer’s vet correctly identified it as a slight neurological issue. But he pointed out that she had lived with this her whole life and it had not affected her performance as a race horse or as a riding horse. He did not feel this was a condition that would deteriorate over time and the woman bought the horse.

I have never pulled blood for a drug test prior to a purchase but having read many horror stories, I would consider having my vet hold blood in case I saw a significant change in behavior after bringing a horse home.

I remember when I was horse shopping my husband used to tease me that I would use up my entire budget having horses vetted but in the end I felt that the money on vetting was well spent. I avoided buying horses with problems that I didn’t want to deal with and learned a lot about how to evaluate both current and potential future soundness.

More Resources

Understanding the prepurchase exam
Horses and the Prepurchase Exam This article is on www.horseadvice.com. It’s a subscription site but the fee is low and it has a ton of useful information that has been written by a vet.

And here are two videos that provide an idea of what to expect.