The Ultimate Pre-Purchase Exam Guide for Buying a Horse

Last updated: June 19, 2025

By: Miles HenryFact Checked

Buying a horse is exciting—but it’s a serious investment. With over 25 years of hands-on experience working with and buying horses, I’ve seen firsthand how a thorough horse pre purchase exam (PPE) saves buyers from costly surprises. This guide offers a comprehensive buying checklist, detailing red flags across all major body systems and key questions to ask your vet—especially for conditions like navicular disease. Whether you’re a first-time buyer or seasoned equestrian, these insights ensure you make informed decisions for a rewarding partnership.

Why a Horse Pre Purchase Exam Matters

A PPE is a risk evaluation, not a pass/fail test. It assesses a horse’s health, soundness, and suitability for your goals, from trail riding to eventing or breeding. Missing subtle signs, like horse lameness or navicular syndrome, can lead to financial strain and limited riding potential. A thorough PPE ensures confidence in your purchase.

Before the Exam: Set the Stage for Success

Preparation maximizes the PPE’s value. Take these steps:

• Define your goals. Share your intended use—trail, dressage, breeding—to shape the exam’s focus.
• Take part. Attending provides insight into behavior and allows real-time questions.
• Provide known history. Share past injuries, treatments, or performance issues.

How to Spot Red Flags in a Horse Pre Purchase Exam

A comprehensive PPE evaluates all major body systems. Below, we detail key red flags across each system and the essential questions to ask your vet to ensure nothing is overlooked.

1. Lameness or Irregular Movement

Subtle signs—uneven strides, reluctance to turn, or heel sensitivity—can signal deeper issues like navicular disease.

Ask Your Vet:

• Is there lameness during flexion tests or on various surfaces?
• Are movement asymmetries present?
• Can we use hoof testers to evaluate heel pain?

2. Abnormal Hoof Conformation

Long toes, low or underrun heels increase the risk of chronic heel pain and navicular-related issues. Learn more in our guide to navicular disease in horses.

Ask Your Vet:

• Are the hooves balanced and structurally sound?
• Could conformation issues increase navicular or laminitis risk?
• What corrective farriery will it need long-term?

3. Radiographic Findings

X-rays may reveal changes like bone cysts or remodeling, but these findings don’t always equal unsoundness. As noted in this peer-reviewed imaging study, radiographs must be interpreted in context.

Ask Your Vet:

• What navicular bone or joint changes are present?
• Do the imaging findings align with the clinical exam results?

4. Inadequate Response to Nerve Blocks

Nerve blocks use local anesthetic to pinpoint pain. A poor response may mean the source is elsewhere—or that further diagnostics like MRI are needed. See this study on diagnostic nerve blocks.

Ask Your Vet:

• How did the horse respond to the nerve block?
• What does a lack of improvement suggest about the lameness source?
• Do these results warrant further diagnostics like MRI or bone scan?

5. Behavioral or Performance Issues

Signs like resistance under saddle, head tossing, or cribbing may point to hidden discomfort. Explore common cribbing behaviors and how to manage them.

🧠 Personal Note: Over the years, I’ve seen subtle behaviors—like a sour attitude under saddle—end up revealing navicular pain or kissing spine. Trust your gut, and always ask your vet to dig deeper.

Ask Your Vet:

• Could this behavior indicate pain or hidden unsoundness?
• Is the horse’s performance consistent with my intended use?
• Are there signs of stable vices like cribbing or weaving?

6. History of Lameness or Maintenance

Repeated joint injections or corrective shoeing may suggest a chronic issue. Learn about horse joint injections and what they really mean.

Ask Your Vet:

• Do treatment records align with today’s findings?
• Has corrective shoeing or injections been ongoing?
• Might this horse need continuous care?

7. Respiratory System Issues

Wheezing, nasal discharge, or chronic coughing could indicate allergies, heaves, or upper airway obstructions that affect long-term performance. In future sport or race prospects, airway scoping helps rule out issues like laryngeal paralysis or EIPH (exercise-induced pulmonary hemorrhage). Learn more about EIPH and nosebleeds in horses and why early detection matters.

🧠 Personal Note: When I bought my yearling, I had it scoped to rule out bleeding or structural airway issues. It’s a simple but important step if the horse has athletic potential—and it gave me confidence moving forward.

Ask Your Vet:

• Were any abnormal lung sounds detected?
• Could respiratory issues impact performance or endurance?
• Would you recommend airway scoping in this case?

8. Ocular (Eye) Problems

Conditions like cataracts or recurrent uveitis (moon blindness) can impair vision and safety.

Ask Your Vet:

• Are the eyes free from recurring disease or vision loss?
• Could this affect performance or safety?

9. Cardiovascular Abnormalities

Heart murmurs or irregular rhythms can reduce stamina or pose health risks—especially for performance horses. The AAEP’s discussion on atrial fibrillation outlines when treatment is needed and what risks to weigh.

Ask Your Vet:

• Was any heart murmur or irregular rhythm detected?
• Could it affect the horse’s workload or fitness?

10. Dental Health Concerns

Dental issues like sharp points, missing teeth, or uneven wear can cause pain or weight loss. Here’s what you need to know about floating teeth and equine dental care.

Ask Your Vet:

• What’s your dental assessment and maintenance recommendation?

11. Gastrointestinal Health Issues

Low body condition or a history of colic may indicate ulcers or other digestive problems. Learn more about ulcers and digestive health in horses or explore our guide on what every owner should know about colic.

Ask Your Vet:

• Does the condition suggest chronic digestive issues like ulcers or colic?
• Will special dietary management be needed?

12. Neurological Deficits

Ataxia or incoordination may point to serious neurologic issues like EPM. Early detection is key—read about early signs of EPM in horses.

Ask Your Vet:

• Were any neurological abnormalities observed?
• Could this affect the horse’s safe use?

13. Skin and External Conditions

Lumps, melanomas, or sarcoids may require ongoing care or reduce resale value.

Ask Your Vet:

• Are any skin conditions potentially costly or recurring?
• Do visible scars suggest past trauma that could affect function?

14. Reproductive Assessment (If Breeding)

For breeding stock, fertility and reproductive soundness must be confirmed through palpation or ultrasound.

Ask Your Vet:

• What’s the reproductive health status?
• Would additional tests be helpful?

✅ Download the PPE Red Flag Checklist

Want a quick-reference guide you can bring to your horse’s pre-purchase exam?
This printable PPE checklist helps you track red flags, ask the right vet questions, and evaluate if the horse truly fits your goals.

👉 Download the PPE Red Flag Checklist (PDF)

Use it during:

• Vet evaluations
• Trial rides or lease periods
• Discussions with trainers or farriers

📌 Tip: Keep a copy on your phone or in your barn bag when horse shopping.

📊 Quick-Reference PPE Red Flag Summary

Area	Red Flag Example	Ask Your Vet
Movement	Subtle lameness or heel pain	Can we use hoof testers or nerve blocks?
Hoof	Long toes, low heels	Will this require corrective farriery?
Imaging	Bone changes, cysts	Do X-rays align with exam findings?
Behavior	Under saddle resistance	Could this be pain-related?
Heart	Murmurs, arrhythmias	Will this limit performance?
Eyes	Uveitis, cataracts	Will this affect safety or vision?
History	Maintenance injections	Will ongoing treatment be needed?

Your Horse Buying Checklist

• Define your riding or breeding goals.
• Hire an independent vet not affiliated with the seller.
• Request a full PPE — including the exam, flexion tests, radiographs, and advanced imaging if needed.
• Observe the horse moving in-hand, under saddle, and on various surfaces.
• Review the horse’s veterinary, farrier, and training records for patterns.
• Discuss the findings with your vet — weighing risks, long-term costs, and suitability.
• Consider negotiating a trial period to assess the horse in your own care. For example, when evaluating barrel horses, I’ve successfully leased them for a month before committing to buy. This gives you valuable time to confirm suitability and avoid costly surprises.

Ethical Buying Practices

Don’t rush the process or skip diagnostics to save money—doing so can lead to far greater costs down the line. Be transparent with sellers and walk away respectfully if serious red flags emerge. Learn more about responsible horse ownership to ensure you’re prepared for long-term care, not just the purchase.

Frequently Asked Questions About Horse Pre-Purchase Exams

Thinking of buying a horse? In this helpful video, equine veterinarian Dr. Erica Lacher walks you through early signs to watch for before the pre-purchase exam. From movement quirks to subtle red flags, her insights can help you identify deal-breakers—and ask better questions during the vet check.

Conclusion: Make Informed Decisions for a Rewarding Partnership

A well-conducted PPE, armed with the right questions to ask your vet before buying a horse, guides you toward a sound, compatible partner. By covering soundness, behavior, and broader health issues, this guide ensures no red flags are missed. Whether evaluating navicular or a general companion, you’re backed with confidence. Share your PPE tips below and join our community of informed equestrian buyers!

If you found this helpful, share it with a fellow horse buyer or trainer.

Key Resources

• AAEP Pre-Purchase Exam Guidelines
• Navicular Syndrome Overview (AAEP)
• Tildren & Osphos in Navicular Disease (FDA)
• Nerve Block Diagnostics (PubMed)
• Peer-Reviewed Imaging Study (PubMed)
• AAEP on Respiratory Conditions
• Merck Veterinary Manual on Equine Eye Diseases
• AAEP on Cardiovascular Exams
• AAEP Principles of Veterinary Medical Ethics