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How to Conduct A Horse Health Examination

A curious horse looks directly at a close up camera as three horses congregate in the distance outside.

Updated June 30th, 2021

Much like the common advice given to humans, it’s important to regularly check the health of horses with a routine physical examination rather than waiting until a horse is showing signs of distress or illness. This is in addition to the veterinary exam ever horse resident should receive, ideally every 6 months, but definitely annually. Not only will this help you get to know what all aspects of a healthy horse looks and feels like, but familiarizing a horse with human handling might help them stay more calm in stressful situations. You will also learn more specifically what is “normal” for the individual horse. Be prepared to check them over at least every six to eight weeks*! For more information on why regular health examinations are important, check out our resource here.

*An Exam Every Six To Eight Weeks Means Daily Observations

Our recommendation for staff to conduct routine health examinations every six to eight weeks must be done in conjunction with daily observations. This is around the time hooves will need trimmed by a farrier or experienced staff member so it can be a convenient time to do both a hoof trimming and a routine health exam. Caregivers should be trained to observe animals both for behaviors that are abnormal for the species and also behaviors that are abnormal for each individual, keeping in mind issues that are common in a particular species and the warning signs. Thoughtful observation plays a crucial role in catching health issues before they progress into more serious situations.

Residents With Challenging Backgrounds

Close daily observation can be difficult with certain individuals or groups who come from challenging backgrounds. They may be more likely to hide signs of illness or injury, or may not allow you to come close enough to them to thoroughly assess their well being on a regular basis. Challenging backgrounds may include individuals who are not socialized, have lived feral, or were abused or malnourished. If you care for individuals who came from a challenging background, it is imperative to make time to foster a bond of trust so careful observation is possible.  A monthly health exam is recommended for these individuals until they exhibit signs that they feel safe and you are confident that close daily observation is possible.

New Resident? Conduct An Intake Examination!

If you are conducting an initial health examination on a new resident, check out our intake examination resource to learn about what you should check for and document!

Problem Signals

By paying regular attention to the herd, you may see some subtle cues in the event that something is amiss. A sick, injured, or otherwise distressed horse may:

  • Avoid contact or appear nervous more often than they used to
  • Change their daily schedule or general behavior
  • Have labored breathing, coughing, choking, sneezing or a constantly open mouth
  • Be immobile, inactive or unresponsive to your approach; depressed
  • Be stretched out or frequently sitting and standing in order to relieve colic
  • Frequently tremor or lack coordination
  • Be standing splay-legged
  • Be sitting or lying down far more often than usual
  • Avoid or be rejected by the rest of the herd
  • Stamp their feet
  • Grind their teeth frequently
  • Have a limp in their step
  • Have unusual or abnormal droppings including diarrhea, blood in stool, or worms
  • Be less hungry or thirsty, or drink water excessively
  • Have an odd posture like hunching over or avoiding putting weight on one of their legs
  • Droop their head and ears
  • Have one side of their face exhibiting paralysis
  • Have a bulge or non-uniform abdomen or belly (could indicate a serious parasite infection)
  • Have an abnormally strong odor
  • Sweat more than usual
  • Have an internal body temperature not in the range of 98-101 degrees Fahrenheit or possibly a degree or so higher if it is really hot out (a foal’s range will be slightly higher 99-102)
  • Have a resting heart rate 25-45 beats per minute. Although heart rate in the 30s is the norm for many horses, some horses have lower or higher heart rates you should know their baseline resting heart rate and speak with a vet to confirm this is normal for them and not part of an underlying health problem. (smaller and younger horses will be significantly higher)
  • Have a respiratory rate outside of 8-18 (fear and high temperatures can increase breathing rate)
  • Have pale mucous membranes
  • Have unusual abscesses on their body or in their mouths (potentially signifying a serious infectious condition called Pigeon Fever)
  • Be reluctant or averse to urinating or urinating frequently
  • Squinting an eye or blinking an eye a lot

In cases of symptoms such as the ones above, it’s especially important to conduct a health examination on the horse. Generally, the examination should begin at their head, working your way back and down. It’s important to keep regular documentation of these checkups, including weight and any abnormal findings, in order to keep an easy-to-follow set of information in case a veterinarian needs the horse’s history.

Safety First!

Horses can potentially become ill with disease that is transmissible to humans. It’s very important to wear gloves when conducting health examinations! If you have never approached a horse before, read our guide to safely being around a horse.

Conducting The Exam

Ask An Expert

Prior to regularly conducting horse health examinations, you should have a veterinarian or compassionate care expert give you hands-on training in order to be the best horse health advocate possible. Being trained to rapidly distinguish healthy conditions from abnormalities can be crucial in early health problem detection and effective treatment!

It can be easier to conduct the examination as they’re tucking in for the evening as they tend to be less fussy or when the farrier comes as you will be setting them a part (this may not work well for super stressed individuals). Before stepping into their living space, you should take note of the horse’s behavior. Are they acting differently than they usually do? How are they getting along with fellow herd-mates? How are they standing? Does something seem off? These clues can say a lot about a horse’s health.

If necessary, you may have to have a second caregiver on hand to help manage the health examination or help restrain the horse with a halter. Once you have the horse calm and ready, conduct the following observations:

When In Doubt...

Unless you are a qualified veterinarian or have been trained to handle specific conditions, The Open Sanctuary Project strongly advocates that you promptly report any health concerns you find during the course of an exam to your veterinarian or care expert. Unless they’re in a life-threatening situation, you should be your resident’s advocate, not their doctor.

Check them from afar

It’s important to observe the horse from a distance before moving in closer. Look how they are holding their body. Are they holding up a leg? Their head? Based on your knowledge of them as an individual, do they seem to be acting like themselves? Are they standing oddly, stretched out or splay-legged? Look briefly over their body for signs of injury or abnormalities. 

Check their gait

Ideally, a horse’s movement should be examined. If a horse is already moving when you go to do their exam then great! It is vital to be trained by a vet or expert as subtle signs of lameness can be easy to miss and there are many things to look out for. Different horse breeds may have particular conformation differences. In general, watch their gait and look for any signs of a limp, hesitation to put weight on a leg, placing their foot in irregular ways, any head bobbing, weight shifting from hoof to hoof, or stiffness. If they aren’t moving on their own have another staff member gently lead them, if they will allow it. You should look for dishing and paddling/winging. If they aren’t interested in walking, start working on developing a bond between them and staff. Clicker sessions as positive reinforcement and patience can help develop trust.

It is common for vets to want to see them moving at a walk and trot but this may not be possible, depending on the health, age, or willingness of the horse. Observing their movement of both soft and hard ground can be useful in determining signs of lameness. They shouldn’t be forced, though you can attempt to encourage them through positive reinforcement, especially if you have already worked on asking for this behavior and rewarding them. 

Check their weight and body condition

It’s important to keep regular measurements or estimates of a horse’s weight. If a horse has lost a lot of weight, this could indicate a sickness, malnutrition, worms, or other parasites. If a horse is mature and has gained a large amount of weight in a short time, it’s critical to ensure that you aren’t overfeeding them, especially with alfalfa, treats, and snacks. Obesity-related complications can regularly lead to dangerous conditions in horses.

Check their head

How are they holding their head? This can first be done from a distance. If they’re shaking, hunching, hanging, or tucking their head, this can be a sign of illness or injury. Check their head for lumps, bumps, lacerations, other injuries, and swelling. Check their head for abscesses, which could be a symptom of Pigeon Fever, which is highly contagious and requires quarantine and intervention.

Check their eyes

A horse should have bright, clean, alert eyes. They should be free of discharge and clear, and not appear sunken or glassy. Cloudy, watery, dry, swollen, constantly blinking, puffy, crusty eyes or an exposed third eyelid indicates likely illness or injury. The above symptoms could be signs of injury or illness such as pink eye, which is highly contagious to other horses and humans. Their pupils should be about the same size and react properly to bright light (get smaller and then return to normal). Take note of the skin around their eyes- if it’s much paler than usual, it could be a sign of anemia or another disease. Check for lacerations on and near the eye. Check for signs of squamous cell carcinoma. Horses with little pigmentation are particularly susceptible.

Check their ears

Check their ears for signs of injury, inflammation, secretions, pus, swelling, aural plaques, insect bites, or excessive ear wax. Their ears can have a modest amount of earwax or debris in them, but should be clear of any ear mites. Excessively sticky, yellow, or odorous earwax needs addressing. You can use a clean, damp, soft cloth or soft gauze clear out excess earwax or to sample potential ear mites. Do not use anything that has excess water as you don’t want it to drip into the horses ear.

Check their nose

A horse’s nose should be free of any discharge, fluid, crustiness, chunks or blood. If there is chunky discharge, it could be a sign of choke and food is coming through the sinuses. Check for foul odors when they breath. This could point to infection. Their nose should be soft and moist, and not cracked.  Consistently flared nostrils could indicate breathing trouble. An excessively runny or blocked nose could be a symptom of allergies, dust irritation, sinus infection, lungworms or another upper respiratory infection. Swelling can indicate injury, inflammation, tumor, or even a snakebite. Check for puncture holes if you notice swelling and live in a region with venomous snakes. Be sure to note any asymmetry and whether symptoms are in one nostril or both, if there are any.

Check their mouth and jaw

A thorough oral examine should be performed by a veterinarian. It is important have staff properly trained to perform a less intensive examination of a horses mouth as the chance of injury is high if done improperly. You will need good lighting. If the horse has a calm demeanor or is accustomed to them, you can try and use a headlamp if strong natural light isn’t available. First take in the appearance of their mouth and jaw overall, noting how they chew (if they are chewing), and if they are grain spilling or quidding. Next check the outer mouth for dry, cracked lips, and any bumps, lumps, cuts, warts, and asymmetry. Depending on where the horse has come from, they may have sores at the edge of their mouths from bits as well. Look for signs of excess salivation or swelling of the lips. Take a minute to smell their breath. Gross, I know but foul odors are a good indication of infection and specific dental issues. Next, you’ll want to take a peak inside. If you haven’t been trained or the horse you are examining is nervous, skittish, or confrontational, do not attempt to check the inside of their mouth. 

Starting on the left side (horses who have a background of being ridden will be more used to someone approaching on their left side), gently hook your finger inside their cheek and pull back and reveal gums, incisors, interdental space, and tongue. Look for lacerations, sores, abscesses, or raised tissue in their mouth, which could be caused by parasites, high amounts of bute, foreign bodies like foxtail, sharp teeth edges or hooks, an infected tooth, tumors, gingivitis, or by grazing on poisonous plants. Gums should be pink to a lighter pink (but not too pale) and moist. If their mucous membranes are a notably paler complexion compared to their usual appearance, it could be a sign of anemia, systemic shock, decreased circulation, internal bleeding, or other concerns. Deep red gums can indicate sepsis, toxicosis, and severe dehydration. In the case of dehydration, the gums can appear pale except for where the teeth meets the gum, which will be noticeably red. This could also be a sign of gingivitis. Yellow looking gums could indicate liver issues (or a diet high in carotene). Purple or blue could be a sign of low oxygen levels in the blood or serious toxicosis, or other serious illnesses. Grayish gums can also be a symptom of severe illness. After noting the color, press on the gum with a finger and count how long the gum returns to pink. This is called capillary refill time. Ideally it will refill immediately (1-2 seconds). Anything longer can be a serious sign of illness.

If a horse has particularly bad breath, it could be symptomatic of an infection and require deeper examination. If the membranes around their lips and gums are dry, this indicates dehydration. If they’re reluctant to eat, they might have a problem with one or more of their teeth that needs to be managed, or problems with their throat. Be sure to check and feel the jaw for asymmetry, bumps, lumps, injuries, and heat or swelling. Have your vet or compassionate care expert show you how to check their intermandibular lymph nodes, under their jaw, for swelling or signs of pain when gently palpated.

Check their respiratory system

It’s critical to check the respiratory health of horse residents. Watch as your horse’s chest moves in and out, or place your hand on his chest to feel it move in and out. You can also use your stethoscope to listen to the breaths either on his lungs or on his trachea. Again, count the number of breaths for fifteen seconds, and multiply by four. Check to see if the breathing appears labored or their diaphragm is contracting. Think hiccups. In horses this is called “thumps” and is caused by electrolyte imbalance or overexertion. Call your vet as this could be a symptom of more serious health concerns.

Listen for dry or wet sounding coughs. Many of these symptoms could be a result of pneumonia, lungworms, or other respiratory infections. Listen for labored, loud, wheezy, rattly, whistling, or squeaky breathing. Note any sneezing too. A breathing-impaired horse might have an infection, serious allergy, lungworms, or be ill with an underlying condition that affects the lungs.

Check their digestive system

As you probably know, digestive health is vital for horses. While there are other ailments to consider and watch out for, preventing, identifying, and quickly treating colic is an important part of caring for horses. If a horse appears to be in pain, is looking at their flank frequently, quivering, is drooping their ears, has an absence of gut sounds or is making abnormal ones, is sweating excessively, has a high or thready pulse, is lying down or attempting to roll frequently, appears dehydrated, is grinding their teeth, urinating frequently, not defecating, isn’t eating at all, is stamping their feet, has difficulty breathing, has anxiety or depression, has an impacted colon, is very gassy, or are stretching themselves out, this is a sign of colic. If you are at all concerned that a horse might have colic, contact your veterinarian as soon as possible. In cases like these, it’s crucial to keep the horse moving while waiting for veterinary intervention.

Additionally, in an examination, observe if the abdomen appears distended. Check their tail and back legs for signs of dried manure which may indicate diarrhea. Be aware of any strange, abnormal odors to the manure. If it lines up with routine fecal exams, your can get a sample and send it in at this time too. Many GI problems can stem from parasite loads so it is important to look for signs.

Check their coat and skin

Check around a horse’s entire body to ensure healthy skin. This is the time to ensure you are checking and feeling every area of the individual’s body, not just those included in this list. This thorough section of the exam is critical to ensure that nothing that can be addressed early is missed.  Their skin should not have lice, mange, itchiness, mites, nits, lumps, cuts, cysts, sarcoids, bruises, gangrene, larvae, dry patches, blisters, circular areas of coat loss, melanomas (pay particular attention to grey horses), or pressure sores. Check for numerous insect bites. Horses can develop seasonal allergic dermatitis “sweet itch” which is caused by the bites of certain flies and midges. More specifically, their saliva is the allergen. You may see them rubbing against things frequently and patches of hair missing, usually on their back, dock, and upper neck. Skin on the ears and withers, tail, and neck can thicken, leaving dry, rough skin where the hair has fallen out from repetitive attempts to scratch the itch. There are severe cases where the forelock and even the mane have been rubbed out.

Look for signs of rain rot which will appear as matted, scabby bunches of hair and coat loss. Abscesses on their body could be a symptom of Pigeon Fever. Circular spots of hair loss could indicate ringworm, a fungal infection. Check their skin for signs of sunburn as well. Their coat should be shiny and flat against their body, not be standing on end. If you lift a horse’s skin around their shoulders, it should quickly return to its original form when you release; if it seems to droop when returning to position, this could indicate dehydration. Ensure they do not have any patchy hair loss or a dull coat, which could be a sign of parasites or a mineral deficiency. Check their tail for hair loss and parasites as well. An excessively heavy coat, particularly in warmer weather can be an indication of Cushing’s disease.

Check their joints

It’s important to check a horse’s joints in their legs and shoulders for swelling or tenderness. They should not be much warmer than the rest of their body. Ensure that the horse doesn’t have pain when they move their joints. There should be no cracking or crunching sounds when they move, and they shouldn’t be avoiding putting weight on any of their joints in particular. Joint inflammation or problems could be a sign of arthritis, which is prevalent in horses as they get older. Your veterinarian will do a more through routine exam.

Check their hooves and feet

Carefully check each of a horse’s hooves. Make sure they are a reasonable length and free of cracks, flares, heat, swelling, debris, or abscesses. Any of these symptoms can cause lameness, discomfort, and could possibly contribute to infections and further damage. Take a look at their hooves, checking for any asymmetry within the hoof or between paired limbs, prominent growth rings, cracks, bruising, and flares. Examine their coronary band (coronet) for heat, swelling, or injury. Their hoof bulbs should be straight and not touch the ground. Now take a look at the bottom of their hoof, looking for debris, injuries, separation of the hoof wall, whiteish chalky powder along the white line, sulfurous or other foul odors, and any discomfort upon palpation. They should be able to put their full weight on their feet. Observe to see if they are shifting frequently from foot to foot (may also do if they are nervous) or compensating for one hoof by putting all their weight into the others. If they are limping, check their hoof bottoms for uncomfortable debris. If their hooves are overgrown, schedule a trimming with a farrier as soon as you can. A farrier can also help build a healthy hoof plan for flared and cracked hooves. Generally, horses should have their hooves trimmed about once every three to six weeks, depending on environment and the individual’s hoof health. If a horse has any of the above issues with their feet, be sure to let your vet know immediately as early intervention is vital.

Check their rear quarters

Check the horses rear quarters and check for discharge, excessive accumulations of fecal matter around it, scab, crust, blood, or foul odor. Ensure that they don’t have any mites, lice, tapeworms, or other parasites. Make sure the rectum or uterus hasn’t prolapsed – contact your vet immediately if they have prolapsed! If a horse has udders, check for any swelling, lumps, rigidity, asymmetry, and unusual discharge. They may have Mastitis or other serious issues and require treatment. If the horse has a penis, visually inspect the sheath for injury, swelling, lumps, and foul odor. If their penis is extended, you have been properly trained, and the horse is calm and relaxed, gently check for dirt, debris, red or raised areas, smegma build up and smegma beans. This is a delicate process that should be done with proper training and care. You veterinarian will be able to train you on the step by step examination of the penis. Be sure to watch them urinate at some point. If they are straining,  it can be a sign of bladder stones or another urinary tract issue and require veterinary intervention.

Check their poop

It’s important to monitor a horse’s poop recognize what healthy horse droppings look like, which can be quite diverse between horses, and even different days. A horse should poop between six and ten times per day. Healthy horse poop is greenish to brown, moist, formed in balls with no recognizable piece of food in it. It shouldn’t be runny, nor should it be too hard, nor should it look like a “cow pie”. If it’s poorly formed, watery, strong smelling, yellow, or bloody, it could be a sign of dehydration, diarrhea, parasites, illness, colic, or improper nutrition. If you’re particularly concerned by a dropping, you can bring it into your veterinarian for analysis, though you should consider fecal testing healthy-seeming horses at a regular interval to check for internal parasites. Conversely, ensure that the horse has regular bowel movements, as a struggle to poop could signify early signs of Colic. Their urine should not be very dark and concentrated, or contain blood in it.

Isolate If Necessary

Depending on the health concern, it may be necessary to isolate the horse in order to protect the rest of the herd from a potentially infectious disease or to help the unwell horse heal. However, with some illnesses, such as pneumonia, often once a horse is showing symptoms, the other residents in the herd have already been exposed. In these instances, you will need to weigh what is in the best interest of all of your residents. A sick horse who is isolated from their herd may become more stressed, which could delay recovery. However, if the horse is being bullied or cannot compete with the rest of the herd for food, or if you need to more closely monitor their food and water intake and fecal output, you may need to separate them at least temporarily. You may find that keeping them in a quiet space with a calm horse companion is a good compromise until they are well enough to rejoin the herd.

Writing It All Down

As you may know, regular documentation is a critical part of responsible sanctuary animal care. In order to maximize the value of your horse health examinations, we’ve developed a free printable horse health exam form for sanctuaries and rescues!


Anemia In Horses | PetMed

Overview Of Lungworm Infection | Merck Veterinary Manual

How To Know If Your Horse Is Sick | WikiHow

Colic In Horses | Pet MD

Sweet Itch In Horses | VCA Hospitals

Learn How To Assess Mouth | Horse Side Vet Guide 

Assess Color Of Mucous Membranes (Gums) | Horse Side Vet Guide

Equine Respiratory Exam | University Of Pennsylvania  

Udder Issues For The Mare | The Horse

Sensible Sheath Cleaning | The Horse (Non-Compassionate Source)

What The Color Of Your Horse’s Gums Can Tell You | Equus Magazine (Non-Compassionate Source)

The Basic Physical Examination | The Horse (Non-Compassionate Source)

Physical Exam of the Horse Hoof | The Horse (Non-Compassionate Source)

Pigeon Fever: Myths & Misconceptions | The Horse (Non-Compassionate Source)

The Scoop On Poop | Horse & Rider (Non-Compassionate Source)

Signs Of Horse Illness | Horse (Non-Compassionate Source)

Signs Of Sickness – How To Read Your Horse’s Behavior | Eclectic Horseman (Non-Compassionate Source)

Knowing When To Call The Vet For Your Horse | Dummies (Non-Compassionate Source)

Identifying Types Of Nasal Discharge In Horses | The Naturally Healthy Horse (Non-Compassionate Source)

Know Your Healthy Horse | Equisearch (Non-Compassionate Source)

Non-Compassionate Source?

If a source includes the (Non-Compassionate Source) tag, it means that we do not endorse that particular source’s views about animals, even if some of their insights are valuable from a care perspective. See a more detailed explanation here.

Updated on July 1, 2021

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