J. Dairy Sci.

107:3197–3206
https://doi.org/10.3168/jds.2023-23928
© 2024, The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®.
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Sensitivity and specificity of mobility scoring for the detection

of foot lesions in pasture-based Irish dairy cows
Finnian Logan,1 Conor G. McAloon,1* Eoin G. Ryan,1 Luke O’Grady,1 Mary Duane,1 Bryan Deane,2
and Catherine I. McAloon1
1
Section of Herd Health and Animal Husbandry, School of Veterinary Medicine, University College Dublin, Belfield, Dublin D04 W6F6, Ireland
2
Veterinary Sciences Department, Health Products Regulatory Authority, Kevin O’Malley House, Earlsfort Centre, Earlsfort Terrace, Dublin 2,
D02XP77, Ireland

ABSTRACT
Lameness is an important production disease in dairy
cows worldwide and has detrimental effects on cows’
welfare, production, and reproductive performance,
thus affecting the sustainability of dairy farming. Time-
ly and effective detection of lameness allows for effec-
tive treatment, minimizing progression of disease, and
maximizing the prognosis of recovery. Mobility scoring
(MSc) is a 4 point (0–3) visual lameness scoring sys-
tem that is the industry standard in several countries.
However, few studies have examined the sensitivity (Se)
and specificity (Sp) of MSc to detect foot lesions. The
aim of this observational study was to determine the Se
and Sp of MSc to detect foot lesions in dairy cattle in a
pasture-based system. Five hundred ninety-five primi-
and multiparous cows were randomly selected from
12 commercial Irish dairy farms and recruited for the
study. Recruited cows were mobility scored and passed
through a foot-paring crate where all 4 feet were lifted
for examination. The team recorded the anatomical lo-
cation and severity of any foot lesions present based on
appearance only. Then, based on the type and severity
of the lesions present, cows were classified according to
3 case definitions case definition 1: Any lesion present;
case definition 2: Moderate lesions present (exclud-
ing minor lesions expected to have a low probability
of affecting gait); and case definition 3: Severe lesions
present (only including lesions most likely to result in a
detectable gait abnormality). Sensitivity and Sp of MSc
was calculated based on a threshold of MSc ≥2, defined
as impaired (MSc = 2) or severely impaired (MSc = 3)
mobility for each of the 3 case definitions, at the overall
level and disaggregated by parity. The overall cow-level
lesion prevalence based on the case definition 1 was
0.54 with significant between-herd variation. The over-
all Se and Sp of MSc for the detection of foot lesions
Received July 4, 2023.
Accepted November 15, 2023.
*Corresponding author: catherine.mcaloon@​ucd​.ie
3197
were 0.18 and 0.96, 0.35 and 0.94, 0.43 and 0.94 for the
case definitions 1, 2, and 3, respectively. Our findings
showed poor Se, but high Sp of MSc for the detection of
cows with foot lesions in a pasture-based system.
Key words: lameness, mobility scoring, pasture based
INTRODUCTION
Lameness is described as the inability to express a
physiological locomotion pattern in one or more limbs,
most frequently as a consequence of pain (Oehm et
al., 2019). Lameness is a significant welfare issue and
economic burden on dairy farms. It can significantly
compromise the “5 freedoms” of animal welfare and
negatively affects the time budget of cows (Whay and
Shearer, 2017). The economic effect of lameness has
been well documented in an Irish pasture-based system
(Ryan and O’Grady, 2004; O’Connor et al., 2020b).
The cost associated with lameness arises from its ef-
fects on production and fertility (Warnick et al., 2001;
O’Connor et al., 2020b), costs of treatment, and costs
of time and labor in addressing lameness by stock per-
sonnel (Bruijnis et al., 2010; O’Connor et al., 2023;
Robcis et al., 2023).
Early detection of lameness enables prompt treat-
ment, and the initiation of preventive measures and
is an important aspect of safeguarding animal welfare
on dairy farms both in housed and in pasture-based
cows (Whay and Shearer, 2017). Effective detection
of lameness at an early stage is important to prevent
progression to severe lameness that can reduce the
prognosis of treatment. Prompt identification of cases
and appropriate intervention can help minimize direct
and indirect costs associated with lameness (Van Nuffel
et al., 2015). Routine lameness prevalence monitoring
is advised and recommended as a component of animal
welfare auditing in some dairy farm assurance schemes
such as the Red Tractor Farm UK national dairy assur-
ance scheme (Mullan et al., 2022).
Several methods can be used to detect lameness in
cattle. Automated detection systems based on gait
 Logan et al.: LAMENESS IN PASTURE-BASED DAIRY COWS
analysis and computer vision (Kang et al., 2020),
weight distribution (Pastell et al., 2010), accelerometry
(O’Leary et al., 2020) and thermal imaging (Werema
et al., 2021), have been developed with varying levels
of success. The development of automated lameness
detection methods is an ongoing area of research.
At present however, observer-based detection meth-
ods are most commonly used in the industry. These
methods use assessment criteria to interpret visual ob-
servation of gait according to a series of score criteria
or descriptions relating to gait abnormality severity. A
range of broadly similar scoring systems are used. For
example, the Sprecher locomotion scoring system is a
5-point scale (1–5; Sprecher et al., 1997) and includes
a requirement to assess back posture while standing,
whereas the Agriculture and Horticulture Development
Board (AHDB) mobility scoring (MSc) system is a
4-point scale (0–3) and does not require an assessment
of the standing animal. The AHDB MSc system has
been adopted as the UK dairy industry standard mobil-
ity scoring system (Afonso et al., 2020), and has gained
popularity in Ireland (O’Connor et al., 2020a; Browne
et al., 2022b) and other dairy producing countries.
Importantly, this system overcomes the need to assess
the back posture of cows at a stance, which requires
an additional assistant to stop cows and is not always
convenient in a pasture-based system where most lame-
ness scoring is carried out as cows are walking back to
pasture after milking (Fabian et al., 2014).
Several studies have evaluated visual lameness scor-
ing methods in terms of both inter- and intra-observer
agreement and have shown varying results. Gardenier
et al. (2021) found that the Australian Healthy Hooves
4-level locomotion scoring system, which is similar to
the AHDB Mobility score, has an inter- and intra-
observer percentage agreement of 79% and 82% respec-
tively when using relative pairwise scoring. Garcia et
al. (2015) have shown varying levels of intra-operator
repeatability, using a 5-point scale based on a revised
version of the Sprecher et al. (1997) locomotion score.
Schlageter-Tello et al. (2014) found that acceptable
inter-rater reliability of ≥75% using the Flower and
Weary (2006) 5-point visual lameness scoring system
was attained only when it was condensed into 2 catego-
ries of “lame” and “non-lame.”
Although a significant body of literature has devel-
oped on the basis of the AHDB Mobility scoring sys-
tem, there have been limited studies investigating the
sensitivity (Se) and specificity (Sp) of MSc, or other
visual gait assessment methods, for the detection of
foot lesions in dairy cattle. Foot lesions are indicative
of pathology which is traditionally the focus of treat-
ment decisions. Although the presence of foot lesions
may not be sufficient to cause locomotion disruption,
Journal of Dairy Science Vol. 107 No. 5, 2024
3198
a poor Se would indicate that significant numbers of
cattle have foot lesions that may be painful, or ben-
efit from treatment, and yet are not detected using
the industry standard method for lameness detection,
with the potential for significant welfare implications.
In contrast, a poor Sp of MSc for the detection of foot
lesions, would lead to many animals being treated, or
inspected for treatment in the absence of a treatable,
or explainable, lameness-causing foot lesion. Finally,
at a herd level, if mobility scores are used to assess
welfare on farms, the potential for a mismatch between
the herd-level prevalence of foot lesions and aggregated
mobility scores has implications for the utility of this
scoring system for herd-level welfare assessment.
Therefore, the objective of this observational study
was to determine the Se and Sp of MSc for the detec-
tion of foot lesions on commercial pasture-based dairy
farms.
MATERIALS AND METHODS
An exemption was obtained from University College
Dublin Animal Research Ethics Committee for this
study before commencement (AREC-E-21-28-McAlo-
on).
Farm Recruitment
Twelve spring-calving pasture-based dairy herds in
Ireland were recruited to take part in this trial during
the summer months of 2021. Six of these herds were
in county Meath, 3 in Kildare, one in Offaly, one in
Wicklow and one in Cavan. One farm used a robotic
milking system, with the rest of the farms using a con-
ventional manual parlor with cows milked twice daily.
Farm recruitment was based on a convenience sample
of herds willing to participate in the research study.
Cow-Level Data Collection
Cow identification lists for each herd were extracted
from the Irish Cattle Breeding Federation database
(https:​/​/​www​.icbf​.com/​), and a randomized sampling
list of 50 cows per herd was generated with the use
of a Microsoft Office Excel random number generator
(Microsoft Excel for Microsoft 365, version 2302).
The sampling procedure on each farm consisted of
2 separate visits, 2 wk apart. During the initial visit,
the 50 randomly chosen cows were identified and an
accelerometer fitted to the hindlimb. This step was for
the purpose of another study, and 50 cows were chosen
per herd as this was the total number of accelerometers
available for that study. During the second visit to the
farm 2 wk later; the recruited cows were drafted out
 Logan et al.: LAMENESS IN PASTURE-BASED DAIRY COWS 3199

from the rest of the herd following milking. On 7 farms
this was carried out with the use of automatic draft-
ing and on the 5 other farms the cows were manually
separated as they emerged from the milking parlor. Fol-
lowing separation of the sample cohort, each cow in the
trial was visually assessed and assigned a MSc using the
AHDB Dairy mobility scoring system (AHDB, 2020).
Foot Inspection
An experienced hoof paring professional was re-
cruited for the trial provided by Farm Relief Services,
(Ballyjamesduff, Co. Cavan, Ireland) who attended
each second day visit (i.e., on the day on which MSc
was conducted). The MSc was conducted after milking
and immediately before the cows being drafted for foot
examination. Each of the recruited cows passed through
a hydraulic foot-paring crate where each cow’s feet were
lifted sequentially in the standing position. Each of the 4
feet were lifted, cleaned, and examined for the presence
or absence of foot lesions. Once a lesion was detected,
it was identified, graded and noted by the first author
(a veterinarian and European College of Bovine Health
Management resident). The International Committee
for Animal Recording (ICAR) claw health atlas (Egger-
Danner et al., 2015) was reviewed and discussed by the
first author and the study co-authors before study com-
mencement but was not carried to farm visits, instead
the lesion category descriptions detailed below were
used as the only aid for identification on-farm. Previous
lameness history was not available and therefore not
considered in the analysis (Table 1).
Lesion Grading
For white line disease, solar hemorrhage and claw
overgrowth, severity grading scales were developed and
agreed upon with the co-authors. These scales were
developed based on existing severity scales from the
literature and modified according to the clinical expe-
rience of the study team in foot lesion presentations
on commercial dairy farms. The full description of the
grading scales used are provided as Supplemental File S1
(https:​/​/​data​.mendeley​.com/​datasets/​7mcmzx4hyc/​1;
McAloon, 2024).
White line disease, as described by Shearer and van
Amstel (2017), was recorded on a severity scale of 1 to
3. Grade 1 corresponded with obvious blackening of the
white line with small patches or specks of dirt; grade
2 was when one or multiple larger areas of blackening
occur within the white line; and grade 3 corresponded
to areas of blackening with dirt within the white line
including the emergence of abscessation proximally at
the coronary band or communication from the white
line lesion to a double (under-run) sole.
Solar hemorrhage was recorded based on Greenough
and Vermunt (1991), with modification to grade 4:
grade 1 was described as yellow discoloration; grade
2 as moderate red or pink discoloration; grade 3 de-
scribed as severe hemorrhage; and grade 4 as severe
hemorrhage with an associated soft spot but not a full
thickness defect in the corium.
Heel erosion or slurry heel was also recorded using a
1-to-4 severity scale with grades 1 and 2 defined as mul-
tiple shallow irregular depressions and multiple deep
irregular depressions of the heel bulbs respectively.
Grade 3 was described as shallow oblique grooves, and
grade 4 as deep oblique grooves with complete loss of
structure of the heel (Smilie et al., 1999).
Claw overgrowth was recorded as a lesion within this
study and encompassed excessive dorsal hoof wall length
more than 8 cm and the angle of the dorsal wall being
<50°. However, it also included axial groove overgrowth
resulting in inappropriate weight-bearing conformation
of the digit. This lesion was recorded on a scale of 1 to
3. Grade 1 corresponded to toe length of 8 to 10 cm
and no axial overgrowth; grade 2 corresponded with toe
length of 8 to 10 cm with some axial overgrowth; and
grade 3 being toe length in excess of 10 cm with severe
axial overgrowth.
Digital dermatitis was recorded using the M-Stage le-
sion grading scale as described by Döpfer et al. (1997).
For the remaining lesions, solar ulcer, interdigital
dermatitis, interdigital necrobacillosis, interdigital nec-

Table 1. The Agriculture and Horticulture Development Board mobility scoring (AHDB, 2020)

Mobility score Lameness category Description

0 Good mobility
1 Imperfect mobility
2 Impaired mobility
3 Severely impaired
mobility
Walks with even weight bearing and rhythm on all 4 feet, with a flat back. Long
fluid strides are possible.
Steps uneven (rhythm or weightbearing) or strides shortened; affected limb or limbs
not immediately identifiable.
Uneven weightbearing on a limb that is immediately identifiable or obviously
shortened strides (usually with an arch to the center of the back).
Unable to walk as fast as a brisk human pace (cannot keep up with the healthy
herd). Lame leg easy to identify (limping); may barely stand on lame leg/s; back
arched when standing and walking. Very lame.

Journal of Dairy Science Vol. 107 No. 5, 2024

 Logan et al.: LAMENESS IN PASTURE-BASED DAIRY COWS 3200

robacillosis, toe necrosis, trauma and double sole, no
grading system was used, instead only the presence or
absence was recorded. The decision not to use sever-
ity scales for these lesions was based on a combination
of the absence of an established scoring system and
whether differences in the severity in these lesion types
would be expected to result in a change in case defini-
tion as outlined below. Trauma was also recorded as a
lesion and consisted of any physical trauma to a digit
not encompassed by any of the aforementioned lesions.
Vertical wall fissures, axial wall fissures, horizontal wall
fissures, broken hoof wall horn, penetrative sole injuries
and loose hoof wall capsule were all recorded under
trauma as simply present or absent.
On-Farm Recording
Foot lesions were recorded independently for each
claw, on each of the 4 feet. The foot lesion and associ-
ated severity grade if applicable, and mobility score of
each cow was recorded using a bespoke Filemaker Pro
package (Filemaker Pro Advanced, Claris International
Inc.) on a hand-held computer. The data from each
farm was subsequently extracted as a Microsoft Office
Excel file with each lameness lesion type corresponding
to a column of data. The severity grade of each lesion
where applicable, was recorded in the lesion column.
Case Definition
A wide range of foot lesions may be present in dairy
cows. It is understood that some foot lesions are ex-
pected to result in greater gait disturbance than oth-
ers; for example, solar ulcers have been shown to be
associated with greater behavioral signs of lameness
compared with digital dermatitis or solar hemorrhage
(Jewell et al., 2021). It was therefore expected that the
ability of MSc to detect foot lesions may vary accord-
ing to the type and severity of the foot lesion pres-
ent. Therefore, cows with lesions present on their feet
were classified into 3 case definitions: case definition 1:
any lesion present; case definition 2: moderate lesions
present (excluding minor lesions expected to have a
low probability of affecting gait); and case definition
3: severe lesions present (only including lesions most
likely to result in a detectable gait abnormality). Le-
sions type and severity grades were mapped to these
case definitions according by a consensus agreement of
the co-authors who were diplomates of the European
College of Bovine Health Management (CIMA, CGMA,
ER, LOG; Table 2). Cases were identified for each of
the 3 case definitions based on whether cows had one
or more lesions that met the thresholds shown in Table
2. In the case of multiple lesions being identified in the
same cow, the cow was assigned the category associated
with the highest scoring lesion. For example, a cow hav-
ing an M3 digital dermatitis lesion (considered to fulfill
the criteria for case definition 1, but not 2 or 3) and
a solar ulcer (considered to fulfill the criteria for all 3
case definitions), was categorized as having fulfilled the
criteria for all 3 case definitions.
Calculation of Se and Sp
Descriptive statistics were carried out in Microsoft
Excel. Prevalence of any lesion was calculated at the
overall, parity and farm levels. For the purpose of
evaluating the characteristics of MSc as a diagnostic
test, a “true positive” was defined as an animal meeting
or exceeding the criteria of the relevant case definition,

Table 2. Lesion types and severity and associated case definitions (Y = yes or “present”; N = no or “absent”)

Case definition 1: Case definition 2: Case definition 3:

Lesion1 any lesion present moderate lesion present2 severe lesion present3
White line disease (1–3) 1–3 2–3 3
Sole hemorrhage (1–4) 1–4 2–4 3–4
Slurry heel/heel erosion (1–4) 1–4 4 —
Claw overgrowth (1–3) 1–3 — —
Digital dermatitis4 M1, M2, M3, M4, M4.1 M1, M4.1, M2 M2
Solar ulcer (Y/N) Y Y Y
Interdigital dermatitis (Y/N) Y Y —
Interdigital Necrobacillosis (Y/N) Y Y Y
Toe necrosis (Y/N) Y Y Y
Double sole (Y/N) Y Y Y
Trauma (Y/N) Y Y —
1
In the case of multiple lesions being identified in the same cow, the cow was assigned the category associated
with the highest scoring lesion.
2
Excluding minor lesions expected to have a low probability of affecting gait.
3
Only including lesions most likely to result in a detectable gait abnormality.
4
M score as per Kofler et al. (2019).

Journal of Dairy Science Vol. 107 No. 5, 2024

 Logan et al.: LAMENESS IN PASTURE-BASED DAIRY COWS
and having a MSc ≥2; a “false positive” was defined as
an animal not meeting the criteria of the relevant case
definition yet having a MSc ≥2; a “true negative” was
defined as an animal not criteria of the relevant case
definition, and having a MSc <2; while a “false nega-
tive” was an animal meeting or exceeding the criteria of
the relevant case definition, yet having a MSc <2.
Sensitivity and Sp were calculated based on the pro-
portion of cows for each of the case definitions that had
a MSc ≥2. These values were calculated at the overall
level as well as broken down into cohorts by parity.
The 95% confidence interval (CI) for these values were
calculated using the Clopper-Pearson (exact) method
for binomial confidence interval. Positive and negative
predictive values were calculated as the probability
that a cow with a MSc ≥2 had a foot lesion correspond-
ing to the relevant case definition, and the probability
that cow with a MSc <2 did not have a foot lesion
corresponding to the relevant case definition respec-
tively. Confidence intervals for predictive values were
calculated using the method proposed by Mercaldo et
al. (2007). Data manipulation was performed in Excel
and R (R Core Team, 2019), summary statistics and
calculation of CI was performed in R using the “binom”
package (Dorai-Raj, 2014), and the “bdpv” package
(Schaarschmidt, 2019).
RESULTS
Descriptive Statistics
The final study population was 595 cows in total
from 12 farms. Herd size ranged from 91 to 490 cows,
with a mean of 243 cows. The average yield for the
recruited herds ranged from 4,936 to 6,644 L of milk
per cow per year with a mean herd average yield of
5,918 L of milk produced per cow per year. Within our
sample population, 144 cows (24%) were in their first
lactation, 148 (25%) were in their second, 100 (17%)
in their third, and 203 (34%) cows were in their fourth
lactation and above.
There were 235 cows (39%) with MSc of 0; 290
(49%) with an MSc of 1, denoting imperfect mobility;
61 (10%) with MSc 2, denoting impaired mobility; and
9 cows with MSc 3 (2%), denoting severely impaired
mobility.
Of cows with MSc = 0, 43% had 1 or more foot
lesions, while 56% of cows with MSc = 1; 82% of cows
with MSc = 2; and all 9 (100%) of cows with MSc = 3
had 1 or more foot lesions.
Overall, 54%, 21%, and 15% of cows had foot le-
sions meeting the criteria for case definition 1 (low),
2 (moderate) and 3 (high), respectively. Of those cows
with 1 or more lesion present, 77% had noninfectious
Journal of Dairy Science Vol. 107 No. 5, 2024
3201
lesions, 9% had an infectious lesion and 14% presented
with both an infectious and noninfectious lesion. Of
the cows with infectious lesions, digital dermatitis was
the dominant infectious pathology, accounting for 96%
lesions. Claw overgrowth and white line disease were
the 2 most prevalent noninfectious lesions. White line
disease was the most prevalent noninfectious lesion of
note, accounting for 38% of cases.
Across all case definitions, there was an increase in
prevalence of foot lesions by parity, increasing from
lactation 1 to lactation 4+ from 0.32 to 0.71, 0.10 to
0.33, and 0.08 to 0.22 for case definitions 1, 2, and 3,
respectively. At farm level, prevalence of lesions varied
widely, from 0.35 to 0.80 for case definition 1; 0.07 to
0.41 for case definition 2; and 0.04 to 0.31 for case
definition 3 (Table 3).
Overall, 12% of cows were positive on MSc (MSc
≥2). The proportion positive on MSc increased with
parity, ranging from 0.03 for primiparous cows to 0.23
in cows in their fourth parity and above. The propor-
tion of MSc-positive cows varied between farms and
ranged from a low of 0.04 on farm 2 to a high of 0.20
on farm 3 (Table 4).
Se and Sp
The overall Se and Sp of MSc at detecting cows with
lesions meeting the criteria for case definition 1 was
0.18 (95% CI: 0.14–0.23) and 0.96 (95% CI: 0.92–0.98)
respectively. The corresponding overall positive and
negative predictive values were 0.84 (95% CI: 0.74–
0.91) and 0.50 (85% CI 0.49–0.51) respectively. The
overall Se and Sp of MSc at detecting cows with le-
sions meeting the criteria for case definition 2 was 0.35
(95% CI: 0.27–0.44) and 0.94 (0.92–0.96) respectively,
with corresponding positive and negative predictive
values of 0.61 (95% CI: 0.50–0.71) and 0.84 (95% CI:
0.83–0.86). The overall Se and Sp of MSc at detecting
cows with lesions meeting case definition 3 was 0.43
(95% CI: 0.32–0.54) and 0.94 (95% CI: 0.91–0.95), with
corresponding positive and negative predictive values of
0.51 (95% CI: 0.40–0.62) and 0.89 (95% CI: 0.88–0.90)
respectively.
The Se of MSc for detecting any lesions (case defini-
tion 1) varied substantially by parity, ranging from 0.04
in primiparous cows to 0.28 in cows of parity 4 and
above. Sensitivity of MSc remained low in primiparous
cows (less than 0.10) across all 3 case definitions. Speci-
ficity remained at 0.98 across the 3 case definitions in
primiparous cows. There was a substantial increase
in Se of MSc for the detection of lesions meeting the
criteria for case definition 1 in the fourth parity and
above cows, with a Se of 0.28. This increased to 0.56
for the detection of lesions meeting the criteria for case
 Logan et al.: LAMENESS IN PASTURE-BASED DAIRY COWS 3202
Table 3. Prevalence (95% CI) of lesions according to case definition by parity and farm

Case definition 1: Case definition 2: Case definition 3:

Lesion prevalence No lesion any lesion present moderate lesion present1 severe lesion present2
Overall 0.46 (0.42, 0.50) 0.54 (0.50, 0.58) 0.21 (0.17, 0.24) 0.15 (0.12, 0.18)
Parity 1 0.68 (0.6, 0.76) 0.32 (0.24, 0.4) 0.10 (0.05, 0.16) 0.08 (0.04, 0.13)
Parity 2 0.51 (0.42, 0.59) 0.49 (0.41, 0.58) 0.15 (0.1, 0.22) 0.11 (0.06, 0.17)
Parity 3 0.43 (0.33, 0.53) 0.57 (0.47, 0.67) 0.20 (0.13, 0.29) 0.15 (0.09, 0.24)
Parity 4+ 0.29 (0.22, 0.35) 0.71 (0.65, 0.78) 0.33 (0.26, 0.39) 0.22 (0.17, 0.29)
Farm 1 0.54 (0.39, 0.68) 0.46 (0.32, 0.61) 0.19 (0.1, 0.33) 0.10 (0.03, 0.21)
Farm 2 0.62 (0.47, 0.76) 0.38 (0.24, 0.53) 0.13 (0.05, 0.27) 0.09 (0.02, 0.21)
Farm 3 0.61 (0.46, 0.75) 0.39 (0.25, 0.54) 0.16 (0.07, 0.30) 0.10 (0.03, 0.22)
Farm 4 0.61 (0.47, 0.74) 0.39 (0.26, 0.53) 0.07 (0.02, 0.17) 0.04 (0.00, 0.12)
Farm 5 0.29 (0.17, 0.44) 0.71 (0.56, 0.83) 0.31 (0.19, 0.46) 0.23 (0.12, 0.37)
Farm 6 0.44 (0.29, 0.59) 0.56 (0.41, 0.71) 0.23 (0.12, 0.37) 0.12 (0.05, 0.25)
Farm 7 0.44 (0.30, 0.59) 0.56 (0.41, 0.70) 0.08 (0.02, 0.19) 0.06 (0.01, 0.17)
Farm 8 0.20 (0.10, 0.35) 0.80 (0.65, 0.90) 0.41 (0.26, 0.57) 0.27 (0.15, 0.43)
Farm 9 0.29 (0.17, 0.44) 0.71 (0.56, 0.83) 0.39 (0.26, 0.54) 0.31 (0.19, 0.46)
Farm 10 0.65 (0.50, 0.78) 0.35 (0.22, 0.50) 0.10 (0.03, 0.21) 0.08 (0.02, 0.19)
Farm 11 0.38 (0.25, 0.53) 0.62 (0.47, 0.75) 0.28 (0.16, 0.42) 0.24 (0.13, 0.38)
Farm 12 0.41 (0.28, 0.56) 0.59 (0.44, 0.72) 0.14 (0.06, 0.26) 0.14 (0.06, 0.26)
1
Excluding minor lesions expected to have a low probability of affecting gait.
2
Only including lesions most likely to result in a detectable gait abnormality.

definition 3. Conversely, Sp was lowest in this parity 15% of cows identified as lame at different times relative
cohort decreasing from 0.88 for the detection of lesions to breeding, while Browne et al. (2022a) found a cow-
meeting case definition 1, down to 0.86 for lesions meet- level lameness prevalence of 9%. In contrast, O’Connor
ing the criteria for case definition 3 (Table 5). et al. (2020a) reported 38.2% of their sampled popu-
lation of cows as having imperfect mobility, however
DISCUSSION this was based on a MSc ≥1. The prevalence found
in our study is also similar to international work from
Our study has demonstrated that MSc threshold of similar production systems. In New Zealand, Fabian et
≥2 has a very low Se coupled with a high Sp for the al. (2014) reported a mean herd lameness prevalence of
presence of visible foot lesions and that Se increases 9% (based on MSc ≥2), with a within-herd prevalence
with increasing severity of case definition without any ranging from 1.2% to 36%. In contrast, estimates from
detriment to Sp. indoor production systems appear to be higher (Olmos
We found that 12% of cows had a MSc ≥2 varying et al., 2009; Solano et al., 2015; O’Connor et al., 2020a).
from 4% to 20% among herds. This finding is similar to Similar to previous studies across productions sys-
previous Irish work: Somers et al. (2015) found 11% to tems, we found that the proportion of cows positive on
MSc increased with parity (Solano et al., 2015; Jewell et
al., 2019; O’Connor et al., 2020a; Browne et al., 2022a).
Table 4. Proportion (95% CI) of cows with mobility scores ≥2 Several explanations for the increase in lameness preva-
Cow Proportion with mobility score ≥2 lence in older parity cows have been proposed. Given
that all cows in the herd are exposed to a similar set of
Overall 0.12 (0.09. 0.15) management and environmental exposures, the number
Parity 1 0.03 (0.01, 0.07)
Parity 2 0.06 (0.03, 0.11) of lameness “events” is likely to increase as animals age
Parity 3 0.10 (0.05, 0.18) given the cumulative effect of these exposures. These
Parity 4+ 0.23 (0.18, 0.30) events may be associated with incomplete recovery
Farm 1 0.10 (0.03, 0.21)
Farm 2 0.04 (0.01, 0.15) and chronic changes to the foot (Newsome et al., 2017;
Farm 3 0.20 (0.10, 0.34) Randall et al., 2018).
Farm 4 0.07 (0.02, 0.17) On foot examination, a lower proportion of infectious
Farm 5 0.17 (0.07, 0.30)
Farm 6 0.08 (0.02, 0.20) foot lesions were found relative to noninfectious lesions
Farm 7 0.04 (0.00, 0.14) in this study. Similar to other studies from pasture-
Farm 8 0.09 (0.03, 0.22) based production systems, white line disease was the
Farm 9 0.18 (0.08, 0.31)
Farm 10 0.18 (0.08, 0.31) most significant noninfectious lesion accounting for 38%
Farm 11 0.14 (0.06, 0.27) of cases (Chesterton et al., 1989; Somers and O’Grady,
Farm 12 0.12 (0.04, 0.24) 2015; O’Connor et al., 2019).

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 Logan et al.: LAMENESS IN PASTURE-BASED DAIRY COWS 3203
Table 5. Sensitivity and specificity (95% CI) of mobility score ≥2 for detecting foot lesions meeting the criteria for case definitions 1 to 3

Case definition 1: Case definition 2: Case definition 3:

any lesion present moderate lesion present1 severe lesion present2

Item Sensitivity Specificity Sensitivity Specificity Sensitivity Specificity

Overall 0.18 0.96 0.35 0.94 0.43 0.94
(0.14–0.23) (0.92–0.98) (0.27–0.44) (0.92–0.96) (0.32–0.54) (0.91–0.95)
Parity 1 0.04 0.98 0.07 0.98 0.09 0.98
(0.01–0.15) (0.93–1.00) (0.00–0.34) (0.93–1.00) (0.00–0.41) (0.94–1.00)
2 0.10 0.97 0.27 0.98 0.38 0.98
(0.04–0.19) (0.91–1.00) (0.11–0.50) (0.93–0.99) (0.15–0.65) (0.94–1.00)
3 0.16 0.98 0.30 0.95 0.33 0.94
(0.07–0.28) (0.88–1.00) (0.12–0.54) (0.88–0.99) (0.12–0.62) (0.87–0.98)
4+ 0.28 0.88 0.45 0.88 0.56 0.86
(0.20–0.36) (0.77–0.95) (0.33–0.58) (0.81–0.93) (0.40–0.70) (0.80–0.91)
1
Excluding minor lesions expected to have a low probability of affecting gait.
2
Including only lesions most likely to result in a detectable gait abnormality.

Our study used foot lesions as an outcome against
which the Se and Sp of MSc was assessed. Importantly,
we found that while only 12% of cows had MSc ≥2, the
proportion of cows with foot lesions on visual inspec-
tion was 54% (case definition 1), 21% (case definition
2) and 15% (case definition 3). Accordingly, we found
that the Se of MSc was surprisingly low, ranging from
0.18 to 0.43 depending on the case definition used.
Although few studies have taken the approach we
adopted; our findings are consistent with previous ob-
servations. For example, Dyer et al. (2007) found that
over 37% of foot lesions, measured to be painful, were
found on cows with a normal (Sprecher-based) loco-
motion score, while Manske et al. (2002) found that
although 72% of dairy cows examined had at least one
foot lesion, only 5.1% were found to be lame based on
a locomotion score. Of particular note from our study
is that even when restricting the case definition to cows
with the most severe lesions that could be expected to
have the largest effect on gait (case definition 3), only
43% of cows were detected.
Of note from our findings is the identification of a
significant population of animals that are lesion posi-
tive, yet not detected using a MSc threshold of ≥2.
Although previous studies have shown that at a group
level, the average pain index in these animals suggests
lower pain than those that are detected on gait obser-
vation, substantial levels of pain were still found within
this cohort (Dyer et al., 2007). Although there is insuf-
ficient evidence at the moment to argue that treatment
of these animals would result in improved cure rates, or
reduced lesion progression, we argue that the existence
and relatively large proportion of animals in this group
are a significant cause for concern and a potential area
of further research their significance and the role they
play in lameness management on-farm.
Given these potential welfare risks in these animals,
better performing diagnostic tests are required. It is
notable that many efforts to develop novel, automated
systems have been trained on MSc scores rather than
foot lesions, which is likely to result in even poorer
performance of these automated systems, if detection
of treatable lameness-causing foot lesions is the target
condition.
The evolutionary pressures to mask signs of pain
originating in the wild cattle from which our domesti-
cated species are descended (Huxley and Whay, 2006)
may provide and explanation for the poor Se of MSc
to detect painful foot lesions. One alternative hypoth-
esis could be that visual assessments may rely at least
to some degree, in asymmetry of gait associated with
unilateral lesions, such that bilateral lesions may not
be detected. However, post hoc analysis of our data
suggests that this is unlikely to be the case because
there appeared to be no difference in the Se of MSc
when disaggregated according to whether lesions were
uni- or bilateral.
Our study used 3 different consensus-based classifica-
tions of foot lesions as case definitions against which
the Se and Sp of MSc was evaluated. In doing so we
assumed that different lesion types and severities have
different likelihoods of affecting gait, and that this effect
is related to the pain experienced by the animal. In our
case, we based the case definitions on a consensus view
from the co-authors. However, the inclusion of physi-
ological parameters such as, for example nociceptive
thresholds (Laven et al., 2008), heart rate and cortisol
response (Kotschwar et al., 2009) may have facilitated
a more accurate classification of cases.
Our study used multiple definitions of foot lesions
as an outcome, against which MSc was assessed (i.e.,
assuming the identification of foot lesions is of inter-

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 Logan et al.: LAMENESS IN PASTURE-BASED DAIRY COWS
est). This approach should not be confused with an
assumption that lesion identification represents a “bet-
ter” diagnostic outcome or that the presence of lesions
should be considered a gold standard for lameness or
pain experienced by the animal. However, as no gold
standard test for lameness exists, nongold standard
methods (e.g., latent class approaches), using multiple
imperfect diagnostic tests could be useful approaches to
consider for future studies.
As expected, Se of MSc could be improved by reduc-
ing the threshold to MSc ≥1, increasing to 0.69 (for
case definition 1). This finding is significant, because
previous work has suggested a benefit to treatment of
cows with locomotion scores of 2 and greater (similar
to MSc ≥1 as used in this study; Schulz et al., 2016).
However, this change of threshold was associated with
a dramatic decrease in Sp, reducing to 0.49.
In addition, we found that Se also increased accord-
ing to parity. It is notable that prevalence of lesions
also increased by parity. Although no formal theoretical
relationship exists between Se and prevalence, Brenner
and Gefeller (1997) have demonstrated a strong effect
of true prevalence on Se owing to the differences in the
distributions of underlying traits among populations or
cohorts that affect both the prevalence and Se of the di-
agnostic test. In contrast, the Sp of MSc was relatively
high, at 0.96, 0.94, and 0.94 for case definitions 1, 2,
and 3, respectively.
A significant strength of this study is that all re-
cruited cows were inspected, irrespective of their mobil-
ity score, allowing us to determine the true prevalence
of foot lesions. However, while cows were randomly
sampled within each herd, herds were recruited from a
convenient sample of herds local to our research insti-
tution. Our results must therefore be considered with
care because it is likely that the distribution of foot
lesions in the herd effects on the Se and Sp of MSc as a
detection method, and the distribution of these lesions
in our herds, may not be reflective of the herds in the
country.
CONCLUSIONS
Mobility scoring has a poor Se for the detection of
cows with foot lesions. Sensitivity could be improved
by restricting the case definition to cows with more
severe lesion types, however even using this threshold,
less than half of the affected animals could be detected
with the potential for negative welfare, health and per-
formance implications for affected animals. More effec-
tive lameness detection methods with improved Se and
Sp are needed for the timely detection of animals with
foot lesions, especially if a proportion of these animals
are potentially painful or would benefit from treatment.
Journal of Dairy Science Vol. 107 No. 5, 2024
3204
ACKNOWLEDGMENTS
This study received no external funding. The authors
have not stated any conflicts of interest.
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