Two studies were conducted to evaluate visual locomotion scoring (VLS) and Stepmetrix locomotion scoring (SLS) in detecting painful digit lesions. In study 1, one veterinarian performed VLS. Cows with VLS > or = 3 were hoof trimmed and the presence or absence of a painful lesion (PL), defined as a reaction to digital pressure, was recorded. A strongly increasing pattern in the proportion of cows with PL was detected as VLS increased. The proportions of cows with painful lesions were 5.6% (n = 53), 20.1% (n = 78), 55.5% (n = 164), 79.9% (n = 159), and 100% (n = 5) for VLS 1 to 5, respectively. Study 2 was conducted on a different farm. The entire farm was visually locomotion scored by 3 veterinarians on the same day, and the cows were Stepmetrix locomotion scored by walking through the Stepmetrix system. Every cow was trimmed during the following 2 d by 1 of 8 professional hoof trimmers. The 3 veterinarians identified, scored, and recorded any PL. Interobserver agreement for the 3 veterinarians had a kappa coefficient of between 0.45 and 0.48 +/- 0.05. In total, 518 cows were used in the analysis, from which 11.2% were identified with a PL. Of the cows diagnosed with a PL, 32.8% were detected with a sole ulcer, 25.9% with white line disease, 13.8% with white line abscess, and 27.5% with other diseases. A receiver operating characteristic analysis was performed; the area under the curve was larger for VLS (0.80; 95% confidence interval, 0.76 to 0.83) than SLS (0.62; 95% confidence interval, 0.57 to 0.66). When performed by trained veterinarians, VLS performed better than SLS in detecting PL.