Understanding Keratoma in Horses: A Case Study and Treatment Insights

Keratomas are a rare but impactful hoof condition that can cause significant discomfort and lameness in horses. Although benign, these tumors grow within the hoof wall, pressing on sensitive structures and often leading to pain. Early detection and a comprehensive treatment plan are essential for effectively managing keratomas and preserving hoof health. Here’s a closer look at what a keratoma is, symptoms to watch for, and a detailed case study on a recent diagnosis and treatment.

A keratoma is an abnormal growth originating in the inner layers of a horse's hoof wall. While it’s a benign tumor, it can still cause serious issues as it expands and creates pressure on the coffin bone (P3) and other sensitive areas. This pressure can lead to pain, lameness, and, in more severe cases, damage to the surrounding bone structure. Diagnosing a keratoma often requires imaging techniques like radiographs or CT scans, which can reveal areas of bone resorption or lucency typical of this condition.

- Moderate to severe lameness that persists or worsens

-Sensitivity or localized pain in the hoof, especially around the toe area

-Subtle structural changes in the hoof that may not be immediately visible

In a recent case, a horse presented with significant lameness (scored at 4/5) and moderate sensitivity in the left front (LF) hoof, particularly around the toe. Here’s a breakdown of the evaluation, diagnosis, and treatment steps taken to restore the horse’s comfort.

The horse’s initial evaluation revealed moderate sensitivity in the LF hoof, though there was no strong reaction to flexion or palpation. Radiographs of the hoof showed a resorptive lesion in the solar margin of P3, suggesting a possible keratoma. To confirm, a CT scan was recommended.

The CT scan confirmed the presence of a keratoma and additionally revealed a bone infection. To address the infection, we started regional limb perfusion with the antibiotic Imipenem. Additionally, the horse was placed on a regimen of Baytril IV and Bute IV for pain relief and infection control.

Under general anesthesia, the LF hoof and pastern were aseptically prepared, and a dorsal hoof wall resection was performed. The keratoma was successfully excised, and the infected area on the distal margin of P3 was debrided. Following surgery, the hoof was wrapped with gentamicin-soaked gauze to prevent infection.

Post-surgery, the horse was monitored closely, therapeutic farriery was performed protecing the sugical site. 

After Surgery and Recovery

Following surgery, we monitored the horse’s comfort and lameness level. After three treatments with regional limb perfusion, the horse showed a noticeable improvement in energy and general well-being. Horses recovering from keratomas often regain energy gradually as pain subsides, which provides them with controlled, steady energy and an overall sense of strength, and of course soundness. 

- The Importance of Early Detection and Comprehensive Treatment

- The combination of surgical removal, targeted antibiotic therapy, and structured aftercare significantly improved the horse’s mobility and quality of life. By addressing both the keratoma and the infection, we were able to relieve pain and restore comfort.

Keratomas can become severe if left untreated, so early intervention is crucial. Imaging, such as radiographs and CT scans, allows for a precise diagnosis, guiding the best course of treatment and preventing further damage.