Roli is a 19 year old pony used as a school horse. He had had several abscesses from the same location in his right front hoof when radiographs were taken of his hoof to look for an underlying cause. From these radiographs, Roli was diagnosed with a keratoma in his right fore foot.
Keratomas are benign tumors of keratin-producing cells of the inner layers of the hoof wall. Keratin is a protein and is the major component of the hoof wall. As a keratoma gradually grows it puts pressure on the hoof wall and against the coffin bone beneath it. This pressure can cause tissue necrosis (death) leading to recurrent hoof abscesses, lameness due to the separation of the lamina layers of the hoof wall, and can cause the coffin bone to resorb at sites of pressure from the tumor. When there is suspicion for a keratoma based on the clinical signs, diagnosis is typically made by identifying these classic areas of bone resorption in the coffin bone on radiographs of the affected foot. You can see in Roli’s radiographs the highlighted area where the bone is much less dense than the surrounding area.
The treatment for a keratoma is surgery to remove all of the abnormal tumor tissue. In concept that seems pretty straight forward, however in keratomas, the tumor is hidden under the hoof wall, which means the hoof wall needs to be resected to allow access to the tumor to remove it. This surgery is best done in a surgical suite under sterile conditions, however for several reasons, that wasn’t a viable option for Roli. He had his keratoma removed on-farm under standing sedation and local nerve blocks. Following the surgery, Roli was managed with antibiotics and pain control, and many, many bandage changes by his very dedicated owner. The healing time from keratoma surgeries is quite prolonged, as the hoof wall grows from the coronary band down, and the hoof cannot fill in defects from side-to-side, so the horse needs to grow a new hoof wall to replace the defect, and the area needs to be bandaged for many months to keep the exposed tissues protected.
Roli is doing well in his recovery and is expected to return to full work again by the summer.
Check out these radiographs that show the keratoma, progress pictures, as well as the video of our vets removing it!
*WARNING – video content is graphic and may not be suitable for all audiences*
Check out the video here: Roli COTM video