Keratoma in Horses: Signs, Diagnosis, Treatment, and Recovery Timeline
- Horse Education Online
- Aug 27
- 17 min read
Updated: Sep 2
A keratoma is a benign ball or column of keratin that grows inside the hoof capsule and slowly pressurizes the sensitive laminae and distal phalanx (P3). In real barns it most often announces itself as abscesses that keep recurring in the same spot, sometimes with a subtle bulge at the toe/quarter or a vertical groove growing down from the coronet.
Diagnosis leans on radiographs; treatment ranges from careful debridement to surgical removal plus supportive shoeing to manage mechanics while the wall regrows. Expect 6–12 months for full hoof-wall replacement in most cases.
At-a-Glance
What it is: Benign keratin mass inside the hoof that causes pressure, pain, and repeat abscesses.
Biggest clue: Abscesses keep returning at the same spot; may see a subtle toe or quarter groove.
Confirm: Radiographs with a smooth semicircular lucency; MRI or CT if X-rays are unclear.
Treat: Targeted debridement or surgical excision, then clean packing, bandage, and pain control.
Shoeing: Short toe with set-back breakover and heel support; protect any wall window.
Timeline: Comfort 1–2 weeks; light work 5–8 weeks; full wall regrowth 6–12 months.
Pro tip: Download the fillable Keratoma Weekly Progress Tracker to log pulses, heat, lameness, and wall growth each week.
What is a keratoma?
A keratoma is a localized overgrowth of hard keratin within the hoof’s horn tissues. It is benign (non-cancerous) but space-occupying, so the damage is from pressure and distortion, not malignancy.
Where it forms: between the hoof wall and sensitive laminae
Most keratomas sit between the stratum medium of the wall and the sensitive laminae, usually at the toe or quarters. As it enlarges, it indentates the laminae or P3 and can disrupt the white line, predisposing to trapped debris and infection.
Plain-language picture:Think of the hoof capsule like a tough boot. A keratoma is a hard knot that forms inside the boot, pushing inward on soft tissues and bone. The foot can’t swell outward, so pressure builds and hurts.
Why it hurts: pressure, distortion, secondary infection
Constant pressure on laminae and periosteum of P3 ⇒ lameness that can be mild at first, then spike suddenly.
Wall distortion ⇒ lever arms change at breakover, stressing the laminae.
Secondary infection/abscessing can occur as the white line is distorted, causing repeat abscesses in the same tract.
Student tip: When you hear “abscesses that never really go away,” start a timeline of locations, drainage sites, and intervals. Recurrence at the same clock position is classic keratoma patterning.
Keratoma vs. abscess vs. white line disease vs. seedy toe
(Use this quick table when triaging in the barn. For full differential steps, see our Comprehensive Lameness Guide and compare with seedy toe.)
Condition | What it is | Owner-level clue | Wall/Sole change | Imaging clue | First step |
Keratoma | Benign keratin mass inside the capsule | Abscess recurs in same spot; subtle bulge/groove at toe/quarter | Vertical groove from coronet; mild toe distortion | Smooth, semicircular lucency near P3 inner margin | Vet exam + radiographs; plan mechanics |
Simple abscess | Local infection under sole/wall | Acute, throbbing pain; rapid relief after drainage | Soft sole/track; often no persistent wall change | Usually no bone change | Drain, soak, bandage; monitor |
White line disease | Fungal/bacterial wall separation | Chalky/crumbly horn; cavities progress upward | Separation at white line; hollow sound on tap | Wall defects; P3 normal | Resection/debridement; shoeing |
Seedy toe | White line separation focused at toe | Recurrent toe “hole,” may pack with dirt | Cavity at toe; easier to probe than WLD | Similar to WLD at toe | Targeted resection; toe mechanics |
Want to compare with seedy toe in depth? Pair this article with our WLD/seedy-toe content when you review hoof capsule pathologies during shoeing labs.
Early signs owners notice
These are the barn-side signals that should put “keratoma” on your list (especially in front feet):
Repeat abscess at the same location
Example: “We’ve had three abscesses at 2 o’clock on the right front in six months.”
Rationale: Space-occupying lesion creates a pressure point and a repeat drainage tract.
Subtle bulge at the coronet or a vertical groove in the wall
Look down the toe/quarter with raking light. A slight bulge at the coronary band may track into a vertical groove that grows down over months.
Shortened stride, toe-first landings, increased digital pulse and hoof warmth
Many horses shift to toe-first landing to avoid heel shock on a painful toe/quarter.
Digital pulses and hoof heat often spike during abscess flares.
Owner tip: When lameness spikes, take a quick “vital signs check”—temperature, pulse, respiration—to help differentiate systemic illness from isolated hoof pain. Start here: The Horse’s Vital Signs and Average Heart Rate.
Quick triage table for the barn
What you see | What it suggests | Track this at home | When to call the vet/farrier |
Abscess keeps returning at same clock position | Keratoma on the list; could also be persistent WLD track | Date, foot, clock position, drainage site | After the second recurrence in same spot or if lameness worsens |
Vertical groove growing down from coronet | Chronic internal pressure/distortion | Monthly photos with a ruler; mark growth ring | If the groove widens, wall cracks, or horse becomes sore |
Toe-first landing, shortened stride | Toe pain; lever arm too long at breakover | Slow-mo phone video from the side | Ask farrier about set-back breakover now (see: understand breakover) |
Bounding digital pulse and heat | Active inflammation/abscess | Pulses AM/PM; temperature | If pulses persist >48 hours or horse is non-weight-bearing |
Pro tip (mechanics): Even before imaging, discuss a temporary mechanical aid with your farrier—e.g., rasp breakover back and reduce toe lever to lower strain while you schedule radiographs. Later sections will detail egg bars and bar shoes as options (see: support shoes like egg bars and bar shoes explained), and how traction choices interact with comfort (traction options for footing).
TL;DR (for quick review of Sections 1–2)
Keratoma = benign keratin mass inside the hoof causing pressure and repeat abscesses at the same spot.
Look for subtle toe/quarter distortion, a vertical groove, and toe-first landing with hot pulses.
Start a recurrence log, photograph the wall monthly, and optimize breakover while you book radiographs.
Keep our Comprehensive Lameness Guide handy; check vital signs during painful flares.
Diagnosis: from barn exam to imaging
Goal: confirm a space-occupying horn mass and rule out look-alikes (simple abscess, white line disease, deep bruise, pedal osteitis). Start systematic and escalate only when findings warrant it.
Step 1 — History & hoof-on exam (barn side)
Pattern matters: “Abscesses at the same clock position every few weeks/months” pushes keratoma horse high on the list.
Visual lines: sight down the wall for a vertical groove from the coronet; check for subtle toe/quarter bulge.
Hoof testers & tap test: focal reactivity at the toe/quarter plus a hollow ‘tap’ over a separated white line can point to wall distortion.
Gait check: toe-first landings and shortened stride support mechanical pain at breakover.
Step 2 — Radiographs (primary imaging)
Oblique, well-exposed views are your workhorse. Ask for:
Lateromedial and dorsopalmar/dorsoplantar
65° DP (coffin bone detail)
Toe obliques (10–20°) if the lesion is suspected at a specific wall quadrant
What you’re looking for
Radiographic finding | What it suggests | Notes |
Smooth, semicircular/oval radiolucency scalloping the dorsal/distal margin of P3 or inner hoof wall | Keratoma strongly suspected | Often has a sclerotic rim; margins look regular, not moth-eaten |
Irregular, patchy demineralization of P3 without a smooth arc | Pedal osteitis, chronic inflammation | Less likely keratoma if edges are uneven |
Wall/white line separation without P3 change | White line disease/seedy toe | Probe tracts; mechanics and debridement help |
No clear lesion but classic history | Could still be a small keratoma | Consider repeating films in 6–8 weeks or advanced imaging if signs persist |
Pearl: If you can, mark the recurrent drainage site with a radiopaque BB before the shot—helpful correlation for surgeons.
Step 3 — When to use MRI or CT
MRI (soft tissue/keratin detail): recurrent abscess + normal or equivocal radiographs, or when differentiating deep bruise vs keratoma matters for management.
CT (bony detail/3D mapping): planning precise wall resection paths, unusual locations (e.g., quarters), or when radiographs suggest complex P3 remodeling.
Step 4 — Differentiate the look-alikes
White line disease / seedy toe: chalky horn, tracts you can follow and debride; P3 often normal. (Compare clinically with your WLD notes; mechanics still matter.)
Canker: exuberant, proliferative frog/sole pathology, not a focal wall mass.
Deep bruising: history of single trauma; resolves with time + mechanics.
Pedal osteitis: diffuse bone change rather than a single, smooth lucency.
Owner takeaway: if barn signs + x-ray show a smooth “bite-out” near P3, you’re likely dealing with a hoof keratoma—a benign mass that needs room or removal to stop the pain cycle.
Treatment options and expected outcomes
Principle: remove the pathologic horn (or unroof the space), restore mechanics (short toe, easy breakover), protect the defect, and guide the wall as it regrows 6–12 months.
Option A — Conservative debridement & “wall window” (select cases)
Best when imaging shows a small, well-bounded lesion close to the inner wall with minimal P3 change.
What it is: targeted hoof wall window to decompress and debride horn overgrowth/affected tracks; leave viable laminae intact.
Why it works: reduces pressure, improves drainage, and may halt recurrence if the mass is limited.
Protection: sterile packing (iodoform/antimicrobial foam), dry bandage, rim pad or pour-in packing under a wide-web shoe to offload the window.
Expectation: some horses go sound quickly; still plan mechanics and close monitoring for regrowth trajectory.
Option B — Surgical removal (definitive in most cases)
Indicated when radiographs/MRI show a discrete mass with recurrent abscessing or wall distortion.
Approach selection
Scenario | Preferred approach | Why |
Calm horse, lesion at toe/medial quarter, good stocks | Standing sedation + regional blocks | Excellent access, avoids GA risk |
Fractious horse, deep/complex lesion, bilateral work | General anesthesia | Control and precision for larger resections |
What the procedure includes
Hoof wall resection/unroofing over the lesion guided by imaging/BB marker.
Keratoma excision (remove the horn column/mass back to healthy laminae).
Curettage of any undermined horn; copious lavage.
Packing & bandaging to create a clean, dry environment for horn to granulate and keratinize.
Mechanical plan set immediately (see next section of the full guide for shoeing): set-back breakover, toe lever reduction, and heel support.
Keratoma Removal in Horse Hoof | Step-by-Step Equine Surgery Guide
Pain control & infection strategy (vet-directed)
NSAIDs for discomfort and inflammation.
Antimicrobial plan guided by intra-op findings (often topical/local; systemic if contamination is suspected).
Tetanus status: verify current vaccination; booster if lapsed. See our vaccine overview for context: 5-way equine vaccine.
Owner bandage routine (post-op outline)
Days 0–3: sterile daily bandage changes; keep foot dry and boxed (stall).
Days 4–14: change every 48 hours if clean/dry; monitor for warmth/pulse spikes.
Transition to protective shoe/pad at the first reset per your vet/farrier schedule.
Farrier collaboration tip: if the resection creates a long wall defect, treat it like a potential quarter crack risk—stabilize with bar shoes or egg bars to keep the capsule quiet while it grows down. Read: Quarter Cracks, support shoes like egg bars, and bar shoes explained.
Outcomes to set expectations
Return to comfort: many horses are notably better within 1–2 weeks post-op once pressure is relieved.
Work timeline: light work often resumes 4–8 weeks if mechanics are right and the defect is well protected (details in the Aftercare section of the full guide).
Wall regrowth: 6–12 months to replace the entire wall from the coronary band.
Recurrence: low if excision is complete and mechanics remain optimized; continue to watch growth rings and symmetry.
Simple owner checklist (print and stick to the tack room door)
☐ Keep foot dry; change bandage on schedule
☐ Log digital pulse & temperature daily for 10 days
☐ Film a 30-sec walk video weekly to track landing pattern
☐ Confirm farrier plan: set-back breakover, wide-web protection, heel support
☐ First recheck date on calendar; bring photos and your log
TL;DR (Diagnosis + Treatment)
Confirm with radiographs: look for a smooth, semicircular lucency near P3; escalate to MRI/CT if signs persist but films are equivocal.
Treat the cause, not just the abscess: decompress/debride small lesions; surgically excise discrete masses.
Protect and rebalance: short toe, easy breakover, heel support, pad/packing over the window; consider egg bar or straight bar for stability during regrowth.
Expect faster comfort in 1–2 weeks, light work in ~4–8 weeks, and full wall replacement in 6–12 months with diligent care.
Shoeing and support while the hoof regrows
Goal: keep the keratoma horse comfortable and the capsule stable while the new wall grows down from the coronet. You’ll win this phase with short toes, easy breakover, additional support and load sharing, and protection over any wall window or resection.
The mechanics (at a glance)
Mechanical goal | What your farrier does | Why it helps | Owner notes |
Reduce toe lever | Set breakover back dress flare | Lowers laminar strain and pain at push-off | Read: understand breakover |
Stabilize the capsule | Choose straight bar, egg bar, or heart bar to distribute weight across a larger surface | Prevents shearing at the defect; reduces crack propagation | |
Protect the defect | Wide-web shoe + rim pad or pour-in packing (urethane) over the window | Spreads load; keeps debris out | Keep bandage clean/dry between resets |
Manage sole soreness | Rim pad or leather pad with medicated packing | Offloads tender areas | Replace packing at resets |
Match footing/discipline | Select traction carefully (clips, studs, textures) | Too much bite increases torque on the wall | Start here: traction options for footing |
Why bars at all? A resection can reduces the weight-bearing surface of the hoof and de-stabilizes the hoof capsule. A straight bar stabilizes the quarters; an egg bar additionally supports the heels and often softens toe breakover when combined with a rolled/rockered toe. A heart bar can transfer additional weight to the frog in cases where large sections of the wall are removed.
Aftercare timeline you can follow
Principle: clean, dry protection; incremental loading; frequent mechanical tune-ups. Most hoof keratoma cases regain light work by weeks 5–8, but full wall replacement takes 6–12 months.
Week-by-week plan (owner view)
Time | Care & bandaging | Exercise | Shoeing/mechanics | Vet/Farrier checkpoints |
Week 0–1 | Daily sterile bandage over packing; keep dry stall; NSAIDs as prescribed | Hand-grazing only | If shod intra-op, no changes yet | Call if heat/bounding pulse persists >48 h |
Weeks 2–4 | Change bandage q 48 h if clean/dry; watch for odor/discharge | Hand walking 10–20 min if comfortable; no circles | Reset at week 3–4: set-back breakover; wide-web; bar shoe if indicated | Re-check exam; consider control radiographs if pain persists |
Weeks 5–8 | Bandage often discontinued; keep window protected with pad/packing | Light ridden work: straight lines, walk–trot; avoid deep footing and tight turns | Reset at week 4–5; maintain rockered/rolled toe | Farrier photos to confirm improving wall symmetry |
Months 3–6+ | No bandage; monitor hoof wall growth from coronet | Gradual return to previous workload; add canter and small circles late in this block | 4–5 week cycles; begin transitioning off bar shoe when wall is continuous and strong | Vet re-check if any new lameness or asymmetry appears |
Go/No-Go gates: Only advance work if (1) landing pattern is heel-first to flat, (2) digital pulse is quiet at rest, and (3) there’s no warmth beyond post-trim day.
What to log (and why)
Bandage & pulse log (10 days): temperatures, AM/PM digital pulse (0–3 scale), drainage/odor notes.
Lameness score (0–5 AAEP): weekly at the trot in a straight line.
Photo line: coronet to toe with a ruler in frame to track the vertical groove growing out.
Simple bandage & pulse log (printable)
Date | AM pulse (0–3) | PM pulse (0–3) | Heat (Y/N) | Drainage/Odor | Bandage changed | Notes |
Red flags—call your vet/farrier promptly
Sudden non-weight-bearing or recurrent draining from the same tract.
Expanding wall crack or separation around the window.
Persistent bounding pulse/heat beyond 48 hours post reset.
Fever, depression, or reduced drinking (rule out systemic issues; see vital signs check and how to spot dehydration).
Return-to-work progression (example)
Stage | Work | Duration |
A | Hand walk | 10–20 min/day × 10–14 days |
B | Walk under saddle; add short trot sets on straight lines | 20–30 min/day × 10–14 days |
C | Add canter, large figures; introduce small hills | 30–40 min/day × 2–3 weeks |
D | Resume discipline-specific work on good footing | As tolerated; avoid deep/rocky footing until wall is grown out |
Owner tip: Keep footing boring for the first 8 weeks—level, firm, and predictable. Re-read understand breakover before each reset to make sure mechanics stay ahead of wall growth.
Expected timeline reminders
Comfort often improves within 1–2 weeks after decompression/excision.
Light work commonly by weeks 5–8 if mechanics are dialed in.
Full wall replacement: 6–12 months from the coronet; the vertical groove should reach the ground and trim away.
Mini-checklist
☐ Dry, clean bandages on schedule
☐ Daily pulse/heat check for 10–14 days
☐ Video gait weekly (30 s, side view)
☐ Reset every 4–5 weeks with set-back breakover
☐ Stay on firm, level footing until Stage C
TL;DR (Shoeing + Aftercare): Short toe, set-back breakover, and bar/egg-bar stability keep the hoof quiet as the wall grows down. Guard the window with wide-web + pad/packing, reset every 4–5 weeks, and progress work only when pulses are quiet and landing is heel-first to flat. Keep a bandage/pulse log and use our vital signs and dehydration guides for quick health checks.
Prognosis and recurrence
Big picture: Most keratoma horse cases have a good to excellent prognosis for long-term comfort and a return to previous workload once the space-occupying horn is removed and hoof mechanics are kept tidy during regrowth. Recurrence is uncommon when the lesion is fully excised and the foot is managed with short toes and easy breakover (review: understand breakover).
Prognosis at a glance
Factor | What it means for outcome | Why it matters |
Early diagnosis + complete excision | ✅✅Best | Stops the pressure/abscess cycle before major wall/bone remodeling |
Set-back breakover + heel support | Better, faster comfort | Lowers toe lever and shearing at the resection site |
Small, well-bounded lesion | ✅ Better | Less wall to regrow; fewer structural deficits |
Minimal P3 remodeling | ✅ Better | Pain is mainly from pressure, not bone pathology |
Clean postoperative environment | ✅ Better | Lowers risk of secondary infection and prolonged drainage |
Delayed diagnosis, large wall defect, multiple old tracts | Guarded until stable | More time to restore hoof capsule integrity |
Poor mechanics between resets | Setbacks likely | Re-creates lever stress; invites cracks/recurrence-like signs |
What “recovery” typically looks like
Comfort: often improves 1–2 weeks after decompression/excision.
Light work: many return to walk–trot in 5–8 weeks if pulses are quiet and landing is heel-first to flat.
Full wall replacement: 6–12 months from the coronet. Expect the vertical groove to reach the ground and trim away.
Recurrence risk: low with complete removal and stable mechanics; watch for repeat abscess at the same clock position—your early warning sign.
Keep traction sensible while the wall is growing down to avoid torque spikes (see: Horseshoes—Understanding Traction). If the resection spans a long segment, bar or egg-bar shoes can stabilize the capsule while it knits (references: Horseshoes: The Egg Bar, Bar Shoes—Common Designs and Uses).
Prevention and monitoring
You can’t always prevent a hoof keratoma, but you can lower risk factors and catch wall distortions earlier, before they become painful.
Hoof care habits that help
Habit | What to do | Why it helps |
Keep toes short; breakover efficient | Reset on 4–6 week cycles; set breakover back (rolled/rockered toe) | Shorter toe = less laminar strain and less distortion pressure. Revisit: understand breakover. |
Manage flares + white line disease promptly | Dress flares; debride/seal separations; avoid packed debris | Reduces trapped contamination and repeat abscess tracts that can mimic keratoma. |
Choose the right traction | Match studs/textures to footing; avoid “too grippy” on hard ground | Limits torsional stress at the wall window or old defect sites. Start here: traction options for footing. |
Protect compromised segments | Use wide-web shoes, rim pads, pour-in packing when you have thin sole or old resection | Spreads load and keeps debris out while horn strengthens. |
Foot hygiene + environment | Daily picking; avoid chronic wet–dry cycling; clean, dry standing areas | Healthier white line; fewer opportunistic infections that confuse the picture. |
Nutrition for resilient horn
Prioritize a balanced ration first (protein quality + minerals). Review: The Basics of Equine Nutrition.
Common hoof-support nutrients: biotin (typically 15–25 mg/day), zinc, copper, methionine—best added in balanced formulas rather than solo megadoses.
Curious about supplements marketed for “hoof circulation/capillary health”? Read our evidence guide: What Is Horse Capillary Strength Powder and Does It Work?.
Your 12-month monitoring plan (post-resection or if keratoma is suspected)
Monthly photos (front and lateral) at hoof height with a ruler in frame; track the vertical groove growing down.
Landing video (30 s, side view) every 4–6 weeks; confirm heel-first to flat.
Pulse/heat spot-checks after trims, hard rides, or footing changes.
Reset discipline: keep 4–5 week cycles for the first 3–4 months, then lengthen only if mechanics remain ideal.
Red flag watch: any recurrent abscess at the same clock position, new bulge at the coronet, or persistent pulses >48 h → call your vet/farrier; consider check radiographs.
Owner checklist (printable)
☐ Breakover reviewed at each reset
☐ Flares addressed; white line inspected
☐ Traction matched to this month’s footing
☐ Photos + landing video added to log
☐ Nutrition reviewed; supplements chosen for balance, not hype
Bottom line: Prevention is largely mechanics + maintenance. Keep the toe short, the wall quiet, the environment clean, and the diet balanced—and you’ll reduce the conditions that let a keratoma become a problem.
Case study template (use this for your keratoma horse records)
Build a consistent file so your vet–farrier team can compare angles, timelines, and outcomes. Pair this with our lameness scoring guide.
1) Signalment & history
Horse: Name, age, sex, breed, discipline, hoofedness (LF/RF/LH/RH)
History: first lameness date, number of abscesses and clock position (e.g., RF at 2 o’clock), shoeing cycle length, footing changes
2) Baseline media
Hoof photos (pre-op): front, lateral, solar, and coronet close-up with a ruler in frame
Short videos: 30-sec walk and trot, side view, on firm level ground
3) Exam & diagnostics
Hoof tester map: mark focal reactivity
Tap test: note hollow vs dull areas
Radiographs: views taken, findings (e.g., “smooth semicircular lucency at dorsal P3, ~8 mm”)
Advanced imaging (if used): MRI/CT summary
4) Surgical or debridement notes
Approach: standing vs GA, window size and location, tissues removed, lavage, intra-op culture (if any)
Immediate packing and bandage type
5) Shoeing plan
Mechanics: set-back breakover, rolled/rockered toe, heel support, weight distribusion (straight bar vs egg bar vs heart bar)
Protection: wide-web, rim or full pad, pour-in packing
Nail placement or adhesive strategy
See: understand breakover, support shoes like egg bars, bar shoes explained
6) Aftercare timeline
Bandage schedule, NSAIDs, antimicrobial plan, tetanus status
Exercise gates: hand walk → walk/trot → canter → discipline work
Red flags to watch (pulse/heat, drainage, wall cracking)
7) Weekly progress tracking (8–12 weeks)
Week | Lameness (0–5 AAEP) | Digital pulse (0–3) | Heat (Y/N) | Work level | Notes/Photos (vertical groove position) |
1 | |||||
2 | |||||
3 | |||||
4 | |||||
5 | |||||
6 | |||||
7 | |||||
8 |
8) Three- and six-month review
Photos at hoof height; confirm vertical groove has migrated distally with symmetrical growth rings
Radiographic recheck if soreness recurs or symmetry stalls
If toe lever is creeping forward, reset earlier and re-dress flare
Bonus: If the toe cavity looks suspicious during follow-up trims, compare with seedy toe principles and address promptly to avoid confusion between recurrent abscess tracts and true keratoma.
Conclusion and next steps
A keratoma in horses is a benign keratin mass that pressurizes sensitive structures and commonly presents as repeat abscesses at the same location, subtle wall or coronet distortion, and toe-first landings. Radiographs (and sometimes MRI/CT) confirm the space-occupying lesion.
Effective care = remove/decompress, then stabilize mechanics with set-back breakover, heel support, and protection while the hoof wall grows down over 6–12 months. Owners who log pulses, photos, and work level tend to spot problems early and rehab more smoothly.
Do this now (owner/student checklist):
Book diagnostic radiographs if abscesses keep recurring at one clock position.
Ask your farrier to set breakover back and reduce toe lever while you sort imaging. Revisit: What is Breakover.
If a wall window or resection is planned, review traction options for footing to minimize torque: Horseshoes—Understanding Traction.
For stability ideas post-op, compare Horseshoes: The Egg Bar and Bar Shoes—Common Designs and Uses.
Keep our Comprehensive Lameness Guide handy during check-ups.
Free resource: Download the Keratoma Aftercare Checklist + Bandage Log (printable). Track digital pulses, bandage dates, and landing videos so your team can make data-driven shoeing and exercise decisions.
Keep learning and level up your hoof-care skills
Study materials: flashcards, posters, and more
Books: deep-dive references for your shelf
Memberships: unlock full site access and tools
Certifications: build credentials and prove competency
FAQ
What causes a keratoma in the hoof?
A keratoma is a benign overgrowth of keratin-producing horn inside the hoof capsule. It isn’t “cancer” and it isn’t caused by bacteria, though secondary infection/abscessing is common. Risk factors include chronic toe leverage (long toe/low heel), wall flares, previous abscess tracts or wall trauma, cycles of wet–dry environment, and compromised horn quality. Not to be confused with white line disease or seedy toe—see compare with seedy toe.
Can a keratoma go away without surgery?
Occasionally a small lesion near the inner wall settles after decompression (a targeted wall “window”) plus optimized mechanics. But most persist or enlarge because they are space-occupying masses. Surgical excision is the definitive option when there are recurrent abscesses from the same spot, wall distortion, or radiographic evidence of a smooth scalloped lucency.
How do vets confirm a keratoma?
Stepwise:
History and exam: recurrent abscess at a single clock position, focal hoof-tester pain, vertical wall groove.
Radiographs: look for a smooth, semicircular lucency along the inner hoof wall or distal P3; mark the drainage site with a BB for correlation.
Nerve blocks to localize pain mechanics; keep a lameness scoring guide.
MRI (soft tissue/keratin detail) or CT (3D bony mapping) when radiographs are equivocal or for surgical planning.
How long does recovery take after keratoma surgery?
Typical milestones:
Comfort improves in 1–2 weeks once pressure is relieved.
Light walk–trot work in 5–8 weeks if landing is heel-first to flat and pulses are quiet.
Full hoof-wall replacement in 6–12 months as the groove grows down from the coronet (hoof wall grows ~6–10 mm/month at the toe).Plan for clean bandage care, NSAIDs as prescribed, and frequent farrier resets during the first 3–4 months.
What shoeing is best after a keratoma resection?
Priorities are short toe, easy breakover, heel support, and protection:
Set breakover back ~8–12 mm from live sole plane with a rolled/rockered toe (understand breakover).
Stabilize the capsule with a straight bar or egg bar if the window is long or quarter-crack risk is high (support shoes like egg bars; bar shoes explained).
Use a wide-web shoe with rim pad or pour-in packing to protect the window; bias nail placement away from the defect (adhesives if wall purchase is limited).
Match traction to footing to avoid torque spikes (traction options for footing).
Will the hoof wall grow back normal?
Usually yes. If the laminar bed is healthy and mechanics stay tidy, the wall grows down strong and symmetric. Expect a vertical groove to track distally; once it reaches the ground it trims away. Rarely, very large resections leave temporary cosmetic irregularities—these improve as new horn strengthens over subsequent cycles.
Is a keratoma an emergency?
It’s not typically life-threatening, but painful abscess flares can create urgent situations. Call your vet promptly if the horse is non-weight-bearing, has bounding digital pulses and heat that persist >48 hours, or if drainage recurs from the same tract. While you wait, perform a quick vital signs check and confine to a dry stall.
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