Outcome of keratoma removal using different surgical techniques, including a modified partial hoof wall resection: A retrospective study (2004-2025).

Overview

• This study investigated the outcomes of different surgical methods used to remove keratomas, a hoof condition in horses, focusing on complications and recovery times.
• A particular modified partial hoof wall resection technique was found to result in fewer complications and faster return to activity compared to complete hoof wall resection.

Background

• Keratomas are abnormal growths in the equine hoof that can cause intermittent lameness or recurring foot abscesses due to space-occupying lesions within the hoof wall.
• These conditions require surgical intervention to remove the lesion and restore hoof function.
• Three surgical techniques are commonly used for keratoma removal:
  • Complete hoof wall resection (CR): Removal of the entire affected hoof wall section.
  • Partial hoof wall resection (PR): Removal of a segment of the hoof wall, less extensive than CR.
  • Modified partial hoof wall resection (MPR): An adaptation of the PR method designed to improve outcomes.

Study Design and Methods

• This was a retrospective study reviewing medical records from 2004 to 2025 at a Veterinary Teaching Hospital.
• Fifty-five horses diagnosed with keratomas or space-occupying lesions in the hoof wall and treated surgically were included.
• The surgical groups consisted of:
  • 18 horses treated with complete hoof wall resection (CR)
  • 35 horses treated with modified partial hoof wall resection (MPR)
  • 2 horses treated with traditional partial hoof wall resection (PR) – excluded from statistical analysis due to the small sample size
• Short-term and long-term postoperative complications were analyzed, as well as the horses’ return to activity.

Short-Term Outcomes

• In the MPR group, 25.7% (9/35) developed postoperative complications.
• When compared to CR, the MPR group had significantly fewer complications overall.
• Specifically, MPR showed lower incidence of:
  • Exuberant granulation tissue — excessive growth of healing tissue that can impair hoof recovery.
  • Hoof wall instability — structural weakness in the hoof wall post-surgery.
• Other complications observed across all surgical methods included:
  • Laminitis — inflammation of the sensitive tissue inside the hoof
  • Infections
  • Fractures
  • Colic — abdominal pain

Long-Term Outcomes

• Follow-up data ranging from 6 to 180 months post-surgery were available for:
  • 15 horses in CR group
  • 2 horses in PR group
  • 22 horses in MPR group
• The MPR group had significantly fewer hoof cracks compared to the CR group, indicating improved hoof integrity.
• Keratoma recurrence rates were:
  • 3 out of 15 in CR group
  • 1 out of 2 in PR group
  • 1 out of 22 in MPR group
• Approximately 70% of horses in both CR and MPR groups returned to their previous level of activity.
• The mean time to return to activity was shorter in the MPR group at 6.5 months, which aligns with durations reported in literature for PR cases, and significantly less than CR.

Conclusions

• The modified partial hoof wall resection (MPR) technique showed promising results as an effective alternative to the traditional complete hoof wall resection.
• MPR led to fewer short-term complications related to healing and hoof stability.
• Long-term outcomes favored MPR with fewer hoof cracks and lower keratoma recurrence rates.
• The shorter recovery time with MPR suggests it can enhance post-surgical rehabilitation and faster return to normal function.
• This study supports considering MPR as a viable surgical option for equine keratoma management while highlighting the importance of careful postoperative monitoring for complications.