7.6. Cylindrical keratoma

                  1. Author:  Ing. Jindřich Vinčálek, CE-F

                   Working place: Stud Farm Tlumačov

               2. Literature overview:   Podkovářství, 39.6. Rohový sloupek, ISBN: 978-80-7490-052-5,  Tisk Pálka 2015

               3. Patient information No. 7.6.1.

                   Breed:                  Belgian warmblood

                   Sex:                      Gelding

                   Age:                     7 years

                   Color:                   Bay

                   Discipline:            Sport - showjumping

4. History

  • Reason why the owner complain:

       Reccuring abscesses on outer front part of the bearing edge of the left hind hoof, lame on left hind leg, especially in left             turns.

  • Length of the problems:

       Five to six months, with progressive worsening.

  • Stabling conditions:

       Box.

  • Bedding:

       Straw.

  • Frequency of the hoof care:

       Regularly every 7-8 weeks 

  • Type of shoeing:

       Regular shoe Mustad Libero 25 x 8 mm, size 3 on all four legs.

  • Lameness and diagnosis:

       While presented in walk and trot, the horse showed 3dr dedgree lameness, mainly in left cyrcle on hard surface.

5. Problem description

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  • Characterisation of the problems:

Reccurence of deep infectous abscesses on outer front part of the bearing edge of the left hind hoof. Deep smelly hole in outer sole,  which would not heal.

  • Shape of the hoof and pathologic changes:

Hoof was not yet deformed too much, only small prominence in the area of keratoma.

  • Conformation:

The conformation of the affected limb was totally physiological, without unusual overload of the affected hoof

  • Evaluation of the hoof care

The hoof was trimmed to a natural balance.

Fig. 1.: Keratoma from the bottom view

  • Evaluation of the type of shoeing:

       Type of shoeing had no effect on the problem.

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  • Results of the examination:

Hoof palpation test confirmed pain in the area of deformed hoof wall and sole. Percussion examination revealed a change in sound in the affected area compared to the remaining perimeter of the hoof wall. A 4 °C higher temperature was detected on the toe by laser thermometer examination. The X-ray examination confirmed the diagnosis of cylindrical keratoma by typical brightening of the coffin bone in its outer part. 

Fig. 2.: X-ray image confirming the keratoma diagnosis, with typical brightening of the coffin bone.

Trimming:

The hoof has been trimmed according to the usual principles of correct balance of the hoof and limb.

Shoe preparation:

Hind shoe Mustad Libero size 2, 22 x 8 with two clips was shaped so that the outer clip lies on the hoof wall behind the keratoma. Two transverse bars were welded in the solear surface to support the solear surface of the coffin bone. Fig. 3. 

A 1.5 mm thick stainless steel plate was cut, drilled and shaped to fixate the two sides of the hoof capsule after ablation. It is advisable to disinfect the fixating plate and screws before screwing by putting them in a disinfectant solution. Fig. 4. 

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FIg. 3: Hoof after ablation shod by two bar shoe.

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Fig. 4: Fixating plate and screws is advisable to disinfect before aplication

Veterinary treatment:

The keratoma must be in cooperation with the vet removed by ablation of the hoof wall at the site of injury. The following procedure was chosen. The first step was infiltration anesthesia at the level of the fetlock joint. Furthermore, to limit bleeding, the limb above the fetlock joint was compressed by Esmarch's elastic turniquet and in the fetlock joint area by several layers of food foil.

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Fig. 5: The level of the edge of the hole at the solear surface was transferred to the hoof wall, the marker indicates the placement of the keratoma.

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Fig. 6: Following the marked lines, the hoof wall was cut with an oscillating saw to the corium.

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Fig. 7., 8., 9.: Above the sole level was the cut part of the wall lifted by metal crowbars and gradually torn away.

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Fig. 10. 11.,12.: From the left - At coronary band, at the horn - skin transition, the horn is carefully cut to prevent damage of coronary cushion. 

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Fig. č. 13. 14.,15.: From left - The thickening of the keratoma is clearly visible on the removed part of the hoof wall. The hoof was shod with two clipped shoe with two bars, with the clip of the shoe positioned behind the removed part of the wall.  

Shoeing:

The hoof was shod with the prepared shoe and the wound was filled with gauze swabs soaked on disinfectant. The hoof wall around the wound was dried with a hot air gun so that the fixation plate can be attached with Superfast prior to application, which ensures a perfect connection of the steel plate to the hoof wall and support the fixation of the split hoof wall.

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FIg. 16., 17.,18.: From left - Hoof after keratoma ablation, the wound is filled with gauze swabs soaked in disinfectant, the hoof wall around wound dried by hot air gun and the fixation plate is attached with Superfast glue. 

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Fig. 19. 20.,21.: From left - After hardeninf of the Superfast, the fixating plate was screwed with self-tapping screws with a length corresponding to the thickness of the hoof wall.

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Fig. 22. 23.: From left - Finally, the space between the shoe and the sole was filled with a hard packing material to support the solear surface of the coffin bone against sinking. Fig. 24. - Removal of the tourniquet. 

Rules of the further care:

After removing the tourniquets the bleeding increases and it is necessary to apply a multilayer bandage over the feltock joint and secure it with adhesive tape against wetting and infection. The hoof bandage should be changed until the wound is completely covered by horn tissue, that is about three weeks after ablation. Even then, it is necessary to keep the wound area clean by replacing the swabs under the fixation plate.

6. Chosen solutions

Trimming effect:

After the healing of the ablation wound, it was possible to start walking the horse on the firm surface. A month after ablation the horse was no longer lame and the hoof was growing with regular koronary band. Next shoeing was done after 8 weeks and the hoof growth on the coronary band was about 15 mm. Hoof was trimmed evenly, fixating plate attached 2 cm higher and the sole packed again with hard material.

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Fig. 25. 26.,27.: From left - Hoof 8 weeks after ablation before second shoeing, after fixating plate removal from the side and from the bottom. 

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Fig. 28.: The hoof after second shoeing. 

Changes in shoe choice and shoeing:

After another two months, at third shoeing, the hoof wall growth was already over 3 cm. After trimming new hoof wall reached alost half of the hoof lenght and therefore the fixating plate could be removed. A third clip was made in the dorsal part of the shoe, which was placed on the dorsal edge of the growing hoof wall, so that both sides of the ablation wound were fixed with clips.

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Fig. 29., 30., 31.: From left - trimmed hoof 24 weeks after ablation, and after shoeing. Fixating plate was removed and substituted by third clip.

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Fig. 32., 33.: From left - Hoof before trimming at fourth shoeing, 32 weeks after ablation. Fig. 34.: On the right - a scar appeared at the weight bearing edge at former place of the keratoma, caused by hoof horn filling the hollow in the coffin bone, caused by keratoma pressure.

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Fig. 35. a 36.:

Hoof after fourth shoeing.

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Fig. 37. and 38.: 

After another two shoeings, the hoof wall grew to the bearing edge and the scar shrunk.

Farriery treatment effect:

After 12 months of the hoof wall ablation, the hoof wall has grown to full strength and the scar in the horn of the weightbearing edge was reduced to its final size.

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Fig. 39. and 40.: 

View of the hoof from the bottom before trimming one year after ablation.

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Fig. 41. and 42.: 

The hoof before trimming a year after treatment.

Result of the care

The keratoma was diagnosed and ablated in September. In March, the horse gradually started working and competed the whole jumping season. However, the regeneration of the hoof capsule lasted 12-14 months.

7. Follow up – Development of changes

Keratoma treatment requires close cooperation of an experienced veterinarian and farrier with good theoretical knowledge and practical experience. The result of such cooperation is a positive prognosis of treatment and the return of the horse back into training without health consequences.

8. Conclusion (take home message):