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Keratoma - Case Study

At the beginning of January Sarnie became chronically lame with an abscess, further investigation revealed a probable keratoma. This page is chronological record of events from the initial diagnosis to the operation and then through hopefully to a successful recovery. This process could take up to a year.

There will pictures, some of which will not be pleasant, but they will show what a thousand words can’t. Also please remember it written by me the owner and although I hope to record accurately what the vets and farrier's do and say it is in my own words.

I hope in time this will be a good record for other owners who may be experiencing the same issues.

6th January 2012

Sarnie came in from the field very lame on her off hind foot. It appeared as she had a pulse to the foot and heat in the foot to be an abscess. Luckily I keep her at a yard belonging to my farrier (Simon Moore) and he was able to look straight away, he released a small amount of pus in the toe but it appeared the abscess had travelled well into the foot. We poulticed the toe and coronet band to encourage the abscess to burst fully.

9th January 2012

Poulticing and hot tubbing had not helped over the weekend so spoke to Rosevean Veterinary and agreed best to carry on to give it a chance to get the infection out.

17th January 2012

Despite constant poulticing tubbing Sarnie was still uncomfortable so the vet (Joe Ivey) was called to investigate. He sedated Sarnie and nerve blocked the foot in order he could make a full investigation. With the pain deadened she allowed further foot to pared back releasing more puss, it appeared the infection was travelling under the sole of the foot in a number of directions. There was concern that the infection could have gone into the pedal bone so x rays were taken.

As can be seen from the xray there is semi circular piece missing in the pedal bone, whilst this can be the result of an infection the semi circular shape and smoothness of the edges indicates the most likely cause to be a keratoma. A keratoma is a rare, benign tumour that is found within the foot. It consists of abnormal masses of keratin (the main substance of hoof), which is deposited between the hoof wall and the underlying pedal bone.

Copies of the x rays were sent to specialists and it was agreed it was pretty certain to be a keratoma. An MRI scan to determine with certainty the diagnosis could have taken place but the x ray was sufficient in this case. This meant an operation would have to take place to cut it out of the foot otherwise abscesses would continue and it could affect performance.

Discussion took place regarding whether she would be referred to specialists in Gloucestershire or the procedure carried out at home. Whist it would be nice to take her to state of at facilities I have a good team of people in Cornwall and I was worried that the journey particularly back (about 4 hours each way) would be too detrimental.

The decision was made that the procedure would be carried out at home, at the yard. The procedure would take place in two parts, day 1 would involve opening the wall of the foot and exposing the keratoma, it would be packed overnight with Iodine to prepare it the for next day and the removal of the keratoma, during this process a tourniquet would be applied and there is a 20 minute window to remove the keratoma.

Sarnita was put on strong intravenous antibiotics to help clear up the infection caused by the abscess.

23 January 2012

I had been hoped the operation to remove the keratoma was going to be carried out but the sub sole infection in the foot from the abscess is still not cleared. Joe pared back the foot so that the pus could be released and made a startling discovery. A small while waxey feeling thing was exposed - this was the end of the keratoma.

30th January 2012

Had a bit of a shock when changing the dressing, the bottom of the keratoma fell out with the dressing! You could still see the rest of it travelling up the foot! The piece is pictured below.

7th February - Sarnie’s Operation

Much as I wasn’t looking forward to today I was glad it had finally arrived so we could get the keratoma out and Sarnie on the road to recovery. Before I start I have to say a big thank you to everyone involved as they did a superb job, we have a long way to go yet but at least the first stage has gone well.

The operation was done a home and a lot of preparation went into making the area suitable for the operation.

A lot of time was spent preparing the foot, my farrier and vet worked together to get her ready. The foot was filed and the areas where the sole had been lost filled to add support. Sarnie was initially lightly sedated.

A plaster was then applied to the foot to offer support and equipac used around the frog.

This once moulded and set had to be cut to allow the vet access to appropriate bits of the foot. However it still helps maintain the shape of the foot. X rays were used to decide where the cut needed to be made and a small circular saw used to cut through.

Once it had been decided where the wall needed to be opened up a dremel tool was used to slowly scrap away the wall of the hoof. A further thicker cast was then fitted to the foot which for the present time will act as a support almost like a shoe. At this point Sarnie was also nerve blocked. The hoof wall was scraped to a point at which it was soft to touch.

As the most critical part of the operation arrived a tourniquet was fitted around the fetlock to stop excessive bleeding and she was heavily sedated. Iodine was used to clean the area and then the vet cut into the foot.

The front piece was taken off and the keratoma came away with it.

The foot was then cleaned, the pedal bone exposed and scraped to remove the infection and the area the keratoma had come from

Once clean it was packed and fitted with a cuff for even more support and then bandaged

I am pleased to report this evening she was eating as normal, relaxed and looking like nothing had happened.

8th February - Recovery Day 1

Sarnie is very bright fully weight bearing and comfortable. The bandage was removed and the packing removed from the hole.It was looking clean and all the plasters were secure and doing there job.

The foot was repacked with sterile dressing soaked in Batril antibiotic and bandaged up again. The dressings will be changed again in 2 days.

We discussed rough timelines and at this stage looking at approximately 6 months in the box.