Complex Keratoma Case Study

Horse:  Annie 18yr old Arab Mare (2018)

Annie Keratoma Case study

Annie Keratoma Case study


1.              Dec 2018 Barefoot trimmer noted seedy toe.

2.              May 2019 New trimmer was suspicious of keratoma.

3.              September 2019 Keratoma Surgery to remove double Keratoma.

4.              January 2020  Equine Podiatrist took over care of Annie

5.              January 2020 Shoes off

6.              June 2020 Laminitis

7.              September 2020 PPID Diagnosis

8.              August 2021 Hock Arthritis

Annies owner has always used a barefoot trimmer. In December 2018 her trimmer noted what he thought to be seedy toe and advised to clean it and pack it. Annie was never lame but was occasionally footsore, particularly on stony ground. This continued for 6 months then Annies owner changed trimmer, and the new one was suspicious of seedy toe and advised to monitor this for 2 trim cycles.

Keratoma case study pre surgery

Keratoma case study pre surgery

After a couple of trim cycles still no improvement was noted so the vet was called and thought it was a keratoma – August 2019  x-ray confirmed a keratoma with some pedal bone loss, still no lameness was detected.






Surgery to remove the Keratoma was performed in September 2019 where 2 keratomas were discovered, one growing over the top of another!

Annie Keratoma close up

Annie had general anaesthetic to have the keratomas removed and remained in hospital for 5 days. Annie came home and went onto box rest for 5 days with small paddock turnout after this. She was shod in both fronts – RF was a surgical plate to offer support where the bridge of the foot had been removed and heartbar shoe was put on the left fore.

Annie Keratoma close up




Annie was not comfortable in the shoes and kept pulling the plate off, the foot got infected and her stable then flooded!  

Annie and her owner were both so stressed and Annie had to be sedated each time the shoes had to be nailed back on.  She had to have daily dressings change and there were 2 episodes of over granulation that the vet had to cut away under standing sedation.

At one point Annie refused to leave her stable, she was in so much pain. Her foot had become so distorted due to an ill-fitting shoe, the coronary band had shunted up! Annies owner asked the vet and farrier if Annie could be managed barefoot but they said this was not possible. Annie then developed ventral oedema, she was just not getting enough movement, despite in hand walking, but this was limited due to pain. Annie’s owner decided enough was enough, her poor girl had been through so much she need to try a different approach, so January 2020 she approached an EP who came to visit and agreed to help.

After talks with the vet it was decided to remove the shoes – at this point Annie had been weight bearing the lateral side of her foot creating even more distortion.

Annie moved so much better as soon as the shoes were off, it was such a relief for both owner and horse. Annie remained barefoot from this day. She had boots and pads fitted.



Unfortunately Annie’s recovery was not straight forward; she abscessed in her keratoma foot, developed laminitis with rotation and sinker and was also she was diagnosed with cushings, hock arthritis & fore feet side bone.

Annie sadly passed away in September 2023 due to COPD. For the past 2 years of her life she had lived a track life with a little companion Apple, she remained sound and in ridden work, her foot did return to a more normal looking hoof, but there was always a deviation at the white line junction due to pedal bone loss however the vet that came to see Annie at the end commented on now nice her feet looked.

Annies owner fondly called “ the wonky foot” and it kept her EP on her toes from the outset. Annie was a super horse and taught her EP so much.  She had an amazing owner who always did her best for Annie with diet and lifestyle changes & taking on board everything that was advised

A collage of the changes in the hoof shape

Annie Keratoma March 20 Lateral Annie Keratoma May 20 lateral

Annie Keratoma Jun 20 lateral

Annie Keratoma Jul 20 lateral

Annie Keratoma march 2020 Annie Keratoma May 20 Dorsal

Annie Keratoma Jun 20 Lateral

Annie Keratoma Jul 20 dorsal

Keratoma case study mar ch lateral