A Hole in the Hoof: Simple keratoma or something sinister?

Trauma and lameness originating from the hoof and third phalanx are common presenting complaints. In contrast, neoplasia of the pedal bone or hoof region is a rarity in the literature. Within the hoof keratomas are the most frequently reported neoplasm. The gross and radiographic appearance of keratomas is well documented, however this is less well established for other neoplasms of the hoof capsule. We will discuss four cases which had clinical and radiographic similarities to keratomas, however key differences were observed. To highlight the key differences in imaging findings and clinical progression.

• • Aggressive neoplasms should be considered as alternatives to keratomas, when either the appearance of the mass itself, history or degree of lameness is atypical.
• • Advanced imaging (CT/MRI) or additional studies(venogram) are useful tools for clinicians faced with these cases and can aid in differentiating neoplasms from the ‘typical’ keratoma.
• • Early identification of neoplasms can improve client communication, as these aggressive neoplasms all carry a much more guarded prognosis. Discussion of the possibility of these masses with clients when warranted can avoid potential pitfalls as the case progresses.