Keratoma and septic pedal osteitis

Question 1

what is a keratoma

Answer 1

Hyperplastic keratin mass within the hoof

Question 2

where do keratomas originate

Answer 2

from epidermal horn producing cells of coronary band

Question 3

List 5 features of keratomas

Answer 3

Space occupying lesion in hoof capsule
can be benign neoplasms
grow distally
hoof deformation
can cause hoof abscess with loss of white line integrity

Question 4

where is the most common region for keratomas to occur

Answer 4

toe region of hoof

Question 5

List 3 thing that keratomas can occur after

Answer 5

hoof abscess
trauma
hoof crack

Question 6

List some clinical signs of keratoma

Answer 6

Recurrent severe lameness/hoof abscess at same location
raised digital pulse
hoof wall distortion
deviation of white line
localised pain on hoof testers

Question 7

will lameness due to keratoma be abolished by peri-neural anaesthesia

Answer 7

Yes

Question 8

What radiographic view is needed to diagnose keratomas?

Answer 8

Dorso 60 proximal, palmar/plantar distal oblique view (upright pedal)

Question 9

what do you see on radiograph with a keratoma

Answer 9

Smoothly demarcated radiolucent lesion in the distal border of distal phalanx

Question 10

What are the 2 forms of keratomas

Answer 10

tubular form
spherical form

Question 11

How are keratomas treated

Answer 11

surgical excision

Question 12

How is surgical excision of keratomas performed

Answer 12

under GA with perineural anaesthesia

Question 13

What is the prognosis with a keratoma

Answer 13

Takes several months for hoof defect to grow out
Good prognosis
Keratoma recurrence in <20% cases

Question 14

what causes septic pedal oesteitis

Answer 14

solar penetration into distal phalanx e.g. nail

Question 15

how does a nail cause septic pedal ostitis

Answer 15

nail penetrates distal phalanx
bacteria enter bone and cause osteomyelitis
sequestrum formation occurs

Question 16

What clinical signs do we see with septic pedal osteitis

Answer 16

Raised digital pulse (single foot)
Discharge and pain with hoof testers at the site of penetration
Initial radiographs may be normal
Ideally radiograph with nail still in place

Question 17

Describe how to initially manage nail foreign body in foot

Answer 17

Poultice
antibiotics
NSAIDs
tetanus antitoxin

Question 18

Describe what septic pedal osteitis looks like on radiographs

Answer 18

Osteolysis around site of penetration and a sequestrum at toe

Question 19

Describe how to treat pedal osteitis

Answer 19

surgical excision and use of hospital plate