To describe the surgical technique for removal of hoof wall masses in horses under standing sedation (SS) and local anesthesia (LA), and to report complications and long-term outcome following surgery. Observational retrospective study. Client-owned horses (n = 30). Horses undergoing keratoma removal under SS and LA in a single equine hospital between August 2016 and July 2023 were included in the study. Signalment, affected foot, history of lameness and/or foot abscesses, degree of lameness on admission, imaging findings (radiography and magnetic resonance imaging [MRI] when available), location of the mass, surgical technique, remedial farriery, postoperative care, complications and outcome were recorded. Long-term follow-up information was obtained by telephone questionnaire. A total of 30 horses met the inclusion criteria. Duration of lameness ranged from 1 to 289 days (mean 90 days). The degree of lameness varied from absent to grade 4/5 (AAEP) (mean grade 3/5). All horses underwent preoperative radiographic examination and 14/30 underwent MRI. All horses underwent partial hoof wall resection. The surgery was performed safely in all cases. Postoperative complications included marked lameness in the early postoperative period in 3/30 horses and exuberant granulation tissue formation in 2/30 horses. Long-term (>6 months) follow-up information was available for 28 horses, and 26/28 horses returned to previous levels of exercise. Recurrence was suspected in 1/30 horses. The complication rate was lower than previously reported for keratoma removal under general anesthesia (GA). Removal of hoof wall masses under SS and LA can be considered as an alternative to removal under GA.