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An 18-year-old Quarter Horse mare was evaluated because of moderate left forelimb lameness of 4 weeks' duration. The clinical evaluation and diagnostic perineural analgesia localized the lameness to the distal portion of the left forelimb. There was swelling on the dorsal and lateral aspect of the coronary band. Radiography, ultrasound, magnetic resonance imaging, and computed tomography of the foot revealed circumscribed well-capsulated soft tissue mass causing a focal deformation of the dorsolateral border of the middle phalanx. The treatment aimed to remove the mass surgically and stabilized the interphalangeal joint, but the owner elected human euthanasia before treatment attempt. Histopathology diagnosis was an epidermoid cyst, which was characterized by multilayers of keratin surrounded by stratified squamous epithelium. Although rare, an epidermoid cyst should be considered as a differential diagnosis for space-occupying mass in horses' foot that develops chronic lameness after trauma. This report describes the multimodality appearance of the epidermoid cyst.