From the Guidelines
For a 38-year-old male with persistent bilateral calluses on the fifth toe that did not respond to cryotherapy, I strongly recommend a comprehensive treatment approach that prioritizes reducing pressure on the affected area and promoting skin health. The patient should soak his feet in warm water with Epsom salt every night for three months, followed by gentle debridement of the callused area using a pumice stone, as this helps soften the callused skin, allowing for easier removal of the hardened tissue while maintaining skin moisture to prevent further callus formation 1. After cleaning, he should apply Lubriderm cream to his feet nightly for 60 days. Additionally, I'm prescribing wide medical shoes to reduce pressure on the fifth toe, as tight footwear is often a contributing factor to callus development, and proper footwear reduces friction and pressure points that lead to callus formation 1. Considering the patient's condition, it is crucial to provide integrated foot care, including professional foot care, adequate footwear, and structured education about self-care, to help prevent a first or recurrent foot ulcer 1. A follow-up appointment in 30 days will allow us to assess progress and make any necessary adjustments to the treatment plan. This combined approach addresses both symptom management and the underlying cause of the calluses for better long-term results. Some key considerations in managing calluses include:
- Educating the patient on proper foot self-care, such as daily foot washing and drying, especially between the toes, and using emollients to moisturize dry skin 1
- Encouraging the patient to examine their feet daily for any signs of pre-ulcerative lesions or ulcers and to seek medical attention promptly if any concerns arise 1
- Considering orthotic interventions, such as toe silicone or (semi-)rigid orthotic devices, to help reduce excess callus on the toe, especially if the patient has a non-rigid hammertoe with nail changes or a pre-ulcerative lesion on the apex or distal part of the toe 1
From the FDA Drug Label
Indications and Usage For debridement and promotion of normal healing of hyperkeratotic surface lesions, particularly where healing is retarded by local infection, necrotic tissue, fibrinous or purulent debris or eschar. Urea is useful for the treatment of hyperkeratotic conditions such as dry, rough skin, dermatitis, psoriasis, xerosis, ichthyosis, eczema, keratosis pilaris, keratosis palmaris, keratoderma, corns and calluses, as well as damaged, ingrown and devitalized nails. The patient's treatment plan with Lubriderm cream and debridement with a pumice stone may be beneficial for the calluses, but urea (TOP) could be considered as an alternative or additional treatment option for the calluses, given its indication for hyperkeratotic conditions such as corns and calluses 2.
From the Research
Treatment of Bilateral Calluses on the Fifth Toe
- The patient's condition of bilateral calluses on the fifth toe has been treated with cryotherapy, but with no improvement 3.
- A new treatment plan has been recommended, including a foot bath with Epsom salt every night with warm water for three months, and gently debriding the area with a pumice stone, cleaning it, and applying Lubriderm cream to the feet every night for 60 days.
Debridement and Wound Healing
- Debridement is an essential element of wound healing therapy, involving the removal of necrotic material, scabs, and other impurities that delay wound healing 3.
- Properly performed debridement can lead to improved microcirculation, reduced inflammation, and lowered metalloproteinases, stimulating wound edges and epidermis, and reducing the risk of infection 3.
Use of Epsom Salt and Warm Water
- A study on the efficacy of warm salt water foot-bath on patients with painful diabetic peripheral neuropathy found that the treatment significantly decreased pain levels 4.
- Epsom salt, which contains magnesium sulfate, has been shown to be safe for use in cosmetics, including leave-on and rinse-off products, with no significant toxicity concerns relating to systemic exposure 5.
Moisturizing and Skin Barrier Function
- Urea is a hygroscopic molecule that plays a fundamental role in regulating keratinocyte proliferation and improving skin barrier function, including antimicrobial defense 6.
- Urea-containing formulations are widely used in dermatology to improve skin barrier function and as moisturizers and keratolytic agents, with significant clinical improvement in various dermatoses 6.
Wound Dressings and Moist Environment
- A moist wound environment has several benefits, including facilitating autolytic debridement, reducing pain, and promoting keratinocyte migration over the wound surface 7.
- Wound dressings can be utilized to create, maintain, and control a moist environment for healing, with optimal dressings providing a moist environment, protecting the wound against trauma and contamination, and being easy to apply and remove 7.