From the Guidelines
Diabetics with calluses should be treated with gentle filing and moisturizing, and consideration of orthotic interventions or digital flexor tendon tenotomy in certain cases, as recommended by the most recent guidelines 1. The treatment of calluses in patients with Diabetes Mellitus (DM) is crucial to prevent further complications such as foot ulcers.
Key Recommendations
- Soak feet in warm water for 5-10 minutes to soften the callus.
- Gently file the callus with a pumice stone or emery board, being careful not to remove too much skin.
- Apply a diabetic-friendly moisturizer containing urea or salicylic acid.
- Wear comfortable, well-fitting shoes and moisture-wicking socks to prevent further friction.
Orthotic Interventions and Surgical Options
For patients with a non-rigid hammertoe and nail changes, excess callus, or a pre-ulcerative lesion on the apex or distal part of the toe, consider digital flexor tendon tenotomy or orthotic interventions such as toe silicone or (semi-)rigid orthotic devices 1.
Importance of Proper Callus Management
Proper callus management is essential to prevent infections and ulcers, as diabetics often have reduced sensation in their feet and slower wound healing 1.
Patient Education
Patients should be educated on daily foot care, including inspection, washing, and drying, as well as the importance of wearing proper footwear and seeking medical attention if a blister, cut, or sore develops 1.
From the Research
Treatment Options for Callus in Patients with Diabetes Mellitus
- The primary therapeutic goals for treating callus in patients with diabetes mellitus include optimal control of diabetes, relieving pressure points, and avoiding or reducing callus formation 2.
- Tangential excision together with topical cantharidin has been shown to be an effective treatment for callus, with a success rate of 79.2% after one session 3.
- The use of orthoses, cushioning, and a combination of both can help reduce peak plantar pressure and callus in diabetic patients, with reductions of up to 63% achieved 4.
- Prompt neurologic and vascular diagnostic studies, coupled with routine examination of the feet and primary prophylactic measures, are crucial in managing callus in patients with diabetes mellitus 2.
- Callus development is often linked to peripheral neuropathy, and motor neuropathy can lead to deformity, while sensory neuropathy causes a lack of sensation, resulting in persistent abnormal pressure on the foot 5.
Management of Callus
- Regular foot care and examination can help identify callus formation early on, allowing for prompt treatment and prevention of further complications 6.
- Education on foot care is essential in managing callus in patients with diabetes mellitus, as lack of awareness and poor glycaemic control are significant factors contributing to diabetic foot problems 6.
- The treatment of callus should focus on addressing the underlying causes, such as peripheral neuropathy and abnormal pressure distribution, rather than just the symptoms 5.