How to manage a 58-year-old male patient's right foot plantar calluses and proceed with a planned left knee intra-articular (IA) injection?

Management of Right Foot Plantar Calluses and Left Knee Intra-articular Injection

Gel insoles (size 10.0) are appropriate for managing this patient's plantar calluses, and you should proceed with the planned left knee intra-articular injection using proper aseptic technique.

Left Knee Intra-articular Injection Management

Preparation and Setting

• Ensure a professional, clean, well-lit, private room for the procedure 1
• Position patient on an examination table where they can lie flat if needed
• Have equipment for aseptic procedures ready
• Have resuscitation equipment nearby (though rarely needed)

Procedure Guidelines

1. Obtain informed consent, explaining the nature of the procedure, potential benefits and risks 1
2. Use aseptic technique for the injection (mandatory) 1
3. Consider offering local anesthetic, explaining pros and cons 1
4. For knee injections, the superolateral approach is recommended for highest accuracy (91% success rate) 1
5. After injection, advise the patient to avoid overuse of the injected joint for 24 hours, but immobilization is discouraged 1

Management of Plantar Calluses

Assessment

• Plantar calluses are painful hyperkeratotic lesions that can cause significant discomfort and disability 2
• They are often associated with areas of high pressure on the foot

Treatment Options

1. Conservative Management (First-line):

   • Gel insoles (as you've prescribed) are appropriate to reduce pressure on callused areas
   • The size 10.0 you've selected matches the patient's foot size

2. Other Treatment Options (if needed in future):

   • Scalpel debridement by a podiatrist is considered the gold standard treatment 2
   • Chemical treatments (potassium hydroxide or trichloroacetic acid) can be effective but show less immediate improvement than professional debridement 2

Expected Outcomes

• Gel insoles will help redistribute pressure away from callused areas
• This should provide symptomatic relief and may slow callus reformation
• A study showed that professional debridement provides immediate and significant changes in skin quality and associated foot pain, while home treatments (including insoles) provide lesser but still beneficial changes over time 2

Follow-up Recommendations

1. Reassess the patient's plantar calluses at the next visit
2. If gel insoles don't provide sufficient relief, consider referral for professional debridement
3. For the knee injection, follow up in 2-4 weeks to assess response

Important Considerations

• Advise the patient on proper footwear that provides adequate support and reduces pressure on callused areas
• Educate on the importance of regular foot care and inspection
• If the patient has diabetes (not mentioned), more careful monitoring of foot conditions is warranted

Your plan to proceed with both the left knee injection and prescription of gel insoles is well-founded and follows evidence-based practice for these common conditions.