How to treat an Achilles callus?

Treatment of Achilles Callus

The most effective treatment for an Achilles callus involves gentle debridement of the hyperkeratotic tissue using a pumice stone or foot file after softening the skin, combined with application of 6% salicylic acid products for regular calluses. 1

Initial Assessment and Treatment

Conservative Management (First-Line)

1. Skin Softening and Mechanical Debridement:

   • Soak feet in lukewarm water for 5-10 minutes to soften the callus
   • Gently file the callus with a pumice stone or foot file
   • Dry thoroughly before applying any topical treatments 1

2. Topical Treatments:

   • Apply 6% salicylic acid products for regular calluses (up to 40% for thicker calluses)
   • Apply thoroughly to the affected area at night after washing
   • Cover overnight and wash off in the morning 1
   • Continue treatment for several weeks until callus is sufficiently reduced

3. Footwear Modifications:

   • Use open-backed shoes to reduce pressure on the area
   • Consider heel lifts or orthoses to redistribute pressure 2
   • Ensure footwear accommodates the shape of the feet and fits properly 2

Addressing Underlying Causes

• Evaluate for biomechanical issues that may contribute to callus formation
• Consider orthotic devices if foot deformity is present 2
• For non-rigid hammertoes with callus formation, consider orthotic interventions such as toe silicone or semi-rigid orthotic devices 2

When to Escalate Treatment

Indications for Professional Care

• Calluses that are extremely painful or bleeding
• No improvement after 2-3 weeks of consistent home treatment
• Signs of infection or inflammation 1
• Pre-ulcerative lesions (especially important in diabetic patients) 2

Professional Treatment Options

1. Professional Debridement:

   • Performed by a podiatrist using manual debridement techniques
   • More conservative approach recommended to avoid making the underlying skin susceptible to increased tenderness 2
   • After debridement, emollients and nonadherent dressings should be used to protect the debrided skin

2. Advanced Interventions (for persistent cases):

   • Assessment and correction of weight distribution with cushioning 2
   • For cases associated with Haglund's deformity, consider immobilization cast or fixed-ankle walker-type device 2
   • In severe cases with significant deformity, surgical intervention may be considered but only after conservative measures fail 3

Special Considerations

For Diabetic Patients

• Diabetic patients should consult healthcare providers before using chemical treatments due to risk of complications 1
• Professional debridement is recommended rather than self-treatment 2
• Regular monitoring for pre-ulcerative lesions is essential 2

For Athletes

• Athletes with Achilles tendon issues may develop calluses as a protective response
• Address any underlying tendinopathy with appropriate exercises and load management 4
• Consider activity modification during treatment period

Prevention Strategies

• Regular use of moisturizing creams to prevent skin dryness
• Properly fitting footwear that doesn't create excessive pressure
• Regular gentle exfoliation before calluses become thick and painful
• For recurrent calluses, address biomechanical issues with appropriate orthotic devices 2

Remember that calluses are a normal physiologic response to chronic excessive pressure or friction, and treatment should focus on both symptomatic relief and addressing the underlying mechanical cause 3.