What is the best treatment approach for a patient with bilateral calluses and dryness, currently using medical shoes that are falling apart?

Management of Bilateral Calluses and Foot Care with Medical Shoes

For patients with bilateral calluses and dry feet, the most effective treatment approach includes replacing worn-out medical shoes, prescribing Epsom salt foot baths followed by moisturizing cream application, and ensuring proper footwear fit to prevent recurrence. 1

Assessment of Calluses and Footwear

• Footwear evaluation: The patient's current medical shoes are falling apart after approximately 10 months of use, indicating appropriate replacement timing
• Callus assessment: Bilateral calluses suggest mechanical stress from:
  • Possible foot deformities
  • Improper weight distribution
  • Friction from inadequate footwear 2, 1
• Dryness assessment: Skin dryness contributes to callus formation and increases risk of skin breakdown 1

Treatment Plan

1. Footwear Management

• Prescription of Apex X520M size 12.0 WIDE with insoles size 12.0 is appropriate as it:
  • Provides proper width to accommodate the foot at metatarsal phalangeal joints
  • Ensures adequate length (should be 1-2 cm longer than foot)
  • Includes appropriate insoles for pressure redistribution 2, 1

2. Callus and Dryness Management

• Epsom salt foot baths:

  • Recommended nightly to soften hyperkeratotic tissue
  • Helps prepare skin for effective moisturizer absorption
  • Provides gentle exfoliation of dead skin cells 1

• Minerin cream application:

  • Apply immediately after foot baths when skin is still slightly damp
  • Contains emollients that help restore skin barrier function
  • Should be applied generously to callused and dry areas 1

3. Patient Education

• Instruct patient on proper foot inspection, especially between toes
• Advise against walking barefoot, even indoors
• Demonstrate how to inspect new shoes before wearing them
• Explain the importance of applying moisturizer daily 2

Follow-up Recommendations

• Schedule follow-up in 1-3 months to assess:

  • Fit of new footwear
  • Response of calluses to treatment
  • Need for professional debridement if calluses persist 1

• Consider referral to podiatry for debridement if calluses remain painful or thick despite conservative treatment 2, 1

Precautions and Considerations

• Monitor for pre-ulcerative signs:

  • Increased redness or warmth
  • Blisters under calluses
  • Pain or discomfort despite treatment 2

• Footwear adjustment period:

  • New shoes should be broken in gradually
  • Patient should inspect feet after wearing new shoes for signs of pressure or friction 2

This comprehensive approach addresses both immediate concerns (replacing worn footwear, treating existing calluses) and long-term prevention through proper foot care and appropriate footwear, which is essential for preventing complications and maintaining foot health.