Management of Diabetic Foot Callus in a Patient with Limited Resources
For a diabetic patient with a callus on the lateral aspect of the left fifth toe, use a pumice stone for gentle debridement and apply Eucerin cream twice daily as an effective alternative to Epsom salt foot soaks. 1
Assessment and Treatment Plan
Immediate Management
- The prescribed Apex X521M size 10.5 shoes are appropriate as properly fitted therapeutic footwear is essential for preventing ulceration in diabetic patients 2
- For the callus on the lateral aspect of the left fifth toe:
- Professional sharp debridement is the most effective immediate treatment for painful foot calluses 1
- Patient self-care with a pumice stone is an appropriate alternative when professional care is not immediately available
- Apply Eucerin cream (prescribed) immediately after gentle debridement to restore skin barrier function and maintain hydration 1
Alternative to Epsom Salts
- While Epsom salt foot baths are useful for softening hyperkeratotic tissue, their unavailability should not delay treatment 1
- Alternative approach:
- Soak feet in clean warm water for 5-10 minutes to soften the callus
- Gently use the pumice stone on the softened callus
- Dry thoroughly, especially between toes
- Apply Eucerin cream immediately after soaking to lock in moisture
Follow-Up and Monitoring
- The scheduled follow-up on 8/22/2025 is appropriate to:
- Assess response to treatment
- Evaluate for any signs of infection or inflammation
- Check for proper fit of the new diabetic shoes
- Provide education on proper foot care techniques 1
Patient Education Points
- Instruct the patient to:
- Inspect feet daily, especially between toes
- Apply Eucerin cream at least twice daily
- Avoid walking barefoot, even indoors
- Wear the prescribed diabetic shoes consistently
- Monitor for signs requiring immediate attention (increased redness, warmth, pain, or discharge) 1
Important Considerations
- Pre-ulcerative lesions like calluses are strong predictors of future ulceration in diabetic patients 2
- Removal of callus reduces plantar pressure, an important risk factor for ulceration 2
- Proper footwear should be 1-2 cm longer than the foot with width equal to foot width at metatarsal phalangeal joints 1
- Worn-out medical shoes should be replaced approximately every 10 months to prevent recurrence of calluses 1
Common Pitfalls to Avoid
- Neglecting to assess vascular status before aggressive debridement 1
- Using over-the-counter chemical callus removers, which can damage healthy tissue 1
- Inadequate drying between toes after soaking, which can lead to fungal infections
- Inconsistent use of prescribed footwear, which significantly increases ulceration risk 2