What is the best management plan for a callus on the left fifth toe in a patient with hemiplegia and hemiparesis?

Management of Callus on Left Fifth Toe in a Patient with Hemiplegia and Hemiparesis

For a 73-year-old male with right-side hemiplegia and hemiparesis following cerebral infarction, Epsom salt foot baths combined with gentle pumice stone debridement is the recommended approach for managing a callus on the left fifth toe lateral aspect. 1, 2

Recommended Treatment Protocol

Primary Management

1. Callus Debridement and Foot Bath Regimen

   • Continue with Epsom salt foot baths as instructed
   • Perform gentle debridement with pumice stone to remove hyperkeratotic tissue
   • Limit duration of soaking to prevent skin maceration (avoid prolonged footbaths) 1
   • Maintain water temperature between 40-45°C for optimal effect 3

2. Pressure Offloading

   • Assess and modify footwear to reduce pressure on the fifth toe
   • Consider silicone or semi-rigid orthotic devices to redistribute pressure 2
   • Ensure shoes are 1-2 cm longer than foot with adequate width at metatarsal phalangeal joints 2
   • For non-plantar ulcers, consider toe-spacers or orthoses 1

Special Considerations for Hemiplegic Patients

• Weight-bearing patterns: Patients with hemiplegia typically bear more weight on their non-paretic side 4, which may affect callus formation on the left foot
• Balance and safety: Ensure patient has appropriate support during foot care activities
• Functional training: Continue reinforcing proper technique as patient has demonstrated correct procedure

Follow-up and Monitoring

• Schedule follow-up in 1-3 months to assess:
  • Response to treatment
  • Need for additional professional debridement
  • Proper footwear fit 2
• Monitor for signs of infection or skin breakdown:
  • Increased redness
  • Warmth
  • Pain
  • Discharge 2

Patient Education

• Instruct on proper foot inspection, especially between toes 2
• Advise against walking barefoot, even indoors 1
• Recommend regular moisturizing after foot baths to prevent skin dryness
• Teach recognition of signs requiring immediate medical attention 2

Potential Benefits and Evidence

The use of salt water baths has shown benefits in several studies:

• Reduced pain in patients with neuropathy 3
• Improved skin condition and reduced infection risk 5
• Enhanced quality of life through symptom management 6

Cautions

• Avoid prolonged soaking which can lead to skin maceration 1
• Monitor for signs of skin breakdown, particularly important in patients with sensory deficits
• Ensure water temperature is appropriate to prevent burns

This approach aligns with current guidelines for foot care management while addressing the specific needs of a patient with hemiplegia and hemiparesis.