What treatment and management options are recommended for a 57-year-old male patient with a callous on his right foot, who has found suitable special shoes and requires a medical memo to support their use?

Management of Foot Callus with Special Footwear

For a 57-year-old male patient with a foot callus, providing a medical memo supporting the use of special shoes is appropriate, as proper footwear is essential for preventing callus progression and potential complications.

Assessment and Diagnosis

• Calluses are areas of thickened, hardened skin that develop due to repeated friction or pressure, often from ill-fitting footwear or foot deformities 1
• Calluses commonly occur on weight-bearing areas of the foot and can become painful when they thicken excessively 1
• Calluses should be evaluated for their location, size, and whether they are causing pain or affecting mobility 1

Appropriate Footwear Recommendations

Key Features for Special Shoes

• The shoes should have adequate room in the toe box to prevent compression of the toes and forefoot 1
• The internal width should equal the width of the foot at the metatarsal phalangeal joints (the widest part of the foot) 1
• The inside of the shoe should be 1-2 cm longer than the foot itself 1
• The height should allow enough room for all toes 1
• Shoes should have flat or minimal heels and good support 1
• Materials should allow for ventilation (leather or fabric mesh rather than plastic or synthetic) 1

Evaluation of Proper Fit

• Fit should be evaluated with the patient in standing position, preferably at the end of the day when feet may be slightly swollen 1
• The shoe should not be too tight or too loose 1
• If the fit is poor because of foot deformities, or if there are signs of abnormal loading of the foot (e.g., hyperemia, callus, ulceration), special footwear with custom insoles may be necessary 1

Treatment of Existing Callus

• Calluses should be treated by a trained foot care specialist through regular debridement 1
• Chemical agents or plasters to remove corns and calluses should not be used by the patient 1
• Lubricating oils or creams can be used for dry skin, but not between the toes 1

Benefits of Special Footwear

• Appropriate footwear reduces pressure on callused areas, potentially preventing ulceration 2, 3
• Custom or specialized shoes can redistribute plantar pressure, reducing peak pressures by up to 33% in areas of concern 2, 3
• Proper footwear can accommodate existing calluses while preventing the formation of new ones 1
• Studies show that customized footwear can significantly reduce maximum plantar pressure, which is particularly important in preventing complications 3, 4

Recommendations for Medical Memo

The medical memo should include:

• Diagnosis of foot callus and its location
• Recommendation for special shoes with specific features (proper width, depth, support, etc.)
• Justification that these shoes are medically necessary to:
  • Reduce pressure on the callused area
  • Prevent progression of the callus
  • Reduce risk of complications such as ulceration
  • Improve mobility and reduce pain
• Duration for which the special footwear is needed (typically long-term)

Patient Education

• Instruct the patient on daily foot inspection, including areas between the toes 1
• Advise regular washing of feet with careful drying, especially between the toes 1
• Recommend daily inspection and palpation of the inside of the shoes 1
• Emphasize the importance of not walking barefoot, both indoors and outdoors 1

Follow-up Care

• Schedule regular follow-up appointments to monitor the callus and evaluate the effectiveness of the special footwear 1
• Adjust footwear recommendations as needed based on changes in the callus or foot condition 1
• Consider referral to a podiatrist if the callus persists despite appropriate footwear 1