What are the treatment options for a callus on the side of the instep of the foot?

Treatment Options for Calluses on the Side of the Foot Instep

Calluses on the side of the foot instep should be treated by removing excess callus tissue by a trained healthcare professional, combined with addressing the underlying mechanical causes through appropriate footwear and orthotic devices. 1

Professional Treatment Options

• Professional removal of excess callus by a trained healthcare professional is the primary treatment, which reduces plantar pressure and helps prevent complications 1
• Callus debridement should be performed carefully to avoid potential harm, especially in patients with diabetes or vascular issues 1
• Soaking the affected area in warm, soapy water for 10-15 minutes before treatment can help soften the callus and make removal easier 2
• For patients with diabetes, professional foot care should be repeated every 1-3 months for high-risk patients and every 3-6 months for moderate-risk patients 1

Self-Care and Topical Treatments

• Salicylic acid preparations (6%) can be applied to the affected area at night after washing and covered, then washed off in the morning 3
• Prior to application of salicylic acid, the skin should be hydrated for at least five minutes to enhance effectiveness 3
• If excessive drying or irritation occurs after using salicylic acid, a bland cream or lotion may be applied 3
• Potassium hydroxide (40%) and trichloroacetic acid are alternative home treatments that show some improvement in callus condition over 21 days, though less effective than professional debridement 4

Addressing Underlying Causes

• Properly fitting shoes with adequate width and depth are essential to prevent pressure on the callused area 2, 5
• Custom-made footwear, custom-made insoles, or orthotic devices should be considered for patients with foot deformities or recurrent calluses 1
• Toe silicone and semi-rigid orthotic devices can help reduce excess callus by redistributing pressure 1
• For calluses associated with hammertoes, digital flexor tendon tenotomy may be considered when non-surgical treatments fail 1

Special Considerations for Diabetic Patients

• In diabetic patients, calluses are considered pre-ulcerative lesions that require immediate treatment to prevent ulceration 1
• Callus removal in diabetic patients has been shown to reduce peak plantar pressures by approximately 26%, significantly decreasing ulceration risk 6
• Integrated foot care for diabetic patients should include professional callus care, appropriate footwear, and structured education about self-care 1
• Surgical interventions should only be considered after full evaluation of non-surgical treatment options by an appropriately trained healthcare professional 1

Prevention Strategies

• Daily application of moisturizers can help prevent callus formation by maintaining skin elasticity 2
• Regular inspection of the feet for early signs of callus development is recommended, especially for diabetic patients 7
• Avoiding barefoot walking and wearing appropriate, well-fitting footwear can prevent callus recurrence 7, 2
• Addressing biomechanical abnormalities through orthotic devices can help prevent callus recurrence by redistributing pressure 5

Treatment Algorithm

1. Initial assessment: Evaluate the callus severity, location, and underlying causes 5
2. For mild to moderate calluses: Begin with conservative treatment including proper footwear, padding, and professional debridement 5
3. For persistent calluses: Consider custom orthotic devices to redistribute pressure 1
4. For severe or recurrent calluses with underlying structural issues: Consider surgical intervention to correct the mechanical cause 1
5. Follow-up care: Regular monitoring and maintenance debridement as needed 1