What is the treatment for a callus?

Treatment of Callus

Professional scalpel debridement by a trained healthcare provider is the gold standard treatment for callus, which should be combined with addressing underlying mechanical causes through appropriate footwear and orthotic devices. 1, 2

Primary Treatment: Professional Debridement

• Sharp scalpel debridement removes all callus tissue and is the cornerstone of management, as it reduces plantar pressure (a key risk factor for ulceration) and prevents complications 3, 2, 4
• Debridement must be performed by an appropriately trained healthcare professional to avoid potential harm, particularly in high-risk patients 3
• The procedure showed immediate and significant improvements in skin hydration, elasticity, texture, and associated foot pain in controlled trials 4
• Repeat debridement every 1-3 months for high-risk patients (diabetics, peripheral arterial disease) and every 3-6 months for moderate-risk patients 1, 2

Addressing Mechanical Causes (Essential for Prevention)

After debridement, you must address why the callus formed:

• Prescribe custom-made footwear, custom-made insoles, or orthotic devices for patients with foot deformities or recurrent calluses 3, 1, 2
• Toe silicone devices and semi-rigid orthotic devices redistribute pressure and reduce callus formation on toes 3, 1
• The shoe should be 1-2 cm longer than the foot, with internal width equal to the foot width at the metatarsal phalangeal joints 3
• Evaluate footwear fit with the patient standing, preferably at the end of the day 3

Home Care and Prevention

• Apply emollients daily to maintain skin hydration and elasticity, but never between the toes (risk of maceration) 3, 2, 5
• Daily foot inspection to identify early callus development, especially for diabetic patients 1, 2, 5
• Daily lukewarm baths (30 minutes or more) with gentle scale removal using sponges, microfiber cloths, or pumice stone 3
• Never walk barefoot, in socks only, or in thin-soled slippers, whether indoors or outdoors 3, 5

Topical Keratolytic Agents (Adjunctive)

While professional debridement is primary, keratolytics may be used as adjuncts:

• Salicylic acid 6% can be applied to affected areas at night after washing, with the medication washed off in the morning 6
• Urea (≥10%) may be used, but not recommended before age 1 year except on limited areas like palms and soles 3
• A combination product containing 1% cantharidin, 30% salicylic acid, and 5% podophyllin showed 79.2% success in one session when applied after tangential excision 7
• Potassium hydroxide (<10%) products showed safety and effectiveness when applied for 3-5 minutes before filing 8

Special Considerations for High-Risk Patients

In diabetic patients, calluses are pre-ulcerative lesions requiring immediate treatment to prevent ulceration 3, 1, 2:

• More conservative debridement approach due to higher complication risk 2, 5
• Integrated foot care including professional removal, appropriate footwear, and structured education 1, 2
• If one or more pedal pulses are absent, perform extensive vascular evaluation before aggressive debridement 3
• Therapeutic footwear is mandatory for high-risk patients 5

Surgical Options for Refractory Cases

When non-surgical treatments fail:

• Consider digital flexor tendon tenotomy for non-rigid hammertoes with callus on the apex or distal toe 3, 1, 2
• This procedure is easily performed in an outpatient setting with no need for immobilization 3
• Surgery should only be considered after full evaluation of non-surgical options by an appropriately trained healthcare professional 3, 1

Critical Pitfalls to Avoid

• Never allow patients to self-treat with chemical corn removers or plasters—this increases infection and ulceration risk 3, 2, 5
• Do not cut corns or calluses at home; professional care is essential 2, 5
• Avoid applying moisturizers between toes, as this increases maceration risk 2, 5
• Do not use iodine-based antiseptics (risk of thyroid dysfunction) 3