Treatment for Callus
Callus should be debrided with a scalpel by a trained foot care specialist, combined with pressure redistribution through appropriate footwear to prevent recurrence. 1, 2
Immediate Management Approach
Professional Debridement (First-Line Treatment)
- Sharp debridement with a scalpel is the gold standard treatment, performed by a trained podiatrist or foot care specialist until the callus resolves 1, 2
- Debride all surrounding callus tissue, not just the central lesion, as this reduces abnormal pressure distribution 1
- Repeat debridement as needed at regular intervals (every 1-3 months for high-risk patients) 1
- This approach shows immediate and significant improvement in skin quality, pain, and function compared to home treatments 3
Critical caveat: Do not debride ischemic ulcers or calluses in patients with severe peripheral arterial disease without vascular assessment first 1
Pressure Redistribution (Essential for Prevention of Recurrence)
- Prescribe well-fitted walking shoes or extra-depth shoes that cushion the feet and redistribute plantar pressure away from the callus site 1, 2
- For patients with foot deformities or recurrent callus, prescribe custom-made insoles or orthotic devices—rigid orthoses show significant reduction in callus grade over 12 months 1, 4
- Ensure footwear is 1-2 cm longer than the foot, with width equal to the metatarsal phalangeal joint width 1
Adjunctive Home Treatments (Secondary Options)
Topical Keratolytic Agents
- Urea-based preparations (FDA-approved for hyperkeratotic conditions including calluses) can be applied for debridement and promotion of healing 5
- Salicylic acid 6% may be applied after hydrating skin for 5 minutes, covered overnight, then washed off in the morning 6
- Trichloroacetic acid (TCA) shows lesser but comparable changes in skin quality over 21 days compared to professional debridement 3
Important warning: These agents should not replace professional care, particularly in diabetic patients, and excessive application can cause local irritation 6
Special Considerations for Diabetic Patients
Risk Assessment Required
- Perform 10-g monofilament testing to assess for loss of protective sensation 1, 2
- Palpate pedal pulses and assess ankle-brachial index if pulses are diminished 1, 2
- Inspect for erythema, warmth, or pre-ulcerative changes around the callus 1, 2
Enhanced Treatment Protocol
- Callus in diabetic patients is a strong predictor of ulceration and requires aggressive treatment 1
- Schedule professional foot care every 1-3 months depending on risk level (IWGDF risk 2-3 patients need more frequent care) 1
- Never allow diabetic patients to walk barefoot, in socks only, or in thin-soled slippers 1, 2
- Refer to multidisciplinary foot care team if there is history of ulceration, amputation, or loss of protective sensation 1, 2
Patient Education for Diabetics
- Daily foot inspection for new lesions, warmth, or color changes 1, 2
- Immediate reporting of any signs of inflammation or skin breakdown 1, 2
- Strict adherence to prescribed footwear both indoors and outdoors 1, 2
Treatment Algorithm Summary
- Initial assessment: Determine if patient has diabetes, peripheral neuropathy, or vascular disease 1, 2
- Professional debridement: Sharp scalpel debridement by trained specialist (unless contraindicated by ischemia) 1, 2
- Pressure redistribution: Prescribe appropriate footwear or custom orthoses based on foot structure and deformity 1, 4
- Adjunctive therapy: Consider topical keratolytics (urea or salicylic acid) for home maintenance between professional visits 5, 6
- Follow-up schedule: Every 1-3 months for high-risk patients, longer intervals for low-risk patients 1
Common pitfall to avoid: Do not rely solely on over-the-counter treatments or allow patients to self-treat with chemical agents or plasters, especially in diabetic patients, as this significantly increases ulceration risk 1, 3