Treatment of Callus
Professional scalpel debridement by a trained foot care specialist is the gold standard treatment for callus, providing immediate and significant improvement in skin quality, pain, and function. 1, 2, 3
Risk Stratification First
Before treating any callus, assess the patient's risk category:
- Check for diabetes - perform monofilament testing (10-g Semmes-Weinstein) to assess for loss of protective sensation 2
- Palpate pedal pulses - assess for peripheral arterial disease 2
- Inspect for warning signs - look for erythema, warmth, or impending tissue breakdown around the callus 2
Treatment Algorithm
For All Patients (With or Without Diabetes)
Primary Treatment:
- Scalpel debridement by a trained healthcare professional until the callus resolves and does not recur 1, 2, 3
- This provides immediate, significant changes in all objective skin quality measures and associated pain 3
Pressure Redistribution (Essential to Prevent Recurrence):
- Prescribe well-fitted walking shoes or athletic shoes that cushion the feet and redistribute plantar pressure 1, 2
- For patients with foot deformities or pre-ulcerative lesions, consider extra-depth shoes, custom-made footwear, or custom-made insoles 1, 4
- Address underlying biomechanics with orthotic devices to redistribute pressure away from affected areas 4
For Diabetic Patients (Additional Requirements)
Mandatory interventions:
- Never allow barefoot walking - patients must wear appropriate footwear at all times, both indoors and outdoors 2
- Visual inspection at every healthcare visit if neuropathy is present 2
- Refer to multidisciplinary foot care team if history of prior ulceration, amputation, or loss of protective sensation 2
Patient education requirements:
- Daily foot inspection for new lesions or changes 2
- Immediate reporting of any warmth, redness, or drainage 2
- Adherence to offloading footwear is critical 2
Home Treatment Options (Adjunctive or When Professional Care Unavailable)
Salicylic acid 6%:
- Apply thoroughly to affected area after washing, cover at night 5
- Hydrate skin for at least 5 minutes prior to application 5
- Wash off in morning 5
- Caution: Do not use in children under 12, patients with renal/hepatic impairment, or those with varicella/influenza due to Reye's syndrome risk 5
- Avoid occlusive dressings and excessive application 5
Alternative topical agents:
- Trichloroacetic acid (TCA) or potassium hydroxide (KOH) show lesser but sometimes comparable changes over 21 days compared to professional debridement 3
- Canthacur-PS (1% cantharidin, 30% salicylic acid, 5% podophyllin) after tangential excision showed 79.2% success in one session 6
Common Pitfalls to Avoid
- Do not treat calluses in isolation without addressing underlying biomechanical abnormalities - this leads to rapid recurrence 4, 7
- Do not use footbaths where feet are soaked - these induce skin maceration 1
- Surgery is rarely indicated and should only target correcting abnormal mechanical stresses 7
- Do not confuse with plantar warts - gentle paring with scalpel will reveal soft, granular, elongated mounds of dermis projecting into epidermis if it's a wart 8
Long-Term Management
- Once callus resolves, occasional use of treatment maintains remission 5
- Integrate patients into foot-care program with lifelong observation, professional foot treatment, adequate footwear, and education 1
- For high-risk diabetic patients (IWGDF risk 2-3), provide integrated foot care every 1-3 months 1