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Callus | calluses in diabetic patients - information and misconceptions

Callus | calluses | Dr Somesh Diabetic Foot Clinic - Misconceptions

My idea behind writing this article is to create awareness in every diabetic patient that callus is the root cause of most of the existing diabetic foot problems , the earlier they get rid of it, the better. I have tried to alleviate the common misconceptions prevailing in diabetic patients with callus, to prevent diabetic foot ulcerations/infections, this is from my personal experience interacting with patients in india

I come across a lot of diabetic foot infection cases daily. when i enquired these patients history, among those who are presently having infection or those who are already amputated ,many were found to have previous history of callus .i generally ask diabetic patients whether they know that callus in diabetic patients can lead to diabetic foot ulcer or diabetic foot infection or whether they have ever consulted any of the doctors before , whether they are being educated about methods of prevention of callus, whether they have followed doctors advise properly, some say yes, some patients say no, but the ultimate worst part is that many of these patients conditions continue to progress and end up in diabetic foot ulcerations/ what goes wrong for patients who listen to their doctors advise, how does patient's negligence lead to diabetic foot infections

What is callus?
Callus is thickened hard skin that develops due to more pressure at certain localized areas most often on foot while walking

Callus in diabetic foot and non diabetic patients- what makes difference?
Callus usually does not cause problems in non diabetics except for pain while walking if it grows harder before any callus can ulcerate. these patients approach doctors at right time because of pain and get callus trimmed and take steps to prevent callus recurrence.
In diabetic patients with sensory impairment due to neuropathy, even if callus grows harder like a stone, pateint does not feel pain and continues to walk with it pressing soft tissues and bone which can lead to diabetic foot ulcer/infections,

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Normal appearing callus in left image 3rd toe tip

Quiesant infection (pus) beneath the same 3rd toe in right side image




Since diabetic patients have misconception that callus is normal thing since it is there for many years to them and it did not do any harm during that period,this is one of the commonest reason why many patients do not follow their podiatrist advise even though patients are warned that callus can harm them but continue to have the risk of ulceration in future

What are treatment options for callus?
Callus trimming, proper foot care, diabetic foot wear and podiatry surgery are various options.the mode of treatment depends upon individual presentation

Callus trimming -misconceptions
Callus can be trimmed to offload the pressure area from hard stone kind of skin, thus preventing diabetic ulcers/ infection formation , but many patients generally fear that procedure is painful or it can lead to wound /diabetic foot infections after trimming. these are commonest reasons for patients denying callus trimming/scraping

Callus/calluses in Diabetic Foot india2Callus scraping can be done without causing wound unless they are presenting in late stages where ulcer has already formed beneath.
callus scraping is a painless procedure that does not require anesthesia or medication since callus is like hard dead skin,hard skin removal without causing wound to normal skin would not cause pain.

Is callus trimming alone sufficient?
Callus trimming is a temporary solution unless proper foot care steps are educated to patients in diabetic foot clinic regarding methods of its prevention. this is one area some doctors in india who are general practitioners or general surgeons mismanage. although they are unaware of how to handle these cases fully they treat these patients, mismanage them by advising MCP/MCR footwear without individual customization and ultimately callus progresses to diabetic foot ulcer even in patients who are compliant to any treatment advised by doctors.
This is the reason why many patients in india deny callus trimming repeatedly since it recurrs within a month or so.

When does callus recur?
If callus recurs or grows more, it suggests that either patients are not using diabetic footwear correctly as advised by doctors or footwear prescribed by their doctor is not reducing pressure at the required points. hence it is need of the hour for patients to have consultation with foot specialist since they require either footwear modifications or podiatric surgeries

A good diabetic footwear with individual customization according to location of callus and proper diabetic foot care procedures could prevent callus turning into ulcer,but some patients with gross deformity and diabetic foot neuropathy would require podiatric sugeries to correct deformity and prevent callus if recurrs with above procedures

Indian patients also do wrong in that they use footwear outside and not inside house but blame doctors if callus recurrs,diabetic footwear has to be weared both inside and outside house for pressure reduction and callus prevention

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