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difficult heel callous

Discussion in 'General Issues and Discussion Forum' started by peter mccloskey, Apr 17, 2012.


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    This is a regular patient who is very heavy and has very dry skin and thick callous around his heels.The heel callous doesn't hurt usually but does for a week after treatment. I debride the callous as much as possible with a scalpel, it is quite vascular, and then smooth it off with the rotary sandpaper drill thing and then moisturise. The patient can't reach his feet to apply any creams. Any suggestions would be welcome.

    Attached Files:

  2. Nice pictures!!

    Bel will doubtless be along shortly with better advice, but if that was mine, I'd say you want to get him a box of allyvn heel (get the gp to prescribe it) and get him to put a dollop of cream in that and replace it every 3 or 4 days. Whoever puts his socks on should be capable of that.
  3. markleigh

    markleigh Active Member

    I had a very similar patient - he weighed 250kg's - seen for debridement every 4-6 weeks. It wasn't until he lost 70kg's from gastric banding surgery, that the callus significantly improved.
  4. Leg looks a bit lymphoedema-y to me. that might make effective weight loss tricky..
  5. Peter

    Peter Well-Known Member

    I vaguely remember using Algeos socks with a gel lining which contacted the skin. They helped secret oil into the skin, but had a horrible tendency to ride up and down the foot. It extended the efficacy of a clinic Rx if nothing else.
  6. toughspiders

    toughspiders Active Member


    I would say granuflex for a week, then debride... no walking barefoot and out of the backless shoes (if guilty) :)
  7. blinda

    blinda MVP

    All of the above, in particular the allyvn heel cup with emollient, plus a topical fungicide. Better still, if the GP is willing, combination therapy of oral and topical anti-fungals. Sometimes, it is worth gently reminding GPs that terbinafine is not the only fruit.
  8. Disgruntled pod

    Disgruntled pod Active Member

    I have a patient like this. A good old no.11 blade and use of a Dia-Twister/water spray drill.
  9. Disgruntled pod

    Disgruntled pod Active Member

    This type of patient is next to impossible to treat effectively on a DOM. I have had patients like this who have had DOM practitioners before, and I am told that I do a far better job!
  10. vuye

    vuye Member

    If you're going to ask the GP for a prescription granuflex is a better option as it adds moisture and holds in whatever tiny moisture from the skin. Best to use it after debridement. He can also get an old flannel put loads of cream on it, put it on the floor then rub his heels into it while sitting down..I think this is one of the best ways to apply cream to feet without having to bEnd down.
    Advise the patient to soak his feet in water for 30mins before his appointment to make life easier on your hand as well :).
  11. Tkemp

    Tkemp Active Member

    Definitely send sample of deeper callus/tissue to pathology to rule out fungus.
    Had similar on a patient. She was prescribed a combination of oral and topical antifungals and it cleared.
  12. Suzannethefoot

    Suzannethefoot Active Member


    I did only DOM work for years and have seen many such heels, which with the help of a strong hand and patient foot rest, was able to treat effectively, along with creams ect. You may do a far better job, but that is more likely to do with skill than anything else.

    You may like to suggest the spray on emollients being widely advertised in pod magazines lately, they can spray at any angle, so usable for almost every patient.
  13. richardrobley

    richardrobley Active Member

    Flexitol heel balm twice a day combined with regular debridement. If they can't reach their feet squirt plenty into a carrier bag, pop your feet in and rub feet together and around the bag, works a treat.
  14. Sarah Byrne

    Sarah Byrne Member

    For hard to reach areas, patients can apply emmolients using the wee paint rollers used to decorate behind radiators.
    PS I do doms, it doesn't stop my blades cutting either!
  15. dsfeet

    dsfeet Active Member

    i find, soaking them first in warm soapy water 10 mins ( yes old fashioned, use a removal plastic liner for hygiene) helps to remove the callous much esaier , less bleeding, less blades much quicker. After debridement apply bactigrass and opsite ,tape on , leave in place for 4 days , helps heal the cracking. ( also great for the psorasis patient) To cream his feet himself, put cream on plate or plastic lid and rub heels in it , pat with towel before standing or put socks on . Train them to come in 10 mins prior to appt time, receptionist can set up soak then they are ready for you at appt time.
    Works for my patients.
  16. Thanks to everybody for advice. I will try some of those treatments when I next see him. If there is a good result I will take some more photos.

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