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I currently have a patient who is having major problems with lateral heel callus/blisters. He had been training for a marathon, but has now switched to walking - currently 12km, 3 times a week. He develops very thick callus with underlying blisters and bruising along his lateral heels. This in turn gets very inflamed and swell - the following day post exercise he has difficulty weigh bearing. The only relief is to get them debrided, but this is required very often. He is using a cushioning runner, has tried a neutral runner. Has tried some masking of the area and tulis heel cups - but with no real change in the development of the callus. He has a marked varus heel but with reasonable ROM.
Are they any suggestions I can offer my patient on how to deal with his heels?
Thanks

 

Get him out of the "Cushioned heels" IMO

If he is Varus a cushioned heel will only exaggerate the varus moment, as the soling material compress on the lateral side during heel strike, increasing the load on the lateral side of the foot, the older the footwear gets the greater this will be visible.

Then provide a suitable orthosis for greater off loading, if this is still failing then l would be doing a lateral flare, heel to mid foot.

 

I treat a lot of race walkers. One of the things that is prone to happening is that the due to the leg having to be fully extended at initial contact, the foot is usually supinated and maximally dorsiflexed due to the strong action of tib ant. The leg is usually adducted and as the heel strikes the ground, the shoe rotates round the foot slightly and the friction/compression at the lateral calc causes significant hard skin and blistering.

How to solve it? That's the big question. In many cases, nothing fixes it and regardless of the prophylactic techniques employed, the blistering occurs, frequently blood filled.

The best results I have had are with no orthoses (sometimes a flat rear foot wedge) and shearban/ENGO blister patches covering the lateral aspect of the heel counter. (The material is stuck to the shoe, not the foot)

The reality is that there are many different ways of reducing blistering from 1000 mile socks/vaseline to talcum powder and 2 pairs of socks. There is no substitute for trying them all to see which works best.

Good luck

 

Why does he have an inverted heel? Rearfoot varus, or supination from the forefoot? What does barefoot gait look like?

 

Are you saying that he switched from running to walking to ease the heel problem or that changing to walking started the heel problem?

Dave

 

Thanks for your questions.
He has a rearfoot varus and supinates only just to neutral that I observed barefoot. He has tight calf complex and has a shortened heel contact time. He had this problem when running with deep callus forming, but not to the this degree with the surrounding tissue becoming inflammed and swollen. He ceased running to concentrate on walking as in 6 months he's booked to trek extensively in Nepal.

 

Then he better buy a ticket for you also:D

 

I'll definitely pass that expert professional advice on to him!

 

Hi
I have read this post and the one under the corns thread that deals with heavy heel callus.
Perhaps someone can help me with a similar scenario?

My patient is a 34 year old woman with barely any fat pad on her heels at all. She presents with evenly distributed heavy calc callus every 6 weeks together with 1st medial ipj callus. She has poor peripheral circulation, suffering from chillblains every winter. She wears flip flops during the summer and ugg boots in the winter, these are non-negotiable; insoles aren't viable as patient compliance is an issue.
She moisturises with flexitol daily.
I am quite happy to continue with regular debridement but there has been little improvement in callus reduction for the last three years and this has made me wonder if there is a stage when over-debridement of callus can cause the bodies' protection mechanism to create greater hyper keratosis?

Is there any evidence out there.? I've checked cochrane library but can only find trials on ulcer debridement.
My guess is that it isn't life threatening therefore doesn't warrant too much investigation, am I wrong? Anyone know any different please?

Podhugh :confused: