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Hi folks,

I'm a 3rd year undergraduate podiatry student who is in the process of looking into the effectiveness of callus debridement for pain relief, quality of life and ulcer prevention in people with rheumatoid arthritis. I would be most grateful for other podiatrists and researchers thoughts on this matter.


Kind Regards

Rachel Liminton:craig::craig::confused::confused:

 

I know there is a research article that looks at callus debridement vs insole therapy for painful plantar callosities..... not sure if that would help as it is not specific to RA - but could be a useful starting point for your research design etc....

 

A study we published is here: http://www.apodc.com.au/AJPM/Contents/volume_392.htm

You should also see:
Redmond A, et al. (1999) Effect of scalpel debridement on the pain of plantar hyperkeratosis. JAPMA 89: 10 515-519

and
Woodburn J, Stableford Z, Helliwell PS (2000) Preliminary investigation of debridement of plantar callosities in rheumatoid arthritis. Rheumatology 39: 6 652-654

 

This paper may also prove useful:

BALANOWSKI, K.R., FLYNN, L.M., 2005 Effect of painful keratoses debridement on foot pain, balance and function in older adults. Gait and Posture. Dec; 22(4): 302-7.

 

Thanks guys,

This information has been really helpful. I know a lot of research has been done to understand the role of callus debridement, especially with regards to diabetes and ulcer prevention. However in RA it seems to be a different ball game....I will certainly follow up these pointers. Thank you once again.
Kind regards
Rachel:drinks:drinks

 

Please feel free to pass on your results when you get them! ;)

 

Dear Rachel,

I am sure that when you do your literature search you are going to come across articles, like one that Simon suggests, by Woodburn J, Stableford Z & Helliwell PS, which compare plantar pressures before and after callus reduction.

A part of my concern with this type of research is that pressure measurements taken before and after callus reduction are measuring and then comparing measurements taken at a different interfaces, ie ‘before’ measurements are taken at the sensor /callus interface and ‘after’ measurements are taken at the sensor/reduced callus interface but following discussion seems to assumes that the measurements are taken at the same interface and can reasonably be compared.

It seems to me that it is like measuring the plantar pressures between the sole of the shoe and the ground and assuming that these measurements will be the same as those between the insole and the plantar aspect of the foot.

Of course the sole of the shoe is unlikely to have the same mechanical characteristics as callus but interposition of callus is likely to modify the forces being transmitted to the underlying living tissues. The effects of callus on the transmission of forces needs to be considered and it cannot simply be assumed that callus has no effect on force transmission.

If callus does not modify the forces (not just the force at right angles to the sensor) transmitted through it then there is no problem with this type of research but if the callus does modify the transmitted forces then conclusions based on such research are flawed in direct proportion to the force modifying effects of callus.

Best wishes,

Bill Donaldson

 

Hi Rachel, i think the general thinking with callus debridement in the RA foot is little and often. Callus is thought to act as a tethering on the foot and over debriding can lead to the RA foot becoming more "at risk" . Several studies have been carried out on this, most have been listed already, i have included a link to a RCT . The evidence suggests that pain reduction was reported but was only short lived (7 days) in one trial and function and pressure there was no significant difference. However, heavy callus increases pressure and therefore would increase the risk of ulceration in the Rheumatoid foot.

http://rheumatology.oxfordjournals.org/cgi/content/full/44/2/207

 

You are also going to have issues with debridement - who debrides - the same person for each subject? There are variabilities between practitioners and their technique and how much callus they debride!