A 47-year-old female patient attends a Birmingham podiatry clinic with callus and heloma durum presenting on the plantar surface of the 1st MTPJ of the left foot. The patient is generally fit and well, and requires routine treatment.
To enable the podiatrist to treat callus and corn, they must first understand the biological process that leads to the pathology. Callus, or hyperkeratosis, a diffuse area of relatively even thickness (Lorimer et al.1997), is formed from hypertrophy of the superficial layer of the epidermis, the stratum corneum, and reduced desquamation rate causing the skin to increase layers and harden (Fig 1). Mechanical stresses on the skin, for example the compression and friction from poorly…show more content…
Fluid building up in the tissues caused by an inflammation response, triggered by the repeated stresses on the tissues, can lead to maceration of the deeper tissues, resulting in wounds and ulcers. Especially in patients with limited healing due to circulation conditions and diabetes, or those suffering peripheral neuropathy (Fig 3)
Assessments
A number of assessments are carried out before diagnosing and treating the patient.
Vascular Assessment
Test carried out
Right foot
Left foot
Pulses palpable
Yes
Yes
Doppler pulses
Dorsalis Pedis
Triphasic
Triphasic
Posterior Tibial
Triphasic
Triphasic
Cappillary refill time
2 seconds
2 seconds
Skin Assessment
Healthy
Healthy
Nail Assessment
Healthy
Healthy
Temperature gradient
Warm to cool
Warm to cool
Hair present
Yes on legs and all toes
Yes on legs and all toes
Other skin signs and
symptoms:
Oedema (Non pitting)
No
No
Oedema (pitting)
No
No
Intermittent Claudication
No
No
Rest pain
No
No
Neurological Assessment
Test carried
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