An article I recently read in Lower Extremity Review, entitled Diabetes: Improving foot care compliance1 discusses the challenge practitioners’ face in keeping foot care top-of-mind with their patients.
The Total Contact Cast (TCC) is the “gold standard” for healing diabetic foot ulcers. However, very few practitioners prescribe them. Moreover, patients are resistant to using the device consistently. The TCC is bulky and unattractive, making the resistance understandable.
Ryan Crews, the author of this article, made an interesting comment regarding the commonly misunderstood topic of calluses, stating “…many individuals consider calluses to be protective in nature. However, calluses on the feet actually result in increased pressure (similar to walking on any other hard object) and stress on the soft tissue below, thereby contributing to ulcer formation.”
While some people use lotions and files to reduce callus formation on the plantar surface of their feet, others have gone the opposite route, choosing to let calluses build up: citing protection against blisters and other skin abrasion, as the desired outcome. Based on Crew’s statement and our own experience, calluses should absolutely be reduced and prevented, whenever possible.
Ultimately, the most effective foot care solutions are those that maximize mobility (within the limits defined by one’s physician), support the healing & prevention of skin trauma, and are cosmetically acceptable. While a TCC may be the most clinically effective at healing diabetic ulcers, it doesn’t do well on the other two requirements.
Daily foot inspection for blister, callus & ulcer development is essential to preventing complications ranging from minor skin abrasions, to infection and amputation. Keep your feet healthy by making foot care a priority.
1 Crews, Ryan, MS, CCRP. Lower Extremity Review. Diabetes: Improving Foot Care Compliance. Volume 1, Number 4. October 2009. PP. 25-30.