Callous ulcer

Callous Ulcer

A callous ulcer, also known as a callus ulcer or callosity ulcer, is a type of skin ulcer that is characterized by the thickening of the skin due to prolonged pressure or friction. This condition is commonly seen in individuals with diabetes mellitus, peripheral vascular disease, and those who are bedridden or have limited mobility. Callous ulcers are most frequently found on the feet, particularly on the soles or under the metatarsal heads, due to the high pressure and friction in these areas.

Causes and Risk Factors

The primary cause of callous ulcers is prolonged pressure or friction that leads to the thickening of the skin, or callus formation, which eventually breaks down to form an ulcer. Several factors can increase the risk of developing callous ulcers, including:

• Diabetes mellitus, due to the associated neuropathy which leads to a loss of sensation, making the individual less aware of the pressure and injuries.
• Poorly fitting shoes or footwear that increases pressure on certain areas of the foot.
• Peripheral vascular disease, which reduces blood flow to the extremities, impairing healing and increasing the risk of ulceration.
• Reduced mobility or conditions that lead to prolonged periods of sitting or lying down.
• Structural foot abnormalities, such as hammer toe or bunions, that may lead to abnormal pressure distribution.

Symptoms

Symptoms of callous ulcers include:

• Hardened, thickened skin in the affected area, often surrounded by a ring of callused skin.
• Pain or discomfort in the area, especially when pressure is applied.
• A visible ulcer that may be shallow or deep, often with a clear, yellow, or greenish discharge.
• In severe cases, signs of infection such as redness, warmth, swelling, or an unpleasant odor.

Diagnosis

Diagnosis of callous ulcers involves a physical examination of the affected area, along with a review of the patient's medical history and risk factors. Additional tests may include:

• Blood tests to check for underlying conditions such as diabetes.
• Imaging tests, such as X-rays, to assess for bone involvement or foreign objects.
• Biopsy of the ulcer tissue, especially if there is a suspicion of malignancy or infection.

Treatment

Treatment of callous ulcers focuses on relieving pressure on the affected area, treating any underlying infection, and promoting healing. Approaches may include:

• Use of specialized footwear or orthotic devices to redistribute pressure.
• Regular debridement of the callus and dead tissue to promote healing.
• Application of dressings or topical medications to manage the ulcer and prevent infection.
• Antibiotics if there is evidence of bacterial infection.
• Control of blood sugar levels in patients with diabetes to promote healing and prevent further complications.
• In severe cases, surgical intervention may be necessary to correct structural abnormalities or remove dead tissue.

Prevention

Prevention of callous ulcers involves regular foot care, especially for individuals at high risk, such as those with diabetes or peripheral vascular disease. Key preventive measures include:

• Regular inspection of the feet for signs of pressure, injury, or skin changes.
• Wearing well-fitting, comfortable shoes and avoiding high heels or tight shoes.
• Maintaining good foot hygiene and moisturizing the feet to prevent dry skin and calluses.
• Managing underlying conditions, such as controlling blood sugar levels in diabetes.

See Also

• Diabetic foot ulcer
• Pressure ulcer
• Skin ulcer