Effectiveness of saline water and lidocaine injection treatment of intractable plantar keratoma: a randomised feasibility study.

BACKGROUND: An intractable plantar keratoma (IPK) is a conical thickening of the epidermis' stratum corneum and a common cause of foot pain which can have a significant, detrimental impact on the mobility, quality of life and independence of individuals. Conservative treatments are currently offered to patients with IPK, but they are unsatisfactory since they do not offer a sufficient or permanent reduction of symptoms. The purpose of this study was the evaluation of the feasibility, safety and effectiveness of innovative treatments for intractable plantar keratoma (IPK). METHODS: A randomized single blind trial with 40 patients divided with block randomization in four parallel groups was conducted to compare treatment combinations: conservative sharp debridement only or sharp debridement with needle insertion, physiological water injection or lidocaine injection. All patients obtained the same treatment four times at a four-week interval. At each visit, visual analog scale (VAS), Foot Function Index (FFI) and IPK size were evaluated. VAS and FFI were also completed at a six and twelve-month follow-up. RESULTS: Our findings in regards to feasibility demonstrated recruitment challenges because of the anticipated pain that would be provoked by needle insertion may not be worth the potential pain relief compared to debridement alone from the patient's perspective. This was also the principal cause of drop out. Our preliminary results show no main effect of group for any of the clinical outcomes: pain felt on VAS, FFI score, IPK's size (p > 0.05). However, the analysis revealed a statistically significant effect of time on VAS (p < 0.001), FFI score (p < 0.001) and IPK's size (width and depth (p < 0.001); length (p = 0.001)), but no group x time interaction was found (p > 0.05). CONCLUSIONS: This study demonstrates that IPK treatment consisting of sharp debridement with needle insertion, physiological saline water injection or lidocaine injection is feasible and safe. There was a non-statistically significant trend toward diminishing pain intensity compared to scalpel debridement alone. The pain provoked by needle insertion and injection treatments must be addressed with a scientifically proven protocol to make it more comfortable for patients before these treatments could be considered in further studies. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04777227 . 2 March, 2021 - Retrospectively registered (All participants were recruited prior to registration).

Efficacy and safety of condylectomy with minimally invasive surgery in the treatment of interdigital corns of the lesser toes compared to conservative treatment.

BACKGROUND: Minimally invasive surgery (MIS) procedures cause less trauma to the patient and might improve recovery. This study aimed to determine the efficacy and safety of condylectomy with MIS to treat interdigital corns of the lesser toes. METHODS: This prospective cohort study was conducted in seven podiatry centers. Patients with interdigital corns of the lesser toes, progressing for more than a year, with one or more recurrences in the last year following conservative treatments were eligible. The recruited patients were classified according to their treatment: conservative or surgical (condylectomy with MIS) and were compared. Patient satisfaction, pain, the clinical and functional status of the foot and the appearance of sequelae were assessed at 3 and 6 months after treatment. RESULTS: At 6 months, patients in the surgical treatment group showed no pain on pressure, which significantly differed from the conservative treatment group (p <  0.001). They also improved clinical and functional status of the foot, reaching values comparable to those of the standard population. No paresthesia, joint stiffness or instability, toe malalignment, or corn transfer to a contiguous site resulted from the surgical treatment. CONCLUSIONS: Condylectomy with MIS is effective and safe to treat interdigital corns of the lesser toes.

Simulation Improves Podiatry Student Skills and Confidence in Conservative Sharp Debridement on Feet A Pilot Randomized Controlled Trial.

BACKGROUND:: An essential skill for podiatrists is conservative sharp debridement of foot callus. Poor technique can result in lacerations, infections and possible amputation. This pilot trial explored whether adding simulation training to a traditional podiatry clinical placement improved podiatry student skills and confidence in conservative sharp debridement, compared with traditional clinical placement alone. METHODS:: Twenty-nine podiatry students were allocated randomly to either a control group or an intervention group on day 1 of their clinical placement. On day 4, the intervention group (n = 15) received a 2-hour simulation workshop using a medical foot-care model, and the control group (n = 14) received a 2-hour workshop on compression therapy. Both groups continued to learn debridement skills as opportunities arose while on clinical placement. The participants' debridement skills were rated by an assessor blinded to group allocation on day 1 and day 8 of their clinical placement. Participants also rated their confidence in conservative sharp debridement using a questionnaire. Data were analyzed using logistic regression (skills) and analysis of covariance (confidence), with baseline scores as a covariate. RESULTS:: At day 8, analysis showed that those in the intervention group were 16 times more likely to be assessed as competent (95% confidence interval, 1.6-167.4) in their debridement skills and reported increased confidence in their skills (mean difference, 3.2 units; 95% confidence interval, 0.5-5.9) compared with those in the control group. CONCLUSIONS:: This preliminary evidence suggests that incorporating simulation into traditional podiatry clinical placements may improve student skills and confidence with conservative sharp debridement.

The evaluation of three treatments for plantar callus: a three-armed randomised, comparative trial using biophysical outcome measures.

BACKGROUND: Callus is one of the most common foot skin complaints experienced by people of all ages. These painful and unsightly lesions often result in disability. The 'gold standard' of treatment is scalpel debridement by a trained specialist; however, people also seek over-the-counter remedies. There is a lack of clinical evidence for the efficacy of such products, which makes selection by patients and practitioners difficult. METHODS: This randomised, three-armed, parallel, comparative trial aimed to test the efficacy of two home treatments for plantar callus using novel, objective outcome measures (skin hydration using the capacitance method; elasticity using negative pressure application; and surface texture using imaging). Additional outcome measures were: size of callus, quality of life (Foot Health Status Questionnaire) and self-reported participant satisfaction and compliance. The results were compared to a podiatry treatment. Participants were randomly allocated to one of three groups: potassium hydroxide (KOH, 40 %); trichloroacetic acid (TCA); and podiatry treatment. Participants were followed for 3 weeks after their initial intervention appointment (days 7, 14 and 21). The primary outcomes were the change from baseline in callus hydration, elasticity, texture, and size at each of the three time points. The secondary outcomes where: change in quality of life 21 days after treatment; resolution of calluses via visual inspection; and participant compliance and perception. RESULTS: Forty-six participants (61 ft) with plantar calluses were recruited. The podiatry treatment showed immediate and significant changes in all objective outcomes, associated foot pain and function (p <0.01). Lesser changes in skin quality and perceived pain and functional benefits occurred with TCA and KOH over 21 days. CONCLUSIONS: This is the first study where objective outcome measures have been used to measure changes in the nature of skin in response to callus treatments. We found significant differences in plantar callus in response to podiatry and two home treatments. The podiatry treatment showed immediate and significant changes in skin and associated foot pain and function. Lesser, but sometimes comparable, changes in skin and perceived pain and functional benefits occurred with TCA and KOH over 21 days. TRIAL REGISTRATION: ISRCTN14751843 : date of registration: 30 April 2015.

Pressure and Friction Injuries in Primary Care.

Pressure and friction injuries are common throughout the lifespan. A detailed history of the onset and progression of friction and pressure injuries is key to aiding clinicians in determining the underlying mechanism behind the development of the injury. Modifying or removing the forces that are creating pressure or friction is the key to both prevention and healing of these injuries. Proper care of pressure and friction injuries to the skin is important to prevent the development of infection. Patient education on positioning and ergonomics can help to prevent recurrence of pressure and friction injuries.

A comparison of types and thicknesses of adhesive felt padding in the reduction of peak plantar pressure of the foot: a case report.

INTRODUCTION: This case report will have implications for any area of medicine that aims to redistribute plantar pressure away from a particular area of the foot. This could be for example in the short-term care of people with diabetes, people who have insensate feet and people with poor blood supply to the foot coupled with plantar ulceration. The aim of the study was to investigate which type and thickness of Hapla felt padding is the most effective at redistributing plantar pressure of the foot. This case report is the first of its kind. CASE PRESENTATION: The participant was a healthy 50-year-old white man with a high peak plantar pressure over the second metatarsal head of both feet; he required removal of a plantar callus on a periodic basis. CONCLUSIONS: The reader should note that different types of Hapla felt padding provide different forms of redistribution of plantar pressure on the foot. In the clinic it may be useful to measure peak plantar pressure using F-Scan before deciding on the most appropriate type of felt padding.

Digital and interdigital corns: a report of two cases with use of hyaluronic acid gel filler.

Digital and interdigital corns are common painful foot conditions encountered by podiatrists during the course of their practice. These corns can often be treated with conservative techniques, although they tend to eventually recur. Currently, no single treatment exists that is efficient, long-lasting, minimally invasive, and easy to administer. This article describes two cases where hyaluronic acid gel injections were used to improve symptoms associated with digital and interdigital corns located in a nonweightbearing area. Both patients tolerated the intervention well and showed considerable improvement of their condition for a substantial period of time after the intervention without developing adverse reactions. Hyaluronic acid gel injections could very well represent an interesting therapeutic alternative for digital and interdigital corns located in nonweightbearing areas.

Skin conditions in figure skaters, ice-hockey players and speed skaters: part I - mechanical dermatoses.

Figure skaters, ice-hockey players and speed skaters experience a range of dermatologic conditions and tissue-related injuries on account of mechanical trauma, infectious pathogens, inflammatory processes and environmental factors related to these competitive pursuits. Sports medicine practitioners, family physicians, dermatologists and coaches should be familiar with these skin conditions to ensure timely and accurate diagnosis and management of affected athletes. This review is Part I of a subsequent companion review and provides a comprehensive review of mechanical dermatoses experienced by ice-skating athletes, including skater's nodules and its variants, pump bumps, piezogenic pedal papules, talon noir, skate/lace bite, friction bullae, corns and calluses, onychocryptosis, skater's toe and skate blade-induced lacerations. These injuries result from friction, shear forces, chronic pressure and collisions with surfaces that occur when athletes endure repetitive jump landings, accelerated starts and stops and other manoeuvres during rigorous training and competition. Ill-fitting skates, improper lacing techniques and insufficient lubrication or protective padding of the foot and ankle often contribute to the development of skin conditions that result from these physical and mechanical stresses. As we will explain, simple measures can frequently prevent the development of these conditions. The treatment of skater's nodules involves reduction in chronic stimulation of the malleoli, and the use of keratolytics and intralesional steroid injections; if malleolar bursitis develops, bursa aspirations may be required. Pump bumps, which result from repetitive friction posteriorly, can be prevented by wearing skates that fit correctly at the heel. Piezogenic pedal papules may be treated conservatively by using heel cups, compressive stockings and by reducing prolonged standing. Talon noir usually resolves without intervention within several weeks. The treatment of skate bite is centred on reducing compression by the skate tongue of the extensor tendons of the anterior ankle, which can be accomplished by use of proper lacing techniques, increasing pliability of the skate tongue and using protective padding, such as Bunga Pads™. Anti-inflammatory medications and cold compresses can also help reduce inflammation. Friction bullae are best managed by careful lancing of painful blisters and application of petrolatum or protective dressings to accelerate healing; preventative measures include the use of well fitting skates, proper lacing techniques and moisture-wicking socks. Corns and calluses are similarly best prevented by the use of well fitted skates and orthotic devices. Symptomatic, debridement reduces the irritant effect of the thick epidermis, and can be accomplished by soaking the area in warm water followed by paring. Application of creams with high concentrations of urea or salicylic acid can also soften callosities. Cases of onychocryptosis benefit from warm soaks, antibiotic ointments and topical steroids to reduce inflammation, but sometimes chemical or surgical matricectomies are required. Preventative measures of both onychocryptosis and skater's toe include cutting toenails straight across to allow for a more equal distribution of forces within the toe box. Finally, the prevention and treatment of lacerations, which constitute a potentially fatal type of mechanical injury, require special protective gear and acute surgical intervention with appropriate suturing. The subsequent companion review of skin conditions in ice skaters will discuss infectious, inflammatory and cold-induced dermatoses, with continued emphasis on clinical presentation, diagnosis, treatment and prevention.

Managing common foot problems in older adults.

Foot problems related to aging or disease processes such as nail fungus or arthritis often go unrecognized and untreated, and can lead to considerable dysfunction. Multiple contributing factors, such as repetitive stress and structural changes in the foot, further compromise function. Effective topical management approaches for xerosis, fissures, hyperkeratotic lesions, and fungal infections can lessen the severity of symptoms. However, when recalcitrant, such as long-standing onychomycosis, prescription medications may be warranted. These medications are not without serious side effects and should be used with caution in older adults. New methods that pose fewer risks, such as film-forming solutions and photodynamic therapy, are emerging to treat skin and toenail infections. Several nonpharmacological and pharmacological treatment approaches are presented in this article.

Nuevos horizontes en el tratamiento de las callosidades plantares de la paquioniquia congénita / New horizons in the treatment of plantar callosities congenital pachyonychia

Los avances recientes en el campo de la terapia génica, tales como el desarrollo de ARN de cadena corta inhibitorios (ARNsi) capaces de silenciar la expresión de alelos mutados dominantes, ofrecen nuevas expectativas para el tratamiento de la queratodermia plantar en pacientes con paquioniquia congénita. Revisamos brevemente las características clínicas de esta entidad y describimos un estudio de fase 1 que arrojó resultados prometedores. Los mismos serían aplicables a todo el campo de las enfermedades monogénicas.

Recent advances in the genetic therapy field like development of short inhibitory RNA (RNAsi) capable of silencing mutant dominant alleles, offer new expectations for treatment of plantar keratoderma in patients with pachyonichya congenita. We briefly review clinical features of this entity and describe a fase 1 study that showed promising results that may be usefull for the whole monogenic diseases field.

Improvement of the soft socket after rotationplasty: a single case study.

Rotationplasty is established as a functionally improving and partially ablative method of tumour surgery, but good clinical and functional results do not only depend on a successful surgery. Due to the changed biomechanical situation the activity level is limited by the weight bearing capacity of the rotated foot. Painful blisters and callosities may limit the use of the exo-prosthesis, because the skin is overstressed in the soft socket. A 28-year-old patient with a rotationplasty type A2 suffered from painful callosities of the rotated foot. Capacitive pressure measurements were performed as well as a gait analysis for kinematics and kinetic characteristics. Clinically a decrease of the callosities and a pain relieve was obvious and the patient learned skiing without prior knowledge. Biomechanically a decrease of the peak pressure (from 240.6-135.0 kPa) and the mean pressure (from 83.2-66.2 kPa), was observed with an increased weight bearing area. The study has shown that a modification of the heel bench can considerably improve pressure distribution. An increase of the load bearing area appears to enable the skin to compensate even intensive strain during athletic activities.

[Diagnosis and treatment of warts, corns, and clavi]. / Was Iässt die Hornhaut an den Füssen wuchern?

The term keratosis covers a variety of growths such as warts and pressure-induced callosities. Warts develop in the absence of pressure, and often clear up again after a certain period, usually without treatment. Clavi can develop as a result of wearing poorly fitting shoes, but also deformed toes or other anatomical deformities affecting the foot. The resulting non-anatomical stressing leads to the formation of pressure callosities and even to pressure sores.

Xerosis and callus formation as a key to the diabetic foot syndrome: dermatologic view of the problem and its management.

The diabetic foot syndrome is a major complication of diabetes mellitus. The two most important pathophysiologic factors are peripheral arterial occlusion and peripheral neuropathy. The cutaneous lesion is a plantar ulcer, often accompanied by soft tissue and bone infections which can require amputation. Triggers include poorly fitting shoes, poor foot care, or overlooked foreign bodies, often coupled with a structural foot deformity. Increased plantar pressure, especially beneath the metatarsal heads, and the resultant callus play an important role. The patients often already have xerosis of the plantar skin with scales, fissures, erosions and impaired barrier function, complicating the situation. Prompt neurologic and vascular diagnostic studies, coupled with routine examination of the feet and primary prophylactic measures are most important. The most important therapeutic goals are optimal control of the diabetes mellitus, relieving pressure points and avoiding or reducing callus formation.