Deb Fuchek's Physio Column
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April, 2000
Callusses (Tyloma)
- local areas of thickened epidermis
What are they?:
- normally present in the skin over boney prominences on the hands and feet
- secondary to constant pressure, friction or shearing stresses
- may be secondary to biomechanical faults of the foot and lower limb. i.e. excessive pronation, claw toes
What happens?:
- excessive callus formation is highly vulnerable to tears and cracks leading to pain, disability and possible infection
- risk of ulceration is greatly enhanced when nutrition of the tissues is impaired. i.e. diabetes
- blisters may develop under the calluses
Signs and Symptoms:
- pain on pressure over the site of the callus
- pain may vary from negligible to disabling
Treatment
1. Preventative
a. Proper fitting shoes
b. Two pairs of one double knit pair of socks
c. Use of lubricant to decrease friction over the specific area
d. Proper foot hygiene including regular powdering
e. Protective covering/padding over the susceptible areas
2. Conservative
a. Rub down callus with pumice stone after showering
b. Protection of an irritated area
c. Identify and correct the biomechanical fault
3. Physiotherapy
a. To treat any biomechanical faults of the lower limbs and foot
Blisters
What are they?:
- friction and shear stresses on the skin
Where do they occur?:
- can occur over any area of skin subjected to stress and shear
- more sensitive skin is more susceptible
What happens?:
- epidermis and dermis become separated and fluid accumulates in the intervening space
- blister may remain '"closed' or become "torn"
- skin develops a normal thickening or callus in response to repeated friction or stress
Signs and Symptoms:
- all blisters are preceded by a 'hot spot'
Prevention:
- use of lubricant, powder or protective covering over susceptible areas of the skin
- use of two pairs of one double knit pair of socks
- immediately protect the "hot spot" when they occur
Complication:
- local infection
Treatment:
1. Closed blister
a. Maintain blister as is and protect with a doughnut pad until the initial irritation has subsided
b. Puncture from the side with a sterile needle, cover with a pressure pad to prevent refilling and protect the area from further irritation
2. Torn blister
a. Clean with soap and water, rinse with antiseptic
b. Apply antibiotic ointment or zinc oxide over newly exposed area of skin
c. Cover with dressing for 2
-3 days
d. Protect area from further irritation