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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

 

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