From the General Council of Official Colleges of Podiatrists alerts are raised about the risk posed by the use of callicides, which are distributed in pharmacies, on the Internet and in supermarkets and which, in some cases, are even prescribed by other health professionals.
The callicidas include in their composition an acid, the most frequent salicylic acid, which burns the heloma (or callus) but also the healthy tissue around it. As warned by the Dr. Rosario MoralesFull Professor of Chiropodology and Podiatric Surgery at the Complutense University, «when the patient tries to eliminate a heloma with a callicide which can cause is another more severe injury: a burn«. This wound caused by the chemical product is a route of entry of germs and, therefore, there is a greater chance that it can be contaminated or infected by bacteria.
In the image, a callus treated with a callusicide, which has caused an extensive burn all over the forefoot. In addition, the callus (yellow area) remains intact. The patient ended up going to the podiatry clinic due to the pain of the burn and the persistence of the callus and had to face a double cost
«The injury that a callicide can cause may not be worrisome in a healthy person, but it is in high risk patients such as diabetics, patients treated with anticoagulants, people with vascular problems or neuropathies»says Dr. Morales. According to this expert, «the callicide does not solve the problem, because the cause that is causing it is not treated. The definitive solution is a conservative (orthopedic) and, in some cases, surgical treatment”.
Dr. Morales recommends that “What a patient who thinks they have a callus or heloma should do is go to the podiatrist to diagnose the cause for which it is being produced and give a final solutionsince the heloma is produced because the skin in that area is subjected to pressure and continuous rubbing, causing a chronic inflammatory process that affects the keratinocytes, the predominant cells in the skin, and this is mainly due to extrinsic factorssuch as inappropriate footwear, or intrinsicsuch as bone deformities, biomechanical alterations, structural alterations of the foot, toe deformitiess…».
There is also the risk that the patientand confuse a heloma with another dermatopathy as, for example, a papilloma. “Whether one condition or the other, what should be done is to go to the podiatrist, so that they can treat both problems”says the doctor. As an indicator, it must be known that papilloma is rare in adults, it is more so in children, adolescents and young people, while heloma has a higher prevalence in adults and the elderly. It usually appears in adults over 20 years of age and the prevalence is higher after the age of 40.
The palliative but not definitive treatment of the callus consists of eliminating this accumulation of dead cells (keratinocytes) by means of chiropody techniquewhich implies a delamination of the hyperkeratosis and enucleation of the heloma, indicate from the If the cause is not acted upon, within a period of 20 to 45 days it will reappear and the treatment will have to be repeated.
The Podiatry professional is the clinician trained to make a correct diagnosis of the cause that is causing the appearance of the heloma and apply the definitive adequate treatment. Thus, the Podiatry professional will make recommendations related to footwear, may propose a treatment with insoles or the appropriate surgical approach depending on the biomechanical alteration in question.
Most frequent dermatological and podiatric disorders
In Spain, the first study carried out in 2004 by Dr. Lázaro, Dr. Novel and others, one dermatological and foot disorders in the feet of people over 60 years, indicated that 90.7% of the elderly presented some deformity in their feet, 71% some dermatological alteration and 71.7% both pathologies. A high percentage of conditions were helomas.
A later study, from 2006, on the prevalence of podiatric pathologies in people over 65 years of age in centers for the elderly in Galicia revealed that 52% of the people treated were for helomas. In fact, 73.6% of the patients studied had keratotic pathologies (on the skin). The study (by doctors Manuel Romero Soto, Fátima Santalla Borreiros, Pedro Gil Manso, Abián Mosquera Fernández, Mª del Carmen Suárez Cotelo and Mª Matilde Maceira Castiñeira) was carried out among 805 patients and tried to relate podiatric problems and degree of dependency.
The most recent study dates from 2013 and is the thesis of Dr. Javier Torralba, with the title «Podiatric pathology in geriatric patients: prevalence, risk factors and functional implications» which yielded enlightening values in this regard. Within the ranking prepared by Dr. Torralba, the most prevalent pathology was hyperkeratosis, with 67.8% of the sample of 606 patients in the multicenter study that he carried out. Second, there were the digital deformities with 58.9% of the population studied and, in third place, the nail deformities with 46.7% of the sample. In his thesis, the ranking reflects the prevalence percentage of the 18 most common pathologies, as well as their correlation with skin hydration, stability and risk of falling.