Managing Pain and Callus Formation After Foot Wound Healing

Hyperkeratosis and pain while walking after wound healing on the sole of the foot?

Hello, doctor.
I would like to consult you about a wound healing issue.
I previously had an accident while riding a bike, which resulted in a wound on the bottom of my right foot (near the heel) that is about 3 centimeters long.
Initially, I only disinfected and bandaged it myself, but due to slow healing, I sought medical attention.
After about a month, the wound healed enough for me to walk normally (I had been walking lightly on my right foot to avoid affecting the healing process, primarily using the ball of my foot for pressure while keeping my heel elevated, almost in a tiptoe position).
However, after about two months of recovery, I noticed some discomfort in the previously injured area after walking more frequently.
Upon self-examination, I found that the healed wound area had developed a thick callus (approximately 3 centimeters in diameter, oval-shaped).
Pressing on it, walking, or bumping into things causes discomfort and pain.
After two visits to the doctor, I was informed that it was "hyperkeratosis" and "scarring," and I was prescribed topical medications for "keratolysis." During my second visit, the dermatologist also helped to thin the affected area.
I have been applying the medication as instructed for a month, but I still experience significant pain and discomfort while walking.
I am quite concerned and would like to ask for your advice on how to proceed with my current situation.
Thank you.

Mr. M, 20~29 year old female. Ask Date: 2014/03/09

Dr. Wu Yuxin reply Dermatology

Your symptoms are primarily due to the thick callus compressing the underlying tissues, causing pain.
It is indeed necessary to use topical agents for "keratolysis." Due to poor penetration, you may feel that the effect is not satisfactory.
It is recommended to debride the callus first, then apply the ointment, and cover it with plastic wrap for about 2-4 hours to enhance the penetration and absorption of the medication.

Reply Date: 2014/03/09

More Info

Managing pain and callus formation after a foot wound can be a complex issue, especially when the injury has led to changes in how you walk and how your foot bears weight. Based on your description, it sounds like you have experienced a significant injury that has resulted in both pain and the formation of a callus at the site of the healed wound. Here’s a comprehensive overview of your situation, along with recommendations for managing your symptoms.

Understanding Callus Formation
Calluses form as a protective response to repeated friction or pressure on the skin. In your case, the callus developed after your foot injury, likely due to altered walking patterns to avoid pain at the original wound site. When you change your gait to avoid discomfort, you may inadvertently place more pressure on other areas of your foot, leading to the formation of a thickened area of skin (the callus) as a protective mechanism.

Pain Management Strategies
1. Footwear Adjustments: Ensure that you are wearing supportive and well-fitting shoes. Shoes that provide adequate cushioning and arch support can help distribute pressure evenly across your foot and reduce pain. Avoid high heels or shoes with narrow toe boxes, as they can exacerbate discomfort.

2. Orthotic Inserts: Consider using custom orthotic inserts. These can help correct any biomechanical issues in your gait and provide additional support to the areas of your foot that are experiencing pain.

3. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can assess your gait and provide exercises to strengthen the muscles in your foot and leg, improve flexibility, and help you return to a normal walking pattern.

4. Pain Relief Medications: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage pain and inflammation. However, consult with your healthcare provider before starting any new medication.

5. Topical Treatments: Continue using the prescribed topical treatments for callus softening. If the callus is particularly thick, your healthcare provider may recommend further debridement (removal of the thickened skin) to alleviate pressure and pain.

Monitoring and Follow-Up
Since you have already seen healthcare providers who have diagnosed the issue as callus formation and have provided treatment, it is essential to monitor your symptoms closely. If the pain persists despite following the recommended treatments, or if you notice any changes in the appearance of the callus (such as redness, swelling, or discharge), you should return to your healthcare provider for further evaluation.

Potential Complications
In some cases, persistent pain and callus formation can indicate underlying issues, such as nerve damage or improper healing of the original wound. If you experience symptoms such as numbness, tingling, or significant changes in skin color or temperature, these could be signs of more serious complications that require immediate medical attention.

Conclusion
Managing pain and callus formation after a foot wound requires a multifaceted approach that includes proper footwear, potential use of orthotics, physical therapy, and ongoing monitoring of your symptoms. It is crucial to maintain open communication with your healthcare providers and to advocate for your health, especially if your symptoms do not improve. Remember that healing takes time, and addressing any biomechanical issues in your gait will be essential for a full recovery.

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