Although a callus can be a relatively unharmful and unserious condition to have there are certain factors that can put in the danger zone or make it more dangerous than if present in its normal counterparts and does play a role in callus treatment. This is diabetic foot callus.
A callus is mainly hyperkeratotic skin (increase in the number of cells) that develops as a protective or adaptive mechanism in abnormal pressure points to avoid injury to the underlying soft tissues of the body.
A callus that is symptomatic is bad but the danger zone is a completely different thing. There are certain factors that make the formation of a callus a prelude to worse conditions.
In this article, we will be discussing them and be seeing how and why these conditions are bad and if you are susceptible to them.
Why is diabetic foot callus a risk factor?
In diabetic foot callus, there are various mechanisms that are acting on the body to cause its ill effects. These are mainly because of the increased glucose in the blood and the body’s decreased ability to make use of it.
Glucose is needed by the body for all its activities. This includes the epithelium and its replicating ability.
- the body is already deprived of its ability to utilize glucose and in addition to this, the circulation or blood flow is also compromised in lower extremities.
- This occurs because the microcirculation or the really small blood vessels in the lower extremities become damaged and are hence not able to deliver the necessary amount of blood to the organs. This is called microangiopathy.
- In addition to this the hemoglobin in the red blood cells, the molecule that is responsible for transporting oxygen, becomes glycosylated, meaning bound to glucose, and hence even its ability to transport sufficient oxygen is impaired.
All these factors contribute to putting the formed callus in the danger zone.
Callus in diabetes:
In diabetic foot callus, a callus can form in a similar manner. A constant friction or pressure causing this hyperkeratotic or thickened skin to form, as an adaptive mechanism. But this can become problematic in the case of diabetics.
In normal people, a formed callus can produce symptoms early on and lead to its identification and intervention. Also, the symptoms will prevent the person from further subjecting that particular area to increasing amount of stresses.
But, in diabetics, the person has peripheral neuropathy (pathology of the nerves) where the sensation is impaired. Thus, the callus can often be neglected or go unnoticed and the person continues to exert increased pressure. This can eventually lead to injury of the underlying tissues and its sequelae(consequences).
The diabetic foot callus causes injury and even necrosis(death) of the underlying tissues. But in many instances, the callus covers up the underlying problems and hides them also from the person.
Again, due to neuropathy, the person is not aware of this and there is no intervention to stop it from progressing.
There is inflammation of the underlying tissues and an ulcer can eventually crop up (diabetic ulcer). Sometimes, small specks of blood may be visible underneath the callus that can help in the identification of progressing problems.
What happens to the formed callus?
If you are a person who has diabetes for quite a long time and if it has not been under control, you might be aware of the diabetic ulcer that most often occurs on the foot or the lower part of the leg.
This is what a diabetic foot callus can lead to.
In diabetics initially, a callosity can develop. This is mainly due to the above-discussed factors. This callosity will then break down and give way to form an ulcer, which is spreading and deep.
And a diabetic ulcer can be very difficult to treat as healing is very slow in case of diabetics and can even sometimes lead to amputation of the leg when the blood supply to the region has been compromised.
- When a diabetic foot callus has formed and the person progresses through these conditions to finally lead to an ulcer that does not heal, the chances of diabetes are high and a test for diabetes has to be done.
- Diagnosis of diabetes involves the routine blood sugar tests, urine sugar tests and OGTT tests that are regularly performed at hospitals.
- They may also perform a doppler ultrasound test to assess the blood supply to the leg. This is necessary for choosing the treatment modalities for the further management of the ulcer.
Treatment of callus in diabetes:
- In diabetic foot callus, once a callus is formed it is usually advised not to adopt methods of mechanical removal of the callus as the chances for ulcer development are high.
- Presently, the preferred approach is to reduce friction in those pressure points by using proper footwear and using orthotics to alleviate the triggers.
- Of the many modes of treatment conventionally used for the treatment of a callus, in concern of diabetes….after consulting a doctor, surgical removal of the callus by a medical professional is usually preferred