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This is a regular patient who is very heavy and has very dry skin and thick callous around his heels.The heel callous doesn't hurt usually but does for a week after treatment. I debride the callous as much as possible with a scalpel, it is quite vascular, and then smooth it off with the rotary sandpaper drill thing and then moisturise. The patient can't reach his feet to apply any creams. Any suggestions would be welcome.
Bel will doubtless be along shortly with better advice, but if that was mine, I'd say you want to get him a box of allyvn heel (get the gp to prescribe it) and get him to put a dollop of cream in that and replace it every 3 or 4 days. Whoever puts his socks on should be capable of that.
I had a very similar patient - he weighed 250kg's - seen for debridement every 4-6 weeks. It wasn't until he lost 70kg's from gastric banding surgery, that the callus significantly improved.
I vaguely remember using Algeos socks with a gel lining which contacted the skin. They helped secret oil into the skin, but had a horrible tendency to ride up and down the foot. It extended the efficacy of a clinic Rx if nothing else.
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All of the above, in particular the allyvn heel cup with emollient, plus a topical fungicide. Better still, if the GP is willing, combination therapy of oral and topical anti-fungals. Sometimes, it is worth gently reminding GPs that terbinafine is not the only fruit.
This type of patient is next to impossible to treat effectively on a DOM. I have had patients like this who have had DOM practitioners before, and I am told that I do a far better job!
If you're going to ask the GP for a prescription granuflex is a better option as it adds moisture and holds in whatever tiny moisture from the skin. Best to use it after debridement. He can also get an old flannel put loads of cream on it, put it on the floor then rub his heels into it while sitting down..I think this is one of the best ways to apply cream to feet without having to bEnd down.
Advise the patient to soak his feet in water for 30mins before his appointment to make life easier on your hand as well :-).
All of the above, in particular the allyvn heel cup with emollient, plus a topical fungicide. Better still, if the GP is willing, combination therapy of oral and topical anti-fungals. Sometimes, it is worth gently reminding GPs that terbinafine is not the only fruit.
Definitely send sample of deeper callus/tissue to pathology to rule out fungus.
Had similar on a patient. She was prescribed a combination of oral and topical antifungals and it cleared.
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This type of patient is next to impossible to treat effectively on a DOM. I have had patients like this who have had DOM practitioners before, and I am told that I do a far better job!
Why?
I did only DOM work for years and have seen many such heels, which with the help of a strong hand and patient foot rest, was able to treat effectively, along with creams ect. You may do a far better job, but that is more likely to do with skill than anything else.
You may like to suggest the spray on emollients being widely advertised in pod magazines lately, they can spray at any angle, so usable for almost every patient.
Flexitol heel balm twice a day combined with regular debridement. If they can't reach their feet squirt plenty into a carrier bag, pop your feet in and rub feet together and around the bag, works a treat.
For hard to reach areas, patients can apply emmolients using the wee paint rollers used to decorate behind radiators.
PS I do doms, it doesn't stop my blades cutting either!
i find, soaking them first in warm soapy water 10 mins ( yes old fashioned, use a removal plastic liner for hygiene) helps to remove the callous much esaier , less bleeding, less blades much quicker. After debridement apply bactigrass and opsite ,tape on , leave in place for 4 days , helps heal the cracking. ( also great for the psorasis patient) To cream his feet himself, put cream on plate or plastic lid and rub heels in it , pat with towel before standing or put socks on . Train them to come in 10 mins prior to appt time, receptionist can set up soak then they are ready for you at appt time.
Works for my patients.
difficult heel callous
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