Tuesday , November 21 2017
Home / Specialties / Podiatry / Michael M. Rosenblatt, DPM: Response to Dr. Richard K. Bernstein’s Article on Calluses and Amputation

Michael M. Rosenblatt, DPM: Response to Dr. Richard K. Bernstein’s Article on Calluses and Amputation

Dr. Bernstein reported that a treatment by a podiatrist probably caused an infection in a known diabetic. He alleges that the DPM used a “pumice” stone to grind it down and therefore caused the infection….

Dr. Bernstein correctly states that treatment of calluses is best accomplished by “redistributing weight off of the area where the callus/corn is located.” Podiatrists attempt to accomplish this by many of the means that Dr. Bernstein suggests.

But corns and calluses occupy space and therefore put pressure on surrounding tissues, disturbing the blood supply to those contiguous areas. This especially occurs during weight bearing; or if there are any direct pressures against the corn or callus. This I think is the primary reason why it is essential to reduce the size of those corns or calluses. There is also an issue of shearing force produced by the lesion itself.

This has generally been a successful model for treatment of corns and calluses in diabetics, ever since the birth of podiatry. Of course it is possible to remove too much callus, or perhaps too much in the wrong area. Obviously digital dexterity is involved, as well as a steady hand and good eyesight.

I don’t know if this occurred in the above situation or not. But direct pressure from a corn or callus can definitely cause further damage, and quite likely Dr. Bernstein has himself seen those results. Sometimes, despite the most expert and best digital dexterity, diabetes wins over good technique. We all do the very best we can.

I think we can all agree that patients’ should not attempt to do this themselves. But the model of treatment for removing calluses and corns successfully by a very competent podiatrist remains intact.

Michael M. Rosenblatt, DPM
San Jose, CA