Preliminary investigation of debridement of plantar callosities in rheumatoid arthritis.

Abstract

To determine the effect of expert debridement of foot callosities on forefoot pain and plantar pressure distribution in rheumatoid arthritis (RA). Plantar callosities on 14 feet of eight RA patients were debrided by a single podiatrist. Measurements of subjective pain severity in the forefoot and global arthritis pain were undertaken using a visual analogue scale, repeated at 7-day intervals to the next treatment (28 days). Plantar pressures were recorded at the lesion sites using an in-shoe flexible transducer insole before and after lesion debridement. Following debridement, all patients reported symptomatic relief with an average change in pain score of 48% (P = 0.01) but the treatment effect was lost by 7 days. Immediately following scalpel debridement, peak pressures were elevated in 10 of 14 feet, whilst contact time was reduced and peak force increased. None, however, reached statistical significance. Scalpel debridement of forefoot plantar callosities reduces forefoot pain for about 7 days, but pressure distribution is not significantly altered.