Computing and Library Services - delivering an inspiring information environment

Debridement of plantar callosities in rheumatoid arthritis: a randomized controlled trial

Davys, Heidi J., Turner, D.E., Helliwell, Philip S., Conaghan, P.G., Emery, P. and Woodburn, James (2005) Debridement of plantar callosities in rheumatoid arthritis: a randomized controlled trial. Rheumatology, 44 (2). pp. 207-210. ISSN 1462-0324

Metadata only available from this repository.


Objective. To compare forefoot pain, pressure and function before and after normal and sham callus treatment in rheumatoid arthritis (RA).

Patients and methods. Thirty-eight RA patients were randomly assigned to normal (NCT group) or sham (SCT) scalpel debridement. The sham procedure comprised blunt-edged scalpel paring of the callus which delivered a physical stimulus but left the hyperkeratotic tissue intact, the procedure being partially obscured from the patient. Forefoot pain was assessed using a 100 mm visual analogue scale (VAS), pressure using a high-resolution foot pressure scanner and function using the spatial–temporal gait parameters measured on an instrumented walkway. Radiographic scores of joint erosion were obtained for metatarsophalangeal (MTP) joints with and without overlying callosities. The trial consisted of a randomized sham-controlled phase evaluating the immediate same-day treatment effect and an unblinded 4-week follow-up phase.

Results. During the sham-controlled phase, forefoot pain improved in both groups by only 3 points on a VAS and no statistically significant between-group difference was found (P = 0.48). When data were pooled during the unblinded phase, the improvement in forefoot pain reached a peak after 2 days and gradually lessened over the next 28 days. Following debridement, peak pressures at the callus sites decreased in the NCT group and increased in the SCT group, but there was no statistically significant between-group difference (P = 0.16). The area of and duration of contact of the callus site on the ground remained unchanged following treatment in both groups. Following debridement, walking speed was increased, the stride-length was longer and the double-support time shorter in both groups; however, between-group differences did not reach levels of statistical significance. MTP joints with overlying callus were significantly more eroded than those without (P = 0.02).

Conclusions. Treatment of painful plantar callosities in RA using scalpel debridement lessened forefoot pain but the effect was no greater than sham treatment. Localized pressure or gait function was not significantly improved following treatment

Item Type: Article
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine
Schools: School of Human and Health Sciences
Related URLs:
References: Woodburn J, Stableford Z, Helliwell PS. Preliminary investigation of debridement of plantar callosities in rheumatoid arthritis. Rheumatology 2000;39:652–4.[Abstract/Free Full Text] Dixon St J A. The rheumatoid foot. Proc R Soc Med 1970;63:677–9.[Medline] Redmond A, Allen N, Vernon W. Effect of scalpel debridement on the pain associated with plantar hyperkeratosis. J Am Podiatr Med Assoc 1999;89:515–19.[Abstract] Arnett FC, Edworthy SM, Bloch DA et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–24.[ISI][Medline] Turner DE, Woodburn J, Helliwell PS, Cornwall ME, Emery P. Pes planovalgus in rheumatoid arthritis: a descriptive and analytical study of foot function determined by gait analysis. Musculoskeletal Care 2003;1:21–33. Edmonds J, Saudan A, Lassere M, Scott D. Introduction to reading radiographs by the Scott modification of the Larsen method. J Rheumatol 1999;26:740–2.[ISI][Medline] Kaptchuk TJ, Goldman P, Stone DA, Stason WB. Do medical devices have enhanced placebo effects? J Clin Epidemiol 2000;53:786–92.[CrossRef][ISI][Medline] Young MJ, Cavanagh PR, Thomas G, Johnson MM, Murray H, Boulton AJM. The effect of callus removal on dynamic plantar foot pressures in diabetic patients. Diabet Med 1992;9:55–7.[ISI][Medline] Pitei DL, Foster A, Edmonds M. The effect of regular callus removal on foot pressures. J Foot Ankle Surg 1999;38:251–5.[Medline]
Depositing User: Sara Taylor
Date Deposited: 17 Apr 2008 15:21
Last Modified: 28 Aug 2021 10:38


Downloads per month over past year

Repository Staff Only: item control page

View Item View Item

University of Huddersfield, Queensgate, Huddersfield, HD1 3DH Copyright and Disclaimer All rights reserved ©