Effectiveness of scalpel debridement for painful plantar calluses in older people: a randomized trial

Abstract

BackgroundPlantar calluses are a common cause of foot pain, which can have a detrimental impact on the mobility and independence of older people. Scalpel debridement is often the first treatment used for this condition. Our aim was to evaluate the effectiveness of scalpel debridement of painful plantar calluses in older people.MethodsThis study was a parallel-group, participant- and assessor-blinded randomized trial. Eighty participants aged 65 years and older with painful forefoot plantar calluses were recruited. Participants were randomly allocated to one of two groups: either real or sham scalpel debridement. Participants were followed for six weeks after their initial intervention appointment. The primary outcomes measured were the difference between groups in pain (measured on a 100-mm visual analogue scale) immediately post-intervention, and at one, three and six weeks post-intervention.ResultsBoth the real debridement and sham debridement groups experienced a reduction in pain when compared with baseline. Small, systematic between-group differences in pain scores were found at each time point (between 2 and 7 mm favoring real scalpel debridement); however, none of these were statistically significant and none reached a level that could be considered clinically worthwhile. Scalpel debridement caused no adverse events.ConclusionsThe benefits of real scalpel debridement for reducing pain associated with forefoot plantar calluses in older people are small and not statistically significant compared with sham scalpel debridement. When used alone, scalpel debridement has a limited effect in the short term, although it is relatively inexpensive and causes few complications. However, these findings do not preclude the possibility of cumulative benefits over a longer time period or additive effects when combined with other interventions.Trial registrationAustralian Clinical Trials Registry (ACTRN012606000176561).

Analysis of a trial assessing the long‐term effectiveness of salicylic acid plasters compared with scalpel debridement in facilitating corn resolution in patients with multiple corns

“…While studies such as Landorf et al 5 have found that scalpel debridement is ineffective in reducing pain compared with a MFPDI (concern about appearance subscale) scores in control and treatment groups.…”

“…While studies such as Landorf et al [5] have found that scalpel debridement is ineffective in reducing pain compared with a sham procedure, the use of this treatment as the control in the current analysis reflects widespread current podiatric practice for the treatment of corns; as While about one third of patients assessed for eligibility refused to take part in the trial, there was no evidence that such patients were untypical of the population, and the proposed intervention did not preclude a large number of patients from participating on health grounds.…”

“…The effectiveness of scalpel debridement was assessed against sham debridement in a parallel randomised controlled trial (n=80) [5]; while both control and treatment groups in this study reported reductions in pain over a 6-week analysis period, no significant differences in pain reduction between groups was observed.…”

Chronic foot pain in older people

“…Although uncontrolled studies have reported immediate reductions in pain following scalpel treatment of plantar calluses [53,54], controlled trials involving a 'sham' treatment group suggest that this apparent short-term improvement can be largely attributed to placebo effects [55,56]. However, these findings do not preclude the possibility of cumulative benefits over a longer time period.…”

Short‐term effect of scalpel debridement of plantar callosities versus treatment with salicylic acid patches: The EMEDESCA randomized controlled trial

“…5 VAS change of 2 points or more was considered clinically significant. 5 VAS change of 2 points or more was considered clinically significant.…”