title: Effectiveness of scalpel debridement for painful plantar calluses in older people: a randomized trial.
abstract: BACKGROUND
  Plantar 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  Both 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.
  
  
  CONCLUSIONS
  The 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.
  
  
  BACKGROUND
  Australian Clinical Trials Registry (ACTRN012606000176561).
authors.affiliation: Department of Podiatry, La Trobe University, Melbourne, Australia. k.landorf@latrobe.edu.au
authors.forename: Karl B
authors.initials: KB
authors.lastname: Landorf
authors.forename: Adam
authors.initials: A
authors.lastname: Morrow
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Spink
authors.forename: Chelsey L
authors.initials: CL
authors.lastname: Nash
authors.forename: Anna
authors.initials: A
authors.lastname: Novak
authors.forename: Julia
authors.initials: J
authors.lastname: Potter
authors.forename: Hylton B
authors.initials: HB
authors.lastname: Menz
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002145:Callosities / Q000175:diagnosis / Q000601:surgery*; D003646:Debridement / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D010147:Pain Measurement; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria
references.citation: J Am Geriatr Soc. 1996 Mar;44(3):310-3
references.pmid: 8600203
references.citation: J Bone Joint Surg Br. 2000 Aug;82(6):781-90
references.pmid: 10990297
references.citation: Clin Exp Dermatol. 2007 Jul;32(4):375-80
references.pmid: 17425648
references.citation: Gait Posture. 2010 May;32(1):141-4
references.pmid: 20399101
references.citation: J Wound Care. 1997 Oct;6(9):427-30
references.pmid: 9370589
references.citation: Arch Phys Med Rehabil. 2011 Jan;92(1):68-75
references.pmid: 21187207
references.citation: Rheumatology (Oxford). 2000 Jun;39(6):652-4
references.pmid: 10888711
references.citation: J Am Podiatr Med Assoc. 2001 May;91(5):222-9
references.pmid: 11359885
references.citation: J Foot Ankle Res. 2010 May 14;3:7
references.pmid: 20465855
references.citation: J Am Podiatr Med Assoc. 1999 Oct;89(10):495-501
references.pmid: 10546420
references.citation: J Am Podiatry Assoc. 1968 Mar;58(3):117-26
references.pmid: 5639315
references.citation: J Am Podiatr Med Assoc. 1999 Oct;89(10):515-9
references.pmid: 10546423
references.citation: BMJ. 1997 Oct 25;315(7115):1054-5
references.pmid: 9366731
references.citation: Foot Ankle Int. 2004 Oct;25(10):739-44
references.pmid: 15566706
references.citation: J Am Geriatr Soc. 1975 Oct;23(10):433-41
references.pmid: 1159263
references.citation: J Aging Health. 2005 Dec;17(6):734-52
references.pmid: 16377770
references.citation: Public Health. 1986 Jul;100(4):219-22
references.pmid: 3774952
references.citation: Gait Posture. 1999 Dec;10(3):255-63
references.pmid: 10567758
references.citation: Am J Epidemiol. 2004 Mar 1;159(5):491-8
references.pmid: 14977645
references.citation: J Am Podiatr Med Assoc. 1998 May;88(5):237-41
references.pmid: 9610048
references.citation: Ann Emerg Med. 1996 Apr;27(4):485-9
references.pmid: 8604867
references.citation: BMJ. 1996 Jun 1;312(7043):1403-6
references.pmid: 8646101
references.citation: Emerg Med J. 2001 May;18(3):205-7
references.pmid: 11354213
references.citation: Gait Posture. 2005 Dec;22(4):302-7
references.pmid: 16274911
references.citation: Acad Emerg Med. 1998 Nov;5(11):1086-90
references.pmid: 9835471
references.citation: Control Clin Trials. 2000 Aug;21(4):330-42
references.pmid: 10913808
references.citation: Am Fam Physician. 2002 Jun 1;65(11):2277-80
references.pmid: 12074526
references.citation: J Public Health Med. 2002 Jun;24(2):77-84
references.pmid: 12141589
references.citation: J Am Podiatr Med Assoc. 2001 Feb;91(2):74-8
references.pmid: 11266481
references.citation: Am J Epidemiol. 1998 Oct 1;148(7):657-65
references.pmid: 9778172
references.citation: J Am Geriatr Soc. 1995 May;43(5):479-84
references.pmid: 7730527
references.citation: J Foot Ankle Res. 2009 Mar 30;2:8
references.pmid: 19331676
references.citation: BMC Musculoskelet Disord. 2006 Aug 09;7:64
references.pmid: 16895612
references.citation: J Clin Epidemiol. 2004 Mar;57(3):223-8
references.pmid: 15066681
references.citation: Arch Phys Med Rehabil. 1996 Mar;77(3):232-6
references.pmid: 8600863
references.citation: J Neuroeng Rehabil. 2009 Jul 30;6:31
references.pmid: 19642991
references.citation: J Foot Ankle Res. 2010 Jun 18;3:11
references.pmid: 20565812
references.citation: Clin Biomech (Bristol, Avon). 2004 Jan;19(1):78-84
references.pmid: 14659934
references.citation: J Rheumatol. 2003 Dec;30(12):2689-93
references.pmid: 14719214
references.citation: Rheumatology (Oxford). 2005 Feb;44(2):207-10
references.pmid: 15479752
references.citation: J Clin Epidemiol. 2010 Aug;63(8):e1-37
references.pmid: 20346624
references.citation: Disabil Rehabil. 2005 Aug 19;27(16):917-23
references.pmid: 16096244