Management of hyperkeratotic lesions in the elderly patient

Many factors contribute in the development of hyperkeratotic lesions in the elderly patient. The internal and external causes render the elderly foot more susceptible to limited ambulation, increased incidence of infection, ulceration, and eventual loss of the limb. Once the lesion is classified and the causes identified, a beneficial treatment plan can evolve. Reduction of the lesion(s), appropriate padding, shielding, splinting, accommodative orthoses, insoles, emollients, and mild keratolytics on regular treatment intervals are helpful in maintaining comfort and allowing function of the elderly foot. If the bony abnormalities or abnormal position of the foot do not respond to conservative measures, then surgical intervention should be considered based on the medical and vascular status of the patient. The evaluation of the elderly patient's presenting footwear, and patient education on the need for proper shoe gear size, shape, and materials cannot be overemphasized. Proper footwear and fitting is essential for the elderly in managing hyperkeratotic lesions. When regular footwear is not beneficial special shoes should be considered to accommodate the foot and treatment plan (e.g., accommodative orthoses, and so forth). The Extra Depth Inlay Thermold, Ambulator, Bunion last and Keystone last are options. If special shoes are too heavy for the elderly patient, there is a wide variety of athletic shoes that are shock absorbent and lightweight. Success in management includes a proper identification of the problem, relief of the symptoms, regular follow-up care, and periodic review of footwear to ascertain the need for repair or modification.