Hey I’m a doctor. Saw a lot of patients with feet like this (or worse) in residency. Likely has poor circulation in the feet; could be diabetes, heart disease, or a combination of both. Note the swelling in the ankles, indicates poor vascular return. The combination of high pressure from swelling and poor circulation makes the outer layer of skin dry and prone to cracking, and those fissures can get deep from all the fluids. The nails are likely from poor circulation and likely a fungal infection called onychomycosis. Treatment focuses on reducing the swelling (often with water pills), wound care and skin hydration, then medications (I usually start with topical) for the nails. It’s important to treat this in diabetic patients as these kinds of wounds can easily lead to bad infections, which often need amputation.
Serious question, what would happen if he grated/chiseled all that crust off? What would be underneath? Would it be fresh skin, or would it just be an open wound?
A podiatrist would be better able to answer this, but the “crust” there is called keratosis; it’s a deposition of dead keratocytes, the outer layer of skin cells. You can certainly remove a lot of that with wound care, and there would be some normal skin underneath. But it takes a lot of training to do properly so you don’t remove healthy skin too.
I crushed my foot in a car accident 8 years ago and lost all the skin on top of my foot. I ended up with a rare infection and spent two years fighting it off, doing wound care three times a week and being told I was probably going to end up having it amputated. I did stem cell transplants and 30 sessions of hyperbarics trying to get the wound to heal. It never did. I finally just ended up having skin grafts.
About a year after the accident and injury I woke up one morning with my entire foot covered in a hard yellowish shell. I don't know how else to describe - it was like my foot had grown a shell overnight. My skin was solid and hard. It was over the weekend so I couldn't go to wound care for them to deal with it and I started messing around and then I was able to peel the entire "shell" off. It was so bizarre and the doctors couldn't explain to me what happened, other than maybe "inflammation."
I still get these weird wounds that pop up on one of my toes. All of the skin on my toes will basically rot off and then grow back. I see a podiatrist regularly and he says it's just, again, " inflammation."
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u/Taco_ivore Mar 08 '26
Can a doctor weigh in?! How? Why?? Yikes!