The need for lower extremity amputation is a dominant fear in most diabetic patients. Such amputations are most often preceded by a history of foot ulceration (see Chapter 151). Although a number of comorbidities contribute to the development of ulceration (e.g., peripheral vascular disease, neuropathy, and limited joint mobility), minor trauma via repetitive pressure is the pivotal precipitating event. As markers of repetitive friction and shear, corns and calluses in the diabetic foot are of special significance. Simple débridement of these hyperkeratotic lesions decreases peak plantar pressures by as much as 26%.5 In a retrospective review of more than 200 diabetic foot ulcerations, patients who had their corns and calluses pared frequently experienced a statistically significant decrease in the incidence of foot ulceration, hospitalization, and surgical intervention.6 Hemorrhage within a corn or callus is an especially ominous sign, indicating subcutaneous breakdown with a strong potential for ulceration. Therefore, ulcer care should include paring of calluses. The use of proper footwear by the diabetic as well as the nondiabetic patient may also play a role in not only preventing but also reducing the development of callosities. Shoes should be correctly sized to accommodate the width and length of the patient's foot, and the heel should be elevated minimally, if at all, to prevent pathology and pain.7,8