Talar callosity (‘prayer foot’) in a haemodialysis patient

A 68-year-old male haemodialysis patient of Asian origin with end-stage renal failure was being evaluated for renal transplantation. His underlying renal disease was unknown. On examination, he was found to have a 13-mm hyperkeratotic nodule on the left foot, antero-medial to the lateral malleolus, with a surrounding area of hyper-pigmentation and lichenification (Figure 1, panel A). A clinical diagnosis of talar callosity (‘prayer foot’) was made [1]. This peculiar skin lesion is seen in devout Muslims as a result of regular prayers in the sitting posture (known as ‘julus’, Figure 1, panel B), with the foot touching and rubbing against the floor under body pressure. The left foot is usually affected owing to the asymmetric posture. A similar mechanism caused talar callosities in tailors in 19th-century England. Callosities may also occur on the forehead as a sequel to prostration in the ‘sajdah’ posture [2], with rubbing of the head against the floor or a prayer stone (‘mohr’). Talar callosities are harmless and rarely necessitate histological proof of the diagnosis. Histology would show epidermal hyperplasia and hyper-keratosis [1]. Surgical removal is sometimes performed for cosmetic reasons although recur-