Hyperpigmentation and thickening of skin with callosity formation over dorsum of both feet and healed ulceration over left lateral malleolus in a patient with type 2 diabetes performing prolonged prayers.

Many types of skin lesions have been described in patients with diabetes, but prolonged prayer-induced hyperkeratosis and callous formation are rare. We describe such lesions in a 62-year-old Muslim patient with uncontrolled glycemia who practiced prolonged, repeated religious prayers in sitting position causing significant pressure over dorsum of both ankles. He developed prayer-induced callous formation on dorsum of both ankles, with more thickening and a healed ulcer on left. Prayer-induced skin lesions should be carefully managed in patients with diabetes, who are more vulnerable for infections and gangrene due to as venous/arterial insufficiency and peripheral neuropathy.