An 80-year-old man with persistent hyperkeratotic foot lesions was diagnosed with localized crusted scabies after misdiagnosis as a fungal infection or psoriasis. Dermoscopy and microscopy confirmed Sarcoptes scabiei infestation. Treatment with oral ivermectin and topical applications of lindane lotion and salicylic acid ointment was successful. This case highlights the need to consider scabies in atypical presentations and the role of keratolytic agents in treatment.