Calluses

John A. Brandeisky, DPM, FACFS

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Dr. John Brandeisky

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Calluses are hyperkeratoses of the skin. This is a thickening of the surface layer of the skin, usually in response to pressure. Calluses usually form on the ball of the foot, the heel, and the underside of the big toe (hallux). They may, however, form over any bony prominence. Calluses may be simple thickening of the skin. Sometimes they have a deep seated "core", known as a nucleation. This type of callus can be exquisitely painful to pressure, and is known to the podiatrist as an Intractable Plantar Keratosis.

Symptoms

  • A hard growth usually on the ball of the foot
  • Pain on weight bearing, relieved by rest
  • Increased discomfort in thin soled and high heeled shoes
  • More common in women than men

Causes

  • High heeled shoes
  • Mal-alignment of the metatarsal bones
  • Abnormalities of gait
  • Flat feet and High arched feet
  • Excessively long metatarsal bone
  • Obesity
  • Bony prominence
  • Loss (atrophy) of fat pad on the underside of the foot
  • Short Achilles tendon

What you can do

  • Avoid high heeled shoes
  • Buy shoes with a good arch and shock absorbing rubber sole
  • Use an insole which absorbs shear forces inside the shoe (e.g. SpencoŽ or SorbothaneŽ)
  • Keep skin moist and supple with regular application of a moisturizer
  • Use a pumice stone or other abrasive to reduce the thickness of the callus
  • Apply non-medicated pads around the callus to relieve pressure
  • Apply moleskin over areas that tend to callus

What the doctor may do

  • Carefully debride (pare down) the callus and any deep seated core it may have. It should be stressed that this provides only temporary relief, if the pressure continues after treatment.
  • Apply various pads to relieve pressure
  • Recommend appropriate shoes
  • Prescribe orthotics to correct functional problems
  • Prescribe accommodative insoles to relieve pressure
  • Surgically realign metatarsals, or remove bony prominences

Complications that can result from corns

  • Development of a bursitis - the formation of a painful inflamed fluid-filled sac beneath the callus
  • Discomfort of the back, hips, knees, legs, or feet due to changes in posture and/or gait in an attempt to "protect" the painful callus.
  • Infection
  • Development of an ulcer. An open area that forms within the callus. This may even extend down to bone.
  • Because of the serious consequences of infection, diabetics and those with diminished circulation should always seek professional help.

Other conditions which can resemble calluses

  • Verruca (warts)
  • Various tumors of the skin and subcutaneous (below the skin) tissues
  • Reaction to a foreign body (e.g. sliver or animal hair)
  • Genetic or metabolic disorders of the skin, and some drug reactions.


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