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Conditions of the Foot
by Dr. Mark H. Tompkins


Corns and Calluses

Introduction

Corns and calluses are just your body's response to increased friction or pressure against the skin. When a particular area of your foot rubs-up against the inside of your shoe(s), the affected area of skin tries to 'protect' itself by increasing the thickness of the skin.

Corns and calluses normally occur over boney prominences in your feet. These prominences create the increased pressure and friction that leads to formation of this extra tissue.

Many corns and calluses are just normal build-up of hyperkeratotic (dead cornified layers of skin) tissue. In many cases, this build-up of tissue may look bad, or unsightly; but are not harmful or painful. However, more severe cases of corns and calluses can cause pain with shoe gear and ambulation, develop into ulcerations (openings to deeper tissues), and can cause serious infections.

Calluses

Calluses associated with the feet are no different than those associated with the hands. They occur in areas of increased pressure and/or friction. The most common type (and place) for calluses to form on the foot are on the bottom.beneath the metatarsal bones. These are the long bones which bear much of the weight which is distributed through your feet when you walk.

These calluses may be very mild (and frequently quite dispersive) but cause no problems whatsoever. However, if the callus tissue is very thick and concentrated in a specific area (usually under one the metatarsal bones), severe pain can result. This type of callus is called an IPK, or Intractable Plantar Keratosis. This type of callus can develop into ulcerations which can become secondarily infected.

Corns

A typical corn, or helloma dura, is a special type of callus that forms in particular areas of the toes. Most notable on the top of the lesser toes and are associated with hammer toes, mallet toes, and claw toes.

For more information regarding these common digital problems, please see Hammer Toes section.

The corns associated with hammer/mallet/and claw toes, occur over the bony prominences created by the buckling of individual joints in the toes-either the proximal interphalangeal joint, the distal interphalangeal joint, or both. The corns can also form at the tips of the toes due to increased pressure. There are varying degrees of hyperkeratosis which occurs with individual corns..from very superficial and mild to very deep and severe. In many cases, the corns can become so thick, that ulcerations develop under the overlying callus tissue. This can be a very dangerous situation as bacteria can enter through the opening within the ulcer and lead to skin and/or bone infections.

Another type of specialized corn that commonly occurs in the foot, is referred to as a helloma molle. This is a 'soft corn' that occurs in-between the toes of the feet. They take-on a whitish color due to the constant perspiration that occurs between the toes. They are commonly mistaken by non-foot specialists as an athlete's foot infection. This can be very problematic, as the application of OTC and/or prescription anti-fungal medications only serves to increase the maceration (fluid-filled tissue) at the site of the corn. Additionally, the lapse in appropriate treatment time while using these medications, normally worsens the condition and frequently the area can become infected by neighboring bacteria.

Treatment

The treatment for calluses and corns depends on the severity of each individual condition.

Mild, asymptomatic (pain free) calluses and corns, in most instances, require no treatment whatsoever. Most callus or corn tissue is just a normal tissue response to areas of pressure and friction. These types of calluses or corns are usually more of a cosmetic problem for many patients due to the unsightly build-up of callus tissue. This is more problematic for darker skinned individuals due to pigment changes that often accompany corns. Treatment of this type of condition with trimming and/or the use of topical medications can many times cause the condition to worsen and ultimately become painful.

Moderately symptomatic calluses or corns can be treated with OTC corn medications, pumice stones, callus files, and the use of topical moisturizers and keralytic creams. Also, the use of various types of pads (moleskin) can be used to relieve pressure with particularly bothersome shoes.

Treatment for more progressive, severe, calluses and corns, are primarily treated by the routine debridement (trimming) of the exogenous callus formation. This should be performed by a medical (foot) specialist with training to perform this procedure properly. Other treatments include the use of both oral and injectible anti-inflammatory medications, shoe inserts, and various types of padding or molded appliances. Surgery is indicated for the treatment of calluses and corns, only after failure of the above noted treatments.

For more information regarding the surgical treatment of calluses and corns, please see Hammer Toes section.

 

OTHER COMMON
FOOT PROBLEMS

Athletes Foot

Bio-Mechanical Pain

Bunions

Calluses & Corns

Diabetic Foot

Flat Feet

Hallux Limitus/Rigidus

Hammer Toes

Heel Pain/Heel Spur

Ingrown Nails

Metatarsalgia

Morton's Neuroma

Neuropathy

Orthotics

Plantar Fasciitis

Plantar Warts

Running Injuries

Sclerosing Injection Treatments

Sesamoiditis

Severs Disease

Shin Splints

Sweaty Feet/Odor

Toenail Fungus

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Copyright © 2001-2009 Dr. Mark H. Tompkins.  All rights reserved.