September 2010 – Patient Sympathy

August 2010 – Back to School Shoewear

July 2010 – Womens Shoewear

June 2010 – Summer Foot Care

May 2010 – Skin

April 2010 – Ingrown Toenails

March 2010 – Barefoot Running

February 2010 – Pediatric Flatfoot

January 2010 – Being a Compliant Patient

December 2009 – Raynaud’s Disease

November 2009 – NA

October 2009 – Shin Splints

September 2009 – Dealing with Corns and Callouses

August 2009 – Relieving Painful Gout

July 2009 – Caring for Plantar Warts

June 2009 – Bunions

May 2009 – Children's Heel Pain

March/April 2009 – Heel Pain

February 2009 – Shoe Fitting

January 2009 – Nail Fungus

December 2008 – Neuroma

November 2008 – Diabetic Foot Care

Dealing with Corns and Callouses

September 2009

Published in - Healthy Lifestyles

One of the most common problems that I, and my fellow Podiatry brethren, see and treat in the office on any given day are corns and callouses. I am grouping these together since they really are one and the same, it’s just a matter of the location or reason may differ as to why they develop at all. Both can, and do, occur pretty much anywhere on the foot where there is excessive pressure or friction. Be it the ball of the foot, on the side of the big or little toe, they can be quite uncomfortable, to say the least.

Anyone who has raked leaves, worked in the garden or frequently uses hand tools will let you know how uncomfortable having callouses can be on their hands. Now let’s place those painful lesions on the weight-bearing surfaces of the feet and anyone with them will certainly let you know how they feel. Sometimes a callous will develop after a blister forms initially, then it opens or “dries’ out. What is left is an area of hardened, dry, dead skin-usually a callous.

Callouses and corns form when an accumulation of dead skin cells harden and thicken over an area of the foot, or anywhere else for that matter where there is increased pressure. This is one of the body's defense mechanisms against excessive pressure and/ or friction. Although they appear to be different in size, callouses and corns are made of the same material.

Callouses have a tendency to cover a wider area although are not as deep as a corn. Corns, on the other hand, are smaller in diameter but are deeper and are usually more painful. The latter will develop over bony prominences (think outside of the pinky toe) while the former over an area that has more padding (think heels or ball of the foot). Some calluses have a deep seated core known as a nucleation, which is especially painful with pressure. This particular condition is referred to as an Intractable Plantar Keratosis or IPK for short. Some may refer these appearing as a corn within a callous since covers a larger area and has a deep core in the center.

The most common sites for callouses to develop are, as mentioned earlier, are on the bottom or along the periphery of the heel, the ball of the foot, on the side of the big toe, the big toe joint or along the side of the foot.

Corns have a tendency to occur on bony prominences like the inside or outside of any of the toes, although the pinky toe is the most common, the tops of the toes at the “knuckles”, or at the tips of the toes.

“Doctor, why, oh why do they occur and how come they keep coming back even after you remove them?” I will occasionally remind my patients that humans were not originally created with the thought that at some point in evolution we’d be wearing coverings on our feet, called shoes.

I refer to one of my earlier articles that most people wear the wrong shoewear for their foot type. Be it the size of the shoe or the type. This is by far THE reason for most foot problems. I am certain that most patients would dis-agree with me while most podiatrists would a-gree. Please realize I am not saying that the shoes are uncomfortable in any way, that’s another thing. It’s just that they may be causing certain pressure or friction sites where the corns or callouses develop. If the shoes are too loose, on the other hand, the foot will piston in the shoe allowing friction to occur.

Biomechanical or gait abnormalities such as bunions, hammer toes, high or low arches, arthritis are to blame for callouses to form.

Okay, now onto the care of the condition.

If there are biomechanical or gait issues these need to be corrected. The underlying problem or issues need to be addressed. If you correct this problem there shouldn’t be an issue, right? Makes sense to me. And no, this does not mean surgery necessarily. Please re-read the previous sentence. Most of the time custom-made inserts, or orthotics will alleviate the underlying problem. Some pre-fabricated inserts will also do the trick. But, I do NOT mean Dr. Scholl’s inserts or any of their products. I make no secret about how I feel about most of those products as some of my patients know. They are a waste of hard-earned money.

Most Podiatrists have in their office quality pre-fabs that may do the job if your insurance doesn’t cover the custom-made orthotics. I prefer and have been using both for about 25 years myself. Personally, I prefer the custom ones since I need a particular correction.

There are many products on the market that claim to prevent, reduce the occurrence of, clear up or remove said lesions, usually to the detriment of the consumer. I say that because most people will apply an item such as a corn plaster or acid to a painful corn a lot longer than recommended by the instructions. Most also feel that more or longer is better. Not usually the case in this instance. The reason being is that the acid in the medication cannot determine normal skin from a corn/ callous.

Take for instance the diabetic with diminished or absent feeling of their feet applying one to a nagging corn and leaving it on a bit longer than he should. Such was the case during my residency. The end result was that the gentleman didn’t have to worry about getting his nails cut anymore. We removed both of his pinky toes and without the use of anesthesia, by the way. It’s not that an extreme case, trust me on this one.

Various creams or emollients are quite helpful. Check for an exfoliating moisturizing cream. This will perform a double duty to gently remove the calloused or build up of dead skin. Padding of the area to prevent pressure from occurring. Debridement, or paring of the callous or corn by a Podiatrist will aid in keeping the lesion to a minimum. This is performed aseptically in addition to the use of the emollients.

And last, but certainly not least, even though I cannot stress it enough- properly fitting shoe wear. I absolutely get a kick out of patients when they bring me 4 or 5 pairs of various new and old shoes, sneakers and boots to evaluate proper fit. I did the same thing when I first went to a Podiatrist 25 years ago.

If you do have recurring problems with corns or callouses, please see your Podiatrist for a full evaluation. It may be a simple solution to a chronic problem.