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skin callus
Etiology:
1) structural defects
a) excessive pronation resulting in excessive pressure on the metatarsal heads
b) hammer toes, subluxation & trauma
c) changes in weight bearing associated with neuropathy
2) improper footwear
a) high heels
b) ballet dancers
c) athletes
Pathology:
- thickened, hardened stratum corneum
- hyperkeratosis
Clinical manifestations:
1) pain on weight-bearing
2) pruritus
3) burning sensation
4) circumscribed area of hypertrophied & keratinized skin on plantar surface of foot
- frequently over bone
- generally over the metatarsophalangeal joint
5) flat papule or plaque at the site of repetitive trauma
6) may occur on any area of the forefoot
7) soft surfaces are often sites of structural abonormalities
Laboratory: none
Differential diagnosis:
1) plantar keratosis
2) plantar wart (does not occur over metatarsophalangeal joint)
Management:
1) patient education
a) use of pumice stone [2]
- may wish to avoid in patients with peripheral neuropathy
b) use of emery board [1]
c) softening callus in a warm soak is helpful
d) diabetics must not damage healthy skin causing the callus to bleed
2) office care for painful callus
a) remove area of hyperkeratosis with scalpel
b) use small parallel cuts
c) may be needed every 2-3 months
d) debridement is needed to evaluate for the presence of an ulcer or an abscess that is not visible on the surface of the skin [3]
3) prevention
a) proper footwear
b) low-heel, soft-sole shoes
c) insoles or orthotics to relieve friction
d) custom footwear
4) padding around pressure points
a) comma-shaped pad or 'cookie' over the metatarsal pad
b) moleskin
5) topical keratolytic therapy
a) recalcitrant callus
b) more comonly done on plantar warts
c) diabetic patients should not use keratolytic agent
6) referral to podiatrist
a) surgical correction of structural defects
- malaligned metatarsal head can be corrected
- other bony prominances can be reduced surgically
- procedures that will lessen excessive pronation
b) non-surgical intervention
- debridement for patients with diabetes mellitus, peripheral vascular disease, or rheumatoid arthritis
- source of metatarsal pads, insoles, molds etc
c) referral for failure of more conservative measures
Specific
skin corn (clavus)
General
skin disease (dermatologic disorder, dermatopathy, dermatosis)
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 753, 970-71
- Geriatrics at your Fingertips, 13th edition, 2011
Reuben DB et al (eds)
American Geriatric Society
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013
- Freeman DB.
Corns and calluses resulting from mechanical hyperkeratosis.
Am Fam Physician. 2002 Jun 1;65(11):2277-80.
PMID: 12074526