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Corns and calluses are frequently found on feet of patient’s in various age groups. But how do they differ and what are the treatment modalities available to deal with them?
What are calluses?
Calluses are a protective response of the skin to pressure and friction forces. Callus is basically a thickened area of the skin. When exposed to pressure, shearing, or friction repeatedly, the skin has two options: to break down or to reinforce itself. If skin breaks down, a wound forms. If it reinforces itself, a callus forms. Calluses are frequently found on the bottom of people’s feet over pressure points such as tips of toes, under heel pad or under metatarsal heads. These are the areas of maximum “direct” pressure. People with high arches have a tripod like foot structure and are more prone to callus development, as they do not make full contact of the skin with the ground. In addition, people with high arched feet are more prone to fat pad atrophy and plantar foot fat displacement. This because particularly important as people age. Aging feet naturally tend to be “bony” because of fat loss. People with severe foot fat loss experience significant pain when walking and require well cushioned shoes and cushioned orthotics indoor and outdoor to reduce symptoms.
To reduce pain, add cushion, combat fat pad loss:
There is a group of calluses that tend to be particularly painful as they have a “nucleus” or a core. Those can form over areas of pressure or anywhere on the plantar skin. Podiatrists call them intractable plantar keratomas. These are calluses that have a “crater” in the center which looks and feels almost like a firm seed when removed. Once extracted, the pain becomes significantly better. These skin lesions could be mechanical in nature but could also be genetic or a result of exposure to certain toxins or form secondary to tissue injury.
Pinch calluses are found as a result of compression forces on the skin. These are commonly found around big toe and over bunions. Patients with flatfeet are more prone to development of pinch calluses as they tend to pivot on their big toe and bunion area during toe off phase of gait.
What are corns?
Corns are similar to calluses but are frequently found on the sides and top of the foot. They also form as a result of direct pressure and tend to be severely painful as create significant pressure over joints and nerves coursing superficially underneath the skin. These can be frequently found in people who have bunion and hammertoe deformities as well as arthritis with bone spurs to top of foot. Some particularly painful ones are found next to nail plates and in between the toes.
What are warts?
Warts are areas of the skin with increased skin thickness similar to a callus. However, the main difference is that these are due to an infection with a virus. In a way, warts are easier to treat than calluses long term as viruses can be cured permanently. Corns and calluses however are almost impossible to resolve. One way to tell a wart from a callus/corn is by apply pressure. Warts tend to hurt when squeezed side to side and calluses tend to hurt with direct pressure application. Another way to tell them apart is by shaving down the wart and seeing if there are black dots at the base of the wart or bleeding is noted. Warts bring capillary beds to the skin surface and do not invade deep skin tissues. Warts also form islands of irregular skin, whereas, calluses and corns tend to preserve normal skin lines. Treatment of the wart involves removing of the top layer of the skin, as this is where wart lives, by chemical, thermal, or mechanical pathway. Sometimes a combination therapy is required.
So how are corns and calluses treated?
For therapeutic pain relief, shaving down and thinning of the hyperkeratotic tissue is essential for pain reduction. People with diabetes, weak immune system, poor sensation, poor circulation, or those prone to bleeding should schedule a visit with a podiatrist to have these shaved professionally to avoid injury and infection. Those who are not at risk for above may try home therapy which would include softening of the hard callus/corn material by soaking feet in warm water and then reducing the build up with pumas stone for superficial calluses. For long term softening, I recommend using topical Callus control cream with 20% urea. This cream hydrates the skin and allows callus/corn to be taken down easier. Deep calluses and corns are better addressed with callus trimmer or foot file. Another great product to remove corns and calluses are Corn Removers with 40% salicylic acid. This compound penetrates deep into callus allowing for easier removal
In addition to active treatment, there are several preventative and pain reducing modalities available to reduce pain and promote comfort. These and other items include padding modalities that can be used with shoes to promote comfort:
It usually takes a combination of therapies to improve symptoms and have sustained relief. By incorporating softening creams, padding, callus/corn thickness reduction, and cushioned supportive shoes, you will be able to enjoy walking and running for years to come!