CALLOUSES

What is A Callous? A callous is thickening of the skin over a bony prominence on the bottom or side of the foot. The term corn is used for a similar process when it occurs on a toe, however, a callous on the top of a toe is usually called a corn.  When I first started practice, callouses on the ball of the foot were a very common complaint from patients. Now, callouses are much less common. The reason is, shoes now have much softer insoles (the portion of the inside of the shoe that touches the bottom of the foot). This is especially true of most athletic shoes, such as running, walking, and aerobic shoes. Shoes with hard insoles, like most dress shoes, are much more likely to cause callouses.

What Causes A Callous To Form?

• Callouses form as natures way of attempting to protect tissue. We are all familiar with callouses that form on the palm of the hand from hard work such as digging in the garden with a shovel or spade. A similar mechanism causes callouses on the foot. If callouses did not form, complete breakdown of the skin (ulcer) could occur. The thicker the callous gets in an attempt to protect tissue, the more painful it becomes. Callouses form over the portion of the joint known as the metatarsal head (the portion of the foot bone that connects to the toe bone).

• Callouses can develop under any of the metatarsal heads. High arched feet will often get callouses on the bottom of the foot behind the first and fifth toes.
• Feet that flatten in the arch will get callouses on the bottom of the foot behind the 2nd, 3rd, or 4th toes.
• Feet that have bunions will often have a callous below the 2nd metatarsal head.
  

How Are Callouses Treated?

• Proper Shoes:  Wearing shoes such as running, walking, and aerobic shoes: These shoes have soft insoles and are the first line of treatment for painful callouses and should be worn as much as possible.

• Soft Insoles:   Soft insoles inside your dress shoes is very helpful for those of us who cannot wear athletic shoes to work . A good insole is Spenco. It comes in a variety of types and styles and is available by prescription or over the counter at most athletic shoe stores.

• After work and on weekends, wearing athletic shoes is highly recommended for those who have callouses on the ball of the foot.

• Orthotics:  More resistant callous conditions, especially those related to flat feet, require a custom made support (Orthotics) with a soft extension added to cushion the involved bones.
• Surgery:   Severe cases require surgery to eliminate the excessive pressure over the bone. Such surgery involves smoothing of rough edges of bone, raising or shortening the involved metatarsal to relieve the excessive pressure.
• Trimming:  Trimming of the callous tissue with a sharp instrument greatly reduces the pressure over the bone, resulting in complete, but unfortunately, temporary relief of the pain. This should only be done by a professional. Most patients do not have the skill or ability to trim callouses on the bottoms of their own feet.  Using a callous file is a safer self care alternative to sharp instruments. 

Things To Avoid When Treating A Callous:

Corn removers and acid patches: These products contain harsh chemicals that eat into the callous tissue. Despite what the ads say on TV and in magazines, corn and callous removers do not remove the corns and callouses forever. They simply eat away at the callous tissue and therefore are no more effective than trimming the corns or callouses with a blade. As mentioned before, callouses are a bone problem, not a skin problem. In addition to eating away the callous tissue, the acid very often gets on the normal skin and a painful burn may occur. Diabetics and people with poor circulation should especially avoid acid patches and callous removers.

Digging Out The "Eye" Of The Callous:

It is a common myth that if you dig out the "eye" of the callous, it will go away. This is not true. The center, or eye of the callous is a ring of deep callous tissue directly over the bony prominence that causes the callous. Callouses are not simple skin conditions that can be cut out, burned out, surgically removed, or even vaporized with a laser. Callouses are a result of excessive pressure over a bony prominence, therefore bone must be considered when treating painful callouses.

To schedule an appointment, please call (405) 751-6152