Calluses are thickened, dead tissue involving the outer layer of the skin (epidermis). They are similar to corns, with the difference being their location. Calluses are located on the soles of the feet, particularly the 'balls,' while corns are located on the toes. A callous may form secondarily to a bunion deformity, a prominent metatarsal bone on the bottom of the foot or a Tailor's Bunion on the outside of the foot. A hammertoe can cause friction on the toe joints and a painful corn may develop.
The primary cause of callus formation, as with corns, is excessive pressure due to the underlying bone. The metatarsal bones, which are the long bones forming the 'balls' of the feet, are the most frequent cause of calluses. These metatarsal bones can be long, rotated, enlarged or lowered in relationship to the other metatarsal bones, causing excessive pressure. Abnormal weight distribution can also cause calluses.This 'thickened' tissue is built up out of the natural defense of the body to protect these areas of abnormal pressure. Footwear can aggravate the condition, however, hereditary is the major cause of the bony abnormalities.
To remove the callus tissue, we do not recommend commercial acid medications, which may cause blistering and infection. Trimming the callus should only be done with a pumice stone or regular sandpaper.
Shoes with a thicker cushion sole may be beneficial in absorbing the abnormal pressure. If abnormal weight distribution is the cause of the callus formation, an orthotic can control the pressure across the balls of the feet. The excessive callus tissue can be trimmed in our office for temporary relief.
If the symptoms persist there are alternatives to permanently prevent the recurrence of the callus or corn. If a bunion is the cause of callus formation correcting the bunion would be appropriate to reduce it. If a hammertoe is the cause, rebalancing the tendons in the toe will straighten the digit to reduce the friction on the toe joints causing the painful corn. When a metatarsal bone is prominent, the bone is repositioned, thus preventing further calluses. These are minor surgical procedures performed under local anesthesia as an outpatient at the hospital. Patients are able to walk out of the hospital without the need for long-leg casting or crutches. Usually only minor discomfort is experienced following these type of procedures. The surgical shoe is worn approximately two to three weeks, and reasonably normal ambulatory activities can be continued during this time.
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