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Common foot complaints:

Calluses

Definition
Calluses are commonly found on the sole of the feet and toes, or overlying the small joints of the toes. Calluses are a thickening of the superficial layers of the skin, usually in reaction to physical forces / stresses. The process is not abnormal, however areas of callus on the foot can become uncomfortable, and for some people very painful.

It needs to be borne in mind that areas of callus on the foot can be a sign of abnormal or excessive force to the area of skin involved. The origin of this force may be extrinsic e.g. tight fitting shoes, or intrinsic e.g. associated with abnormalities of gait or bony structure.

Calluses form by a process known as hyperkeratosis. Hyperkeratosis is primarily a thickening of the horny layer of the skin, as a normal protective mechanism. If calluses do not cause any discomfort they can be considered normal ‘physiological callus,’ and be left in the majority of cases untreated. However if calluses become painful ‘pathological callus,’ they will require some form of treatment.

Some individuals may require treatment of calluses that they do not find painful because they are classified by a State Registered Podiatrist / Chiropodist as having ‘at risk feet’ e.g. due to insensitivity of the foot to pain.

Incidence / Age
All ages can present with calluses on the feet. However there is an increased prevalence of pathological callus with increasing age. Calluses may be present due to gait abnormalities, ill fitting footwear or congenital skin conditions. Particular attention should be paid to thickened skin that appears on none weight bearing surfaces or on the feet of children.

Treatment
Only calluses that are painful need be treated. If painful it is advisable to consult a State Registered Podiatrist / Chiropodist. The Podiatrist will be able to advise you as to which treatments are best for the types of calluses you present with. More importantly they will consider the reason for the calluses presenting and attempt to address the cause of the problem rather that the callus in isolation.

Self treatment
Self treatment should only be considered by healthy individuals with minor irritation from small areas of callus. Never cut calluses with anything sharp. Follow the following points of advice:

Shoes: You should first look closely at your foot wear. Stand on a piece of paper and draw around your foot. Now place your shoe over this outline and draw around it. Compare the two outlines. It is often the case that we wear shoes that are too tight, thus they rub and form calluses. The higher the heel of a shoe the more pressure is placed on the forefoot. Shoes should also have some form of restraint e.g. laces or a strap, to hold the foot back, stopping the forefoot from being compressed into the toe box. If your calluses are on the tops of your toes, look carefully at the top of the toe box of your shoes, the toe box may be too low for the shape of your toes.

Reduction: There are quite safe ways to reduce minor areas of foot callus for healthy individuals. These include a pumice stone or emery board. It is never advisable to use any sort of blade or cutting instrument to reduce calluses for yourself due to the risks of over reduction and infection. Whatever method is used take care not to over reduce the skin, making the area sore. It is always better to carryout a small amount of callus reduction regularly, that a large amount infrequently.

Creams: It is a good idea to use a simple moisturising cream on the soles of the feet daily. Any hand or face cream will serve the purpose. The cream should be rubbed into the foot, but not between the toes as these areas are already quite moist. By maintaining the integrity of the skin calluses are less likely to become pathological. Some creams are available for the purpose of softening or reducing calluses. Many of these contain varying strengths of acids. Creams containing acids are best avoided for the treatment of calluses unless advised by a Podiatrist.

Clinical and biomechanical treatments
Painful areas of callus should always be assessed by a State Registered Podiatrist / Chiropodist. Such Podiatrists will carryout a full assessment as to the cause of the presenting calluses and advice appropriate treatment accordingly. These treatments may include debridement and / or biomechanics as well as self help regimes.

Debridement is a technique used to reduce excessive thickening of the skin. This is carried out using a sterile disposable scalpel. The skin is not cut and the treatment is not painful in the slightest. Expert debridement usually alleviates any pain being experienced from an area of callus immediately. However pain relief is temporary if the cause of the presenting callus has not been fully addressed. The relief from debridement of a callus usually lasts from 6 weeks to 6 months approx. depending on the severity of the lesion. It should be noted that for many people it is not possible to address all the causes of the presenting callus and regular routine debridement may be required.

Biomechanics: is a science in which gait patterns and the interaction of the foot to the ground are assessed. From these findings the podiatrist may decide to manufacture an insole (orthotic), which will adjust the interaction of your foot to the ground and the function of the skeleton and soft tissues. Most people find orthotics very comfortable to wear. Orthotics can for some people change pathological callus to physiological callus reducing or removing the need for further treatments.

Surgical
For some people surgery is carried out to resolve areas of painful callus. However this is only considered when a structural or functional abnormality is specifically identified as the cause of a painful area of callus. A common example would be callus overlying a lesser toe due to a hammer toe deformity, raising the joint of the toe, causing it to rub on standard foot wear forming a painful callus. To treat this condition surgically the toe may be straightened which would prevent rubbing.

Outcome / Prognosis
Calluses need not be a cause of concern when considered and addressed appropriately. Treatments are available to alleviate and / or cure pain associated with areas of callus.

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