What are Foot Calluses?

Picture of foot calluses.Calluses are areas of skin that thicken in response to repeated pressure and friction. This callus formation is the body’s defense mechanism to protect the foot against excessive pressure and friction that could cause injury to the structures beneath them. They form on the bottom of the foot underneath the metatarsal bones, which are the five long bones that connect to the bones of our toes. These bones are analogous to the knuckles of our hand. If you make a fist, the bumps that form the big knuckles are the metacarpal bones. The metatarsal bones are the “knuckles” of our feet, and they play a big role in bearing the weight of our bodies when we stand or walk.

Some calluses have a deep-seated center core known as a nucleation that is often confused with a wart. This particular type of callus can be especially painful to pressure when walking. This condition is often referred to as Intractable Plantar Keratosis.

Calluses on the feet usually indicate a biomechanical problem, resulting in excessive pressure between the skin and the underlying metatarsal bone.

Calluses can develop under one or more of the five metatarsal heads for two reasons. Either one or more of the metatarsal heads is to low (dropped or plantar flexed metatarsal) or too long, causing it to bear more weight and pressure than the others, or one of the metatarsals is unstable, causing the adjacent metatarsal head to absorb more pressure. This is very common in people with bunions, when the first metatarsal drifts upward, causing the second metatarsal to accept the extra weight.

The formation of calluses and resulting pain can be accelerated by high heeled shoes, shoes that are too small, obesity, abnormalities in the gait cycle, flat feet, high arced feet, bony prominences, and the loss of fat pad on the bottom of the foot that can occur with many medical problems such as arthritis and diabetes.

Many people try to alleviate the pain caused by calluses by cutting or trimming them with a razor blade or knife. Other people may try medicated (acid) corn or callus removers. This is not only the improper way to properly treat calluses, but can be very dangerous and even disastrous to people with impaired circulation, such as diabetics. Remember that the underlying cause is a bone problem, not a skin problem.

There are numerous conservative and surgical ways to properly treat calluses. The doctor may carefully debride the callus and any deep-seated core and apply various pads to properly redistribute the weight and temporarily relieve the pressure. An effective orthotic or accommodative insole may transfer pressure away from the “hot spots” or high-pressure areas and allow the weight bearing to be more evenly distributed. The orthotics should be made with materials that absorb shock and shear (friction) forces, and they must fit comfortably in a shoe.

For people who desire a permanent cure, or for those where conservative therapy has produced a less than desired result, surgery is also an option. The surgery is an in-office procedure performed under local anesthesia with or without IV sedation that will either realign the metatarsals or remove bony prominences.


What are Foot Corns?

Picture of foot corns.A corn is a thickening of the skin, usually over the prominent part of the hammertoe, but corns can occur over any bony prominence on the toe. A corn can be hard or soft depending on the location. If it is located on top of the toe, it is usually hard; and if it is located between the toes, it is usually soft and is often confused with athlete’s foot. A corn develops due to friction and rubbing of the bony prominence or bone spur on a shoe or on the adjacent toe. It is important to note that while shoes aggravate a corn, the actual cause is the malfunctioning of the toes. As the corn gets thicker, it produces more pressure on the underlying bone and soft tissue and increased pain. If the pressure gets severe enough, an ulcer or infection may occur under the corn, especially in a person with impaired circulation such as a diabetic.

You only get one pair to last a lifetime, and most people will clock over 70,000 miles on their pair of feet in a 70-year life span. Mechanically, the feet are one of the most complex parts of the body. There are 26 bones, 30 joints, 19 muscles, and 107 ligaments in each foot, and all these structures tie together to allow the foot to move in six different directions to produce each complete step. No wonder Leonardo Di Vinci called the foot “A masterpiece of engineering and a work of art.”

Even though they are “built to last a lifetime”, foot problems are one of our most common medical ailments. It has been estimated that 80-85% of the general population will suffer from a foot complaint at some time in their life. This is second in frequency only to dental problems.

In the past, many sufferers have avoided permanent cures, opting instead for periodic palliative care. While this type of treatment is very valuable for the elderly and for people with medical conditions that affect circulation (such as diabetes), it is often not the treatment of choice for the active person in pain. In the long run, these regular visits may be extremely time consuming, very expensive, and will not cure a problem that may eventually worsen and produce increasing pain and disability.

Minimal incision foot surgery is a technique that enables a specially trained doctor to eliminate most bunions, twisted and contracted hammertoes, corns, calluses, bumps, and spurs through a small skin incision while keeping the patient ambulatory throughout the healing process. The procedure grew out of a desire to permanently cure foot problems in an office setting without causing extended periods of disability to the patient.

The minimal incision surgery technique utilizes a small instrument not much larger than a pen point. The incision is usually no longer than 1/8-1/4 inch, because the bones to be repositioned or the bony overgrowths (spurs or calcium deposits) to be eliminated can be visualized by use of a fluoroscope. Growths such as bunions, spurs, and maligned bones that produce hammertoes, corns, and calluses can be permanently cured. Just as the knee joint can be visualized with an arthroscope, the bones of the foot can be clearly visualized with the fluoroscope in order to reposition and straighten them. Usually one or two stitches are all that is required to close the tiny incision.

The procedure may be performed in the office under local anesthesia with or without IV sedation and postoperative recovery period normally involves no more than one day off your feet, no casts or pins, and often little or no time off work depending on your occupation. Patients having digital surgery to permanently cure bone spurs and corns can often return to their own shoes in 1-3 days.