Corns & Calluses

Corns

CALLUSES AND CORNS — Calluses and corns (clavi) are among the most frequent skin conditions and, by virtue of their location on the feet, may be the source of considerable disability, discomfort, and pain. Calluses are generally not harmful, but may sometimes lead to other problems, such as skin ulceration or infection.

 

 

 

Calluses are a diffuse thickening of the outermost layer of the skin, the stratum corneum, in response to repeated friction or pressure (picture 2).

 

Corns develop similarly, but differ by having a central "core'' that is hyperkeratotic and often painful. Corns typically occur at pressure points secondary to ill-fitting shoes, an underlying bony spur, or an abnormal gait.

 

These lesions are typically located on the plantar aspect of prominent metatarsals, between toe clefts, or on the dorsal aspect of toe joints.

 

 

 

Diagnosis — The diagnosis of calluses and corns is based upon their clinical appearance. They must be differentiated from plantar warts. After paring down, warts will have several dark specks that represent punctate capillary thromboses. Warts also disrupt normal skin markings so that the skin lines are no longer evident. Skin lines are more prominent in callosities.

 

 

 

Treatment —

Calluses and corns may go away by themselves eventually, once the irritation is consistently avoided.

Calluses and corns are treated the same. Treatment begins with prevention. Patients should be advised to avoid ill-fitting shoes. Consider referring patients with severe recurrent problems for orthotic consultation to fit inner soles or metatarsal bars.

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The treatment of choice for calluses or corns is application of salicylic acid plasters. Salicylic acid plaster, 40 percent, is available without a prescription.

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Products that can be applied to affected areas include 40% salicylic acid pads and plaster, 40% urea cream, and 12% lactic acid cream.However, patients with peripheral neuropathies should avoid or use topical salicylic acid with caution.

 

 

Debulk the callus or corn by paring skin with a no. 15 scalpel blade.

Cut the plaster to the size of the lesion.

Leave in place for 48 to 72 hours; keep dry.

Pare down the remaining skin; replace the plaster patch and let the patient resume proper foot care. Tape can be used to keep the patch in place; the patch can be left on all day as long as it is confined to the involved site and does not slip onto unaffected areas. Patients should be advised to remove the white "dead" skin with a metal nail file or pumice stone each night before replacing the patch. Use of the patch should stop once the lesion has resolved.

 

Do NOT use plaster in patients with peripheral neuropathies. These patients may not notice pain with improper patch placement and can develop damage to normal skin.

 

Salicylic acid 10 to 20 percent in petrolatum (available in 30 to 45 g tubes) is available by prescription and compounded by a pharmacist. This preparation may be useful for callous or corn formation that is too large for plaster use, but it is not useful for warts.

Consider obtaining a foot x-ray to evaluate for an underlying bony abnormality in lesions that are recalcitrant or recurrent.

FOLLOW UP:

Follow-up care is important to ensure control of the hyperkeratosis because patients may require regular, repeated applications of keratolytic agents in conjunction with careful paring. Its appropriate to followup in 1-2 weeks

 

Patients with special health concerns, including diabetic patients, amputees, and elderly persons, may require more frequent follow-up visits in order to decrease the likelihood of a more catastrophic complication, particularly secondary bacterial infection, from the initial lesion.


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