Calluses under the feet are a common source of pain and frustration, and there is often a misconception about these things being treatable, with many people believing they can simply be cut away. This article will discuss what can actually be done to provide treatment, and dispel some of the myths surrounding their treatment.
Calluses on the bottom of the foot are a natural process designed to protect the skin of the foot from excessive pressure. This excessive stress can come from many sources. Externally, stress can come from simply walking or standing on the ground, whether or not the person is wearing shoes. The shoe itself can be a source of external pressure, although this is usually seen causing calluses on the top of the toes (the same type of callus condition). Internally, the pressure can come from the bones that lie under the skin. If the bones protrude abnormally due to an abnormality in the structure of the foot (such as a bunion or flat foot), or if the skin and padding under the bone are abnormally thin, pressure will increase on the skin covering them. The skin is usually irritated by both internal and external sources of pressure at the same time, where external pressure from walking combined with internal pressure from protruding bones or thin skin causes a reaction in the skin tissue. This reaction causes the skin to form a thickening of the outer layer of keratin-based cells, which squish together to form multiple layers.
Over time, a callus (also called hyperkeratosis) develops as the skin becomes excessively thick at the site of pressure. This callus, if it is thick enough, can be painful because the original, normal layer of skin beneath the callus is damaged by the pressure of the covering layer. What was once a simple skin preventive measure can turn into a source of pain and damage to the skin if the growth progresses far enough. Sometimes, a callus grows inward toward the underlying layer of skin, creating a thick, hard core that pokes inward (but does not break through the skin). This is also called plantar intractable keratosis, and is often confused with a wart. Finally, the sweat and other skin glands can fill with keratin, forming a small callus called a bursa. This type of callus does not need to have prominent bone underneath for it to form, and it is usually painless.
Callus treatment is often misunderstood, and in fact it can be rather complicated. The most common form of treatment is simple shaving of the callus by the person, podiatrist, or podiatrist. The process of thinning the hard skin makes walking on it more comfortable and reduces pain. However, the cause of the callus will still be there, and the callus will eventually return within a month or two. This causes great confusion for some people, who simply associate a callus with a temporary skin growth, rather than something directly related to the structure and activity of the foot. Using special shoe inserts or foot supports to reduce pressure on the bottom of the foot can help limit corn growth, when used in combination with corn shaving and appropriate footwear. Unfortunately, this will not permanently eliminate the callus, and will only help reduce the overall thickness of the callus when it grows back. Even prescription shoe inserts (orthotics) won’t permanently reduce calluses, although they do cushion the affected area better than store-bought inserts by being specifically made to mold to the foot.
It should be noted that diabetics should never attempt to manage their nails on their own. Because of poor sensation, diabetics cutting corns or an unskilled family member trying it at home can lead to wounding and infection from an accidental cut in normal skin.
Some people assume that a callus can be burned off, like a wart or other skin growth. Using chemicals, lasers, cold therapy, and electricity to destroy skin growths is very common, and often effective for other types of skin disorders. Unfortunately, these techniques also do not work on callus tissue, because callus growth is continuous, and does not depend on the mere presence of abnormal skin cells that can be removed. The callus tissue is normal tissue, and any destructive action against that tissue will only be temporarily successful until the skin begins to grow back, and the callus is repaired. The only exception to this is borreliosis, which can be removed if the underlying gland and gland duct are destroyed.
Surgical treatment is the next level of callus care. This is another area where there is significant confusion and treatment myths abound. In short, the callus cannot be surgically cut or removed, with the expectation that the callus will not return. The new skin that grows after surgery will continue to form a callus, and when combined with a surgical scar may be more painful than the original callus. The only exception again is borreliosis, which can be successfully removed with surgery. The only way to permanently get rid of a callus is to get rid of the underlying bone protrusion, and to ensure that shoes fit and are properly lined to account for any thinning of the skin and tissues over these bones. There are many bones in the foot that can cause protrusion enough to irritate the skin, and many ways to relieve pressure through orthopedic surgery. Procedures can include raising bones that are too steep towards the bottom of the foot, removing excess bone that naturally forms during growth (very common), shaving or removing bone spurs or loose bone fragments, or even complete removal of the portion of bone that is causing pressure. Procedures may be needed to correct a general deformity that is causing pressure, such as a polyp or abnormality of the arch. Recovery times vary, and depend on whether the bone was shaved or extracted, or whether the position of the bone was moved. These procedures are generally successful in eliminating callus formation if done correctly, although there is a risk of the pressure point of the foot moving to the next bone. Orthoses are often used after surgery to prevent this from happening.
As one can see, corn care is not just about shaving or cutting hard tissue. In reality, this myth doesn’t quite work, and orthopedic surgery is necessary to keep callus care from becoming an exercise in regular skin maintenance through regular shaving and shoe inserts. This may provide complete relief to some. For others, surgery is required to break the persistent cycle of pain.