The chronic callus index | News, Sports, Jobs


Have you ever shaken hands with a carpenter? Did you notice how thick and calloused their hands were? For a doctor who regularly studies the lower extremities, these are important questions, because the formation of calluses can be the prelude to another problem. It is a characteristic of human skin that offers protection but also produces problems.

When your skin is under regular pressure, it undergoes a process of increased production of keratin, a protein produced by many skin structures that has strong interlocking chains that give it strength and protection. Hair, nails, even corns, they are all essentially composed of keratin. The result of localized pressure, with repetition and time, is thickening of the skin. And it’s not just pressure that can increase keratinization; higher temperatures can also speed up the process. The inside of a shoe can be the “perfect storm” for the formation of calluses.

Essentially, a localized, discrete callus is a clue that a pressure problem exists. Certainly, there are genetic factors that modify the speed of this process, but the main factor is the existence of excessive pressure on the skin. The pressure may be due to some type of bony deformity, such as a hammer toe, a protruding bone (eg, bunion deformity), or a bone spur from an arthritic process.

In contrast, callus forms simply because the foot moves slightly out of position with each step. For example, if the arch of the foot sags too much, pinching of the skin on the inside of the foot can occur. The skin is physically stressed and produces calluses as a result. Support the arch enough and the callus should disappear.

Surprising to many, corns are simply calluses that form on a toe. Because there is so little padding in this area of ​​the body, the skin is not padded like elsewhere. Of course, shoes are part of “pressure equation”. If a shoe doesn’t fit properly, the constant pressure and irritation can stimulate a corn to form as the body tries to protect itself. More commonly, there is a structural reason for the skin pressure because the finger is bent or twisted in some way.

Most people would dare to say that foot calluses are an annoyance, but that’s okay. And yet, the pressure from the callus can lead to nerve damage, causing pain with every step. In turn, this can lead to a variety of compensatory mechanisms in walking to avoid pain. Any change in the complex process of walking will eventually cause stress to another part of the body, leading to an entirely new problem that may seem unrelated to the original problem.

Potentially devastating, the skin under a chronic callus can become diseased due to the pressure preventing normal blood flow. Without sufficient alteration of blood flow, a real hole in the skin can develop and produce ulceration. This means that the victim has lost the protection against local bacteria that the skin provides and an infection can easily develop.

What to do in case of chronic and painful callosity? Keeping the skin well hydrated can help slow the production of calluses, but is generally not a cure. The key to stopping callus formation is to change the pressure on the area in question. A change in shoe gear can help, especially if one is wearing tight or incorrectly shaped shoe gear. Does the average women’s dress shoe come to mind? There are many types of padding, some more effective than others, and these can help, provided the padding is worn regularly. But these devices are not curative, but palliative, that is, they treat the pain but not the cause.

One of the best ways to change the distribution of pressure on the foot is to use some type of arch support or insole. Obviously, a device designed and built for this purpose will achieve much greater pressure relief, so a prescription foot orthotic is the most effective. For many, changing the cause of the pressure is a better solution, which often means some type of surgery. When it comes to an isolated bone spur, it can often be removed through a small incision, with very little trauma, and recovery is therefore an easy process.

Whatever the reason, a physician specializing in lower extremity care should play detective. To get to the root of the problem, the anomaly causing the pressure must be determined. This way the problem may be “healed!” Today’s lesson: Those painful patches of thickened skin are a clue… you don’t have to live with calluses!

Dr. Conway McLean is a physician who practices foot and ankle medicine in the Upper Peninsula, with an upcoming expansion into the Hancock-Houghton area. McLean has lectured internationally on wound care and surgery, being certified in surgery, orthotics and wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes topic requests for future articles at [email protected]



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