CORNS AND CALLUSES Corns and calluses are local accumulations of keratin or thickened skin in reaction to stress. We usually refer to a corn as occurring on the toes and a callus as occurring on the bottom of the foot, but they are actually the same type of tissue. Corns are usually deeper and show a focal point of pressure. Hard corns are on the tops of toes and at exposed areas. Calluses build up in areas of repetitive friction and pressure. Corns and calluses are secondary to the same forces that cause blisters: friction and shear. Superficial (shallow) calluses are very common to manual workers and athletes, and show that the skin has adapted to the increased load and friction placed upon it. It is when skin can no longer tolerate the forces put upon it that the blisters form and calluses. The skin of a callus will feel thickened, skin lines will appear exaggerated, and the color will be toward a yellowish hue. This skin, if not bothersome, can be left alone. A small amount of callus is protective and good, but as it thickens, it impedes circulation, causing a burning sensation. If a slight burning pain exists, use a callus file or pumice stone after bathing to reduce this tissue. Shearing calluses and corns are a much greater nuisance. They are caused from shear and not just friction. The pain from calluses and corns can be sufficient enough to cause a limp or abnormal weight distribution to favor the painful area. Early treatment is recommended to avoid this sequence of events. The shearing callus may look similar to the shallow type but is deeper, and close examination may show a plug or nucleus which is very much like a corn. It is this hard plug that compresses the surrounding nerves to cause the pain. To temporarily relieve the pressure, the corn may be carefully trimmed down with a sharp instrument and the core removed. We discourage the use of corn plasters for these preparations contain acids which may burn the surrounding normal tissue. The use of corn pads or aperture-type accommodative pads to redistribute the weight and pressure may relieve pain significantly. Pads, if used, must not be placed directly over the corn, for this will only increase the pressure and pain. They must be placed around the behind the lesion. Soft corns and corns between the toes may be helped by foam or felt separators. Consider the shoes, first making sure they are the proper size and width. Look for irregularities in the shoe that may be causing abnormal pressure points. If one pair of shoes is the problem, get rid of them. Most corns on the top of the foot are due to contracted or hammered digits. The contraction, which is the result of a longstanding structural or muscular imbalance, makes the top of the toe more prominent and subject to pressure. With corns, a minor surgical correction is sometimes necessary to straighten the toes in order to provide permanent relief. Calluses usually build up on the bottom of the foot under the weight-bearing area of the metatarsals. Special types of “pinch” calluses build up where the upper meets the lower of the shoe. If painful, recurrent calluses are present, medical attention should be sought to determine if the callused tissue is due to a mechanical imbalance. If this is the case, protective padding or accommodative orthoses are helpful in redistributing the weight pattern. Plantar calluses may also be caused by the abnormal position of only one bone in relation to the others. We find that a metatarsal bone can be out of balanced with other metatarsal bones, therefore, taking a greater than normal amount of stress with each step. A surgical realignment in the bone is usually curative, or the area can be protected from pressure with a custom orthotic inside the shoe.
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