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Corns and Calluses

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Corns and Calluses

COMMONLY ASSOCIATED CONDITIONS

para>In elderly patients, especially those with neurologic or vascular compromise, skin breakdown from calluses/corns may lead to increased risk of infection/ulceration. 30% of foot ulcers in the elderly arise from eroded hyperkeratosis. Regular foot exams are emphasized for these patients as well as diabetic patients (2).

Initial Tests (lab, imaging)

Biopsy with microscopic evaluation in rare cases

Abnormal accumulation of keratin in epidermis, stratum corneum

Admission Criteria/Initial Stabilization

Wound care, dressing changes for infected lesions

Complete cure is possible once factors causing pressure or injury are eliminated.

11 Freeman DB. Corns and calluses resulting from mechanical hyperkeratosis. Am Fam Physician. 2002;65(11):2277-2280.22 Pinzur MS, Slovenkai MP, Trepman E, et al. Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committee of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int. 2005;26(1):113-119.

Theodosat A. Skin diseases of the lower extremities in the elderly. Dermatol Clin. 2004;22(1):13-21.

L84 Corns and callosities

Most therapy for corns and calluses can be done as self-care in the home using padding over the affected area to decrease friction or pressure. However, if simple home care is not helpful, then removal of the lesions is often immediately curative.

  • Foot ulcers, especially in diabetic patients or patients with neuropathy or vascular compromise
  • Infection: look for warning signs of:Increasing size or rednessPuslike drainageIncreased pain/swellingFeverChange in color of fingers or toes
  • Signs of gangrene
  • Increasing size or redness
  • Puslike drainage
  • Increased pain/swelling
  • Fever
  • Change in color of fingers or toes

DIAGNOSIS

  • Most commonly a clinical diagnosis based on visualization of the lesion
  • Examination of footwear may also provide clues.

HISTORY

  • Careful history can usually pinpoint cause.
  • Ask about neurologic and vascular history and diabetes. These may be risk factors for progression of corns/calluses to frank ulcerations and infection.

PHYSICAL EXAM

  • CallusesThickening of skin without distinct bordersOften on feet, hands; especially over palms of hands, soles of feetColors from white to gray-yellow, brown, redMay be painless or tenderMay throb or burn
  • CornsHard corns: commonly on dorsum of toes or dorsum of 5th PIP jointVaried texture: dry, waxy, and transparent to a hornlike massDistinct bordersMore common on feetOften painfulSoft cornsOften between toes, especially between 4th and 5th digits at the base of the webspaceOften yellowed, macerated appearanceOften extremely painful
  • Thickening of skin without distinct borders
  • Often on feet, hands; especially over palms of hands, soles of feet
  • Colors from white to gray-yellow, brown, red
  • May be painless or tender
  • May throb or burn
  • Hard corns: commonly on dorsum of toes or dorsum of 5th PIP jointVaried texture: dry, waxy, and transparent to a hornlike massDistinct bordersMore common on feetOften painful
  • Soft cornsOften between toes, especially between 4th and 5th digits at the base of the webspaceOften yellowed, macerated appearanceOften extremely painful
  • Varied texture: dry, waxy, and transparent to a hornlike mass
  • Distinct borders
  • More common on feet
  • Often painful
  • Often between toes, especially between 4th and 5th digits at the base of the webspace
  • Often yellowed, macerated appearance
  • Often extremely painful

DIFFERENTIAL DIAGNOSIS

  • Plantar warts (typically a loss of skin lines within the wart), which are viral in nature
  • Porokeratoses (blocked sweat gland)
  • Underlying ulceration of skin, with or without infection (rule out especially with diabetic patients)

DIAGNOSTIC TESTS & INTERPRETATION

  • Radiographs may be warranted if no external cause is found. Look for abnormalities in foot structure, bone spurs.
  • Use of metallic radiographic marker and weight-bearing films often highlight the relationship between the callus and bony prominence.

TREATMENT

GENERAL MEASURES

  • D ©bridement of affected tissue and use of protective padding
  • Low-heeled shoes; soft upper with deep and wide toebox
  • Extra-width shoes for 5th-toe corns
  • Avoidance of activities that contribute to painful lesions
  • Prefabricated or custom orthotics

MEDICATION

  • Most therapy for corns and calluses can be done as self-care in the home (1).
  • Use bandages, soft foam padding, or silicone sleeve over the affected area to decrease friction on the skin and promote healing with digital clavi.
  • Use socks or gloves regularly.
  • Use lotion/moisturizers for dry calluses and corns.
  • Keratolytic agents, such as urea or ammonium lactate, can be applied safely.
  • Use sandpaper discs or pumice stones over hard, thickened areas of skin.

Use of salicylic acid corn plasters can cause skin breakdown and ulceration in patients with thin, atrophic skin; diabetes; and those with vascular compromise. The skin surrounding the callus will often turn white and can become quite painful. Aggressive use of pumice stones can also lead to skin breakdown, especially surrounding the callus.

ISSUES FOR REFERRAL

  • May benefit from referral to podiatrist if use of topical agents and shoe changes are ineffective
  • Abnormalities in foot structure may require surgical treatment.
  • Diabetic, vascular, and neuropathic patients may benefit from referral to podiatrist for regular foot exams to prevent infection or ulceration.

SURGERY/OTHER PROCEDURES

  • Surgical treatment to areas of protruding bone where corns and calluses form
  • Rebalancing of foot pressure through functional foot orthotics
  • Shaving or cutting off hardened area of skin using a chisel or 15-blade scalpel. For corns, remove keratin core and place pad over area during healing.

COMPLEMENTARY & ALTERNATIVE MEDICINE

  • Many over-the-counter topical creams, ointments, and lotions are available for calluses (Kera brand, CalleX, Urea, Lac-Hydrin). Do not use on broken skin.
  • Warm water/Epsom salt soaks.

INPATIENT CONSIDERATIONS

  • Admission usually not necessary, unless progression to ulcerated lesion with signs of severe infection, gangrene
  • May require aggressive d ©bridement in operating room should an abscess or deep space infection be suspected. Deep-space infections can develop where an abscess can penetrate into tendon sheaths and/or deep compartments within the foot or hand, potentially leading to rapid sepsis. Vascular status must be assessed and vascular referral considered.

ONGOING CARE

PATIENT EDUCATION

  • General information: http://www.mayoclinic.org/diseases-conditions/corns-and-calluses/basics/definition/con-20014462
  • American Podiatric Medical Association: http://www.apma.org

PROGNOSIS

COMPLICATIONS

REFERENCES

ADDITIONAL READING

CODES

ICD10

ICD9

SNOMED

  • 201038005 Corn - lesion (disorder)
  • 201040000 Callosity (disorder)
  • 201037000 Corns and callus
  • 394999002 Callosity on hand (disorder)
  • 403172005 Plantar callosity (disorder)

CLINICAL PEARLS