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Corns and Calluses

Basics

  • Corns (heloma) are focal hyperkeratotic lesions with central conical keratin cores causing pain.
  • Calluses (tyloma) are diffuse hyperkeratosis without distinct borders, usually painless.
  • Corns commonly occur on toes (esp. 5th toe PIP joint); calluses on palms and soles.
  • Intractable plantar keratosis under metatarsal heads is more difficult to treat.

Epidemiology

  • Most prevalent foot disorders, more common in elderly.
  • Women affected slightly more, likely due to shoe choices.
  • Blacks report 30% higher prevalence than whites.
  • Represent 46% of podiatric clinic foot disorders; affect ~9.2 million Americans.

Etiology and Pathophysiology

  • Result from repetitive friction and pressure causing hyperkeratosis over bony prominences.
  • Hard corns linked to bony protrusions rubbing against shoes.
  • Soft corns form in interdigital spaces due to moisture maceration and friction.
  • Calluses form diffusely over weight-bearing or friction sites.

Risk Factors

  • Extrinsic: poorly fitting/narrow shoes, absence of protective socks/gloves, repetitive activities (sports, guitar), barefoot walking.
  • Intrinsic: bony deformities (hammertoes, bunions), neuropathy (e.g., diabetes), gait abnormalities.

Prevention

  • Wear protective, well-fitting shoes and socks/gloves.
  • Avoid chronic friction-inducing activities.

Associated Conditions

  • Foot ulcers in vascular compromise or diabetic neuropathy.
  • Local infection signs: redness, swelling, purulent discharge, fever, skin color or temperature changes.

Diagnosis

History

  • Identify activities causing friction.
  • Assess vascular/neurologic comorbidities (smoking, diabetes).
  • Review prior treatments.

Physical Exam

  • Calluses: inspect hyperkeratotic areas, palpate for tenderness and skin changes.
  • Hard corns: well-circumscribed lesions with painful keratin core on toes.
  • Soft corns: interdigital macerated lesions, painful.

Differential Diagnosis

  • Plantar warts (with black dots, pain on bilateral compression).
  • Porokeratosis.
  • Pressure eschar over pathological wounds.

Diagnostic Tests

  • Radiographs if no clear external cause; use marker to localize lesion relative to bone.
  • Evaluate for diabetes, vascular insufficiency, recurrent infections.

Treatment

General Measures

  • Soak affected area in warm water.
  • Mechanical debridement with pumice stone or office tangential shaving.
  • Use foam padding, silicone sleeves, toe spacers to off-load pressure.
  • Wear wide, low-heeled shoes with soft uppers.
  • Shoe stretching services may help.
  • Avoid activities causing repeated friction.

Medications

  • Keratolytics (urea-based lotions) cautiously used; avoid in elderly or fragile skin.
  • Avoid salicylic acid plasters in diabetic or vascular-compromised patients.

Surgery

  • Consider for bony deformities causing persistent corns.
  • Procedures: hammer/claw toe correction, bony prominence removal.
  • Surgical shaving of corns’ keratin core in office with scalpel.

Complementary Medicine

  • Warm water or Epsom salt soaks.
  • Urea-containing creams.

Admission and Nursing

  • Rarely admitted unless complicated by infection, gangrene, or sepsis.
  • Nursing care includes wound management, teaching footwear and hygiene.

Ongoing Care

  • Periodic foot exams in at-risk patients.
  • Daily skin care with emollients to prevent dryness and hyperkeratosis.

Patient Education

  • Proper shoe selection: wide toe box, low heel, good support.
  • Regular use of protective socks.
  • Avoid self-aggressive skin removal.

Prognosis

  • Complete resolution possible if all pressure and friction factors eliminated.

Complications

  • Ulceration and infection if untreated.
  • Potential progression to deeper soft tissue infection.

ICD10: - L84 Corns and callosities

Clinical Pearls: - Most corns and calluses can be managed with self-care: debridement, padding, and pressure correction. - Cryotherapy is not recommended and may worsen symptoms.