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Corns and Calluses

Callus evolution.

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The foot is an engineering marvel that cannot be duplicated by robotics. It is composed of 26 bones, 33 joints and around a hundred tendons, ligaments and muscles of various sizes, well oiled and sliding smoothly over each other.

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The foot is encased in thick and leathery skin that protects it from injury. Our feet take us everywhere from the time we first learn to walk till we are finally laid to rest. Yet, somehow, we tend to take our feet for granted until they malfunction, cause pain or refuse to perform as instructed.

Some orthopaedic abnormalities of the feet, like clubfoot, flat feet, congenitally dislocated hips or knock knees, are present from birth. Sometimes shoes may be purchased for conformity to fashion disregarding the requirements of the feet. They maybe ill fitting, too tight or too large. Pointed toe stilettos are notoriously guilty. The gait becomes abnormal as pressure is applied unevenly to the skin of the foot. Irregularity may also occur in old age as a result of arthritis or injury.

When pressure is exerted unevenly on the foot, the skin tends to thicken abnormally. This callused skin may remain like that or develop into a corn. This happens in areas where the skin is rubbed persistently or where the skin is under uneven pressure. Common places are the heel, the ball of the foot and the sides of the toes.

The skin over the unsightly hardened area on the foot, a callus, is dead. So there is no inflammation or pain. Eventually the callus may harden to form a corn. The corn has a central area of inflammation and is painful and tender. It is usually situated near the base of the fifth toe. If the feet are pushed into tight fitting shoes, corns will form between the toes as well. Perspiration and moisture cannot escape from this area causing the corn to become macerated and tender.

If a callus or corn is beginning to develop, the first step would be to determine if there is any source of pressure which has set off the thickening of the skin. Sometimes it may even be due to a sudden increase in the level of exercise or interest in some new sport. Once the cause has been identified it should be removed, or else the callus will exacerbate.

The foot should first be soaked in warm water with rock salt and commercially available liquid soap. After 10 minutes the affected area should be gently rubbed with a pumice stone or a foot scrubber. Some baby oil or moisturiser should then be applied. This gets rid of the corn (or callus) at an early stage.

If the callus is hard and the punctum or tip of the corn is easily visible, commercially advertised OTC (over the counter) corn plasters may be used. Most of them contain salicylic acid — a keratolytic agent that softens and breaks down hard skin. They need to be applied on a dry foot and left in place till the corn softens and falls out. They should not be used on soft corns between the toes.

Wearing loose footwear with low heels and a well-cushioned insole can also relieve the pain. Slippers should be made of soft rubber like MCR (micro cellular rubber). Acupressure slippers are also helpful.

If the corn does not respond to these simple measures, it has to be surgically removed. A qualified dermatologist or surgeon can do it as an outpatient office procedure.

Newer, relatively painless techniques involve freezing the corn with liquid nitrogen or dry ice or removing it with laser technology. It is dangerous to perform “home surgery” — slicing off the corn with a knife or blade. Dangerous debilitating infections can occur due to such amateur attempts.

Diabetics need to take particular care of their corns and calluses and consult their physicians if they have a problem. They may have compromised blood supply to their feet or numbness of the nerves. This may make them insensitive to the pain making them inadvertently ignore the corn. Any self-treatment (especially salicylic corn plasters) is likely to result in dangerous infection.

Some simple rules one should follow:

• Wear proper footwear and socks

• Wash the feet well at night before going to bed

• Moisturise the feet with oil or cream once a day

• Keep the areas between the toes dry, particularly after a bath

• Treat arthritis, blisters, corns and calluses promptly

Appropriate footwear for various sports should be used. One pair of “canvas” shoes should not be used for all activities.

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Sources: The Telegraph (Kolkata, India)

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Corns and Calluses

Synonyms and Keywords:Corns and Calluses, Tyloma,Heloma, Clavus, Sore Toe, Knot

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Definition:
A callus (tyloma) is an area of skin that thickens after exposure to repetitive forces in order to protect the skin. A callus may not be painful. When it becomes painful, treatment is required.

When a callus develops a mass of dead cells in its center, it becomes a corn (heloma). Corns generally occur on the toes and balls of the feet. Calluses occur on the feet, hands, and any other part of the skin where friction is present.

Causes:

  • Factors outside the body that can cause calluses and corns from friction and stress
    • Ill-fitting shoes or socks
    • Bunching of socks or socks with seams by the toes
    • Manual labor
    • Not wearing shoes
    • Activities that increase stress applied to the skin of the hands and feet, such as athletic events
  • Factors within the body that may lead to the formation of corns and calluses
    • Bony prominences
    • Enlarged bursa or faulty foot function and structure

Symptoms:

  • Calluses :-
    • Thickening of skin without distinct borders
    • Most commonly on feet and hands over bony spots
    • Vary in color from white to gray-yellow, brown, or red
    • May be painless or tender
    • May throb or burn
  • Corns :-
    • Texture varies from dry, waxy, transparent to a horny mass
    • Distinct borders
    • Most common on feet
    • May be hard or soft
    • Usually painful

When Medical Care is Needed:

If home remedies fail to eliminate the corns and calluses and they continue to be painful or bothersome, consult your doctor. Anyone with diabetes or poor circulation should seek medical attention earlier because of a higher risk for infection.

Normally, corns and calluses do not require emergency attention. These conditions, however, would need a visit to the hospital’s Emergency Department or doctor’s office:

  • Spreading redness around the sore
  • Puslike drainage from or around the sore
  • Increasing pain and swelling
  • Fever
  • Change in color of fingers or toes
  • Signs of gangrene (tissue decay)

Exams and Tests:

Diagnosis is almost always made by looking at the corn or callus. A biopsy with microscopic evaluation can be done. The doctor also may take x-rays of your feet or hands to look at underlying bony structures that may be the cause of the corns and calluses.

Treatment:

Self-Care at Home:-

  • Place protective covering or bandages over the sore to decrease friction on the skin until the sore heals.
  • Apply moisturizing agents such as lotions to dry calluses and corns.
  • Rub sandpaper disks or pumice stone over hard thickened regions.
  • Avoid stress to hands or feet by using gloves or changing shoes or socks.
  • Soak feet or hands in warm soapy water to soften corns and calluses.

Modern Medical Treatment:

  • Antibiotics for any infected corn or callus
  • Removal by surgical means or with keratolytic agents (medicines that break up hardened areas of skin)
  • Surgically removing areas of protruding bone where corns and calluses form
  • Shaving or cutting off the hardened area on the skin

A common method, often done by a podiatrist, is to shave the calluses down, and perhaps pad them.

For calluses on the feet an inexpensive home remedy is to dissolve a foot soap powder composed of borax, iodine and bran in warm water and soak the feet in the solution for 15 to 20 minutes. This softens the calluses so that layers of dead skin can be rubbed away with a cloth towel. Repeated soaking over a period of several days can often allow removal of even the core with nothing more than the friction of the cloth towel. If this fails, use of a pumice stone can also remove the skin.

Most corns and calluses located under the foot are caused by the pressure of the foot bones against the skin, preventing it from moving with the shoe or the ground. While well-fitting shoes will help some of these problems, occasionally some other degree of intervention is required to completely rid the foot of the problem. The most basic treatment is to put a friction-reducing insole or material into the shoe, or against the foot. In some cases, this will reduce the painfulness without actually making the callus go away.

In many situations, a change in the function of the foot by use of an orthotic device is required. This reduces friction and pressure, allowing the skin to rest and to stop forming protective skin coverings.

Salicylic acid (0.5%-40%) can be used for two reasons, “(1) it decreases keratinocyte adhesion, and it increases water binding which leads to hydration of the keratin.”

Using a knife to cut it away is dangerous because it can result in bleeding of the foot and infection.

At other times, surgical correction of the pressure is needed.

Next Steps:

Follow-up:-

Follow-up is needed for ongoing corns and calluses that don’t go away with treatment as well as for signs of infection or severe pain.

Prevention:

  • Wear gloves to protect hands.
  • Make sure shoes and socks fit properly and do not rub.
  • Wear felt pads over bony points where there is increased friction to the skin.
  • Surgically correct bony abnormalities.
  • Keep hands and feet moisturized.

Generally speaking, corns are a disease of civilization. If we didn’t wear shoes, we wouldn’t have them. Potential preventive measures therefore include:

Moving to Tahiti to stroll on the sand in your bare tootsies! This is a pleasant approach, as long as you never have to go back home and walk in shoes again.
For the incurably civilized, wearing comfortable shoes is useful. The idea is to avoid having footgear press on the outside of the 5th toe, or pressing the 4th and 5th toes together.
Another approach is to pad the potentially affected area. You can buy many sorts of padding at the drugstore:
Cushions to put between the toes;
Foam or moleskin pads to put over the places where corns form;
Foam pads with holes in the center (like doughnuts or bagels), which redistribute pressure around the corn instead of right over it; and
Cushioned insoles to pad your feet and alleviate mechanical pressure.

Herbal Foot Care Tips

Ayurvedic Foot Care

Corns Home Remedies

Outlook:

Once the corns and calluses are eliminated, a complete cure is possible if the factors causing them have been eliminated.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.emedicinehealth.com/corns_and_calluses/article_em.htm
http://www.medicinenet.com/corns/article.htm
http://en.wikipedia.org/wiki/Callus

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