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High Yield Topics

Calluses and Corns

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Ovid: 5-Minute Sports Medicine Consult, The


Calluses and Corns
Kathleen Weber
Basics
  • Calluses and corns are common skin conditions.
  • They result from increased pressure or friction; typically located on the hands and feet.
  • A callus is an adaptive response to repetitive friction.
  • Calluses and corns may lead to considerable discomfort and pain.
Description
  • A callus is a plaque of hyperkeratosis of relatively even thickness caused by repetitive friction, pressure, or trauma, and commonly occurs over bony prominences (1).
  • A corn is a localized, tender, sharply defined area of hyperkeratosis found usually on the foot (1).
  • A corn has a central core that penetrates into the dermis.
Epidemiology
Calluses and corns are common skin conditions.
Risk Factors
  • Activity: Occupational (eg, manual workers); musicians (eg, guitarists); athletic activities that apply increased stress to the skin (ie, racquet sports—hands, runners—feet, rowers—hands, sacrum) (2)
  • Ill-fitting footwear: Tight, loose irregularities in shoe, or not wearing shoes (3)
  • Bony prominences (4)
  • Faulty foot mechanics or foot structure (3)
  • Toe deformities
General Prevention
  • Proper footwear (low-heeled, a soft upper portion, and wide toebox)
  • Orthotics
  • Toe separators
  • Place felt pads over bony prominences or areas of increased friction to the skin.
  • Wear gloves to protect the hands.
  • Keep the hands and feet skin soft by applying a moisturizer (5).
Etiology
  • Calluses and corns develop as a result of hyperkeratosis, a normal physiologic response of the skin to chronic friction, pressure, or trauma and commonly occur over bony prominences (1).
  • Calluses commonly develop overlying bony prominences as a normal adaptation of the body to protect the skin when chronic pressure or friction is encountered (3,4).
  • Abnormal stresses may be either extrinsic (eg, tight toebox) or intrinsic (eg, hammertoe) or a combination of both (3).
Diagnosis
  • The diagnosis of calluses and corns is based upon their clinical appearance.
  • Radiographs may be obtained if your physician suspects an underlying bony prominence is a contributing factor.
History
  • Corns and calluses are typically located at sites of friction, pressure, repetitive trauma, or at bony prominences.
  • Factors that typically provoke the formation of corns and calluses are:
    • Sports that require cutting, turning, and sudden stops
    • Occupations that are categorized as manual labor requiring the repetitive use of the hands or kneeling, such as a carpenter or landscaper
    • Leisure activity that involves activities that cause repeated friction or pressure
    • Poorly fitting footwear
    • Coexisting illnesses (eg, diabetes)
    • Inherited disposition (autosomal-dominant inheritance)
Physical Exam
  • The most common site for calluses is under the metatarsal heads and over bony prominences; may occur anywhere on the skin as a result of friction (4).
  • A callus may be asymptomatic or painful, often appearing as a thick yellowish plaque that retains the natural skin lines (helps distinguish from warts) (2).
  • A hard corn is a dry horny mass found commonly over the interphalangeal joints (dorsally) or the 5th toe (dorsolaterally).
  • Soft corns are extremely painful; occur interdigitally; skin appears white and macerated; commonly located between the 4th interdigital space (often mistaken for tinea).
  • Observe gait and the alignment of the feet for any faulty mechanics.

    • P.61


  • Note the location and appearance of the hyperkeratotic lesions:
    • Common sites for corns and calluses: Plantar surface (over the metatarsal heads, sides of the arch, and the heel) and dorsum of the foot (over the interphalangeal joints)
    • Common sites for calluses on hands: Palmar surface and over metacarpophalangeal joints
  • Palpate for any abnormal bony prominences.
  • Assess for pain or tenderness.
Diagnostic Tests & Interpretation
Physical examination of the area is typically all that is necessary to make the diagnosis.
Imaging
  • Usually not necessary
  • Radiographs: Hands and weight-bearing views of the feet used to identify bony prominences or abnormalities (3)
Differential Diagnosis
  • Verruca vulgaris or plantaris (differentiated by paring the skin: The corn becomes more normal in appearance and the wart displays the characteristic tiny red dots when pared)
  • Tinea pedis (interdigital)
  • Psoriatic plaque: Hyperkeratosis with red base
Treatment
Treatment is aimed at providing symptomatic relief and avoiding the underlying mechanical forces that caused the development of the callus or corn (1,2,3,5)[C]:
  • Careful and regular paring
  • Use an emery board or a pumice stone daily, if necessary, to remove excess thickened skin.
  • The pumice stone works best after bathing when the thickened skin has softened.
  • Soft corn: Toe separator or lamb's wool
  • Doughnut-shaped corn pads
  • Proper footwear with soft upper and a roomy toebox
  • Orthotics can reduce pressure by redistributing forces.
  • Use a skin-softening cream to prevent cracking of the callus or corn.
Medication
Antibiotics are only indicated when there is evidence of an infected corn or callus.
First Line
Salicylic acid (40%): Careful application or pads containing keratolytic agents (2)
Surgery/Other Procedures
Surgery may be required to correct the bony abnormalities or deformities, and is indicated only if all conservative measures have failed (3).
Ongoing Care
Follow-Up Recommendations
Follow-up is needed for ongoing corns and calluses despite conservative management, signs of infection, or severe pain.
Patient Monitoring
  • Diabetics, the elderly, and individuals with peripheral arterial disease or peripheral neuropathy should consult with their healthcare providers before initiating treatment for calluses or corns.
  • These individuals should be monitored closely for signs of nonhealing or infection.
References
1. Freeman DB. Corns and calluses resulting from mechanical hyperkeratosis. Am Fam Physician. 2002;65:2277–2280.
2. Cordoro KM, Ganz JE. Training room management of medical conditions: sports dermatology. Clin Sports Med. 2005;24:565–598, viii–ix.
3. Singh D, Bentley G, Trevino SG. Callosities, corns, and calluses. BMJ. 1996;312:1403–1406.
4. Spink MJ, Menz HB, Lord SR. Distribution and correlates of plantar hyperkeratotic lesions in older people. J Foot Ankle Res. 2009;2:8.
5. Robbins JM. Recognizing, treating, and preventing common foot problems. Cleve Clin J Med. 2000;67:45–47, 51–52, 55–56.
Codes
ICD9
700 Corns and callosities


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