Thursday, June 26, 2008

CALLUSES – Removing Calluses

Calluses develop on the hands after a particularly repetitive activity such as shoveling, raking, or swinging a tennis racket. On the feet, calluses are often found on the soles just behind the base of the toes, the undersurface of the great toe, and around the edge of the heel. If the great toe is shorter than the adjacent toe (sometimes referred to as Morton's foot), a large callus often forms in the middle of the forefoot behind the base of the second toe. Usually, the other foot is similarly affected.

Calluses may be painful on pressure if they become large, and may precede the development of corns, which are more tender and painful. Callus build-up occurs around and over warts, and may cause much discomfort.

If a callus is shaved down, the normal fine ridges of the skin remain intact. No blood vessels or "seeds" are present and the callus does not exhibit a central core, unlike warts and corns, respectively.

Several factors are prominent in the development of calluses. Faulty weight distribution, whether due to foot problems or ill fitting shoes, is a common denominator. Shoes that are too narrow, have high heels, or soft, flexible soles can produce undue stress. Structural and functional deformities of the feet and toes can also be causal.


Removing Calluses

Calluses are usually less bothersome than corns and may not require much attention. Shoes must fit properly. Chiropody felt, moleskin, or foam rubber pads can be applied to minimize friction and pressure. These pads vary in thickness from 1/16 to 3/16 of an inch and often have adhesive backings. Such pads can be cut into strips and placed parallel to the callus, on either side, and held in place with rubber cement or glue. Often they will remain in place for days, even if wet at times. Large sections of padding can be cut to the shape of the callus to fit the shoe or to apply directly to the foot. Either method shifts pressure from the callus onto the surrounding pad and skin.

Insoles made of neoprene can be used under the forefoot. Devices such as metatarsal bars or orthotic inserts can be designed and used to correct imbalances in weight distribution; a podiatrist must fit the feet for orthotics.

CORNS Treatment

There are four different types of corns: hard, soft, seed, and neuro-vascular. Hard corns are very firm and dry, and have a compact central "core" that becomes more noticeable when the corn is shaved down. Hard corns are typically found on the outer edge of the little toe but are frequently seen on the balls of the feet. In the latter area, they are often surrounded by large calluses. Corns are preceded by callus formation, are quite tender, and respond to pressure with sharp pain.

Soft corns are found between the toes, most often in the space between the little toe and its neighbor. Composed of masses of soft, soggy skin, these corns sometimes erode, drain, and become infected. They are formed by pressure from the overriding bones of the adjacent toes.
Seed corns are tiny, compact, usually multiple corns found on the soles.

Neuro-vascular corns contain blood vessels and sometimes bleed within the core. They are usually on the inside surface of the foot, especially near the great toe, and are typically recalcitrant and very painful.

Corns can be identified by their appearance when the surface is pared away. With the exception of the soft corns, they have a waxy, translucent, clear-cut "core" in the center. The fine dots or blood vessels of a wart are not seen, though neuro-vascular corns may bleed when pared. Corns interrupt the normal ridges or lines of the skin, while calluses do not.

Corns and calluses are caused by similar factors. Corns often arise due to pressure from ill-fitting shoes or friction. Bony pro­minences frequently underlie corns.

CORNS Treatment

Shoes should not crowd the toes, and it is sometimes necessary to cut holes in the shoe to give the corn more room. Rings and pads with adhesive backings are avail­able in various shapes and sizes. Horseshoe-shaped or half-moon pads can be cut and taped into place around corns on the toes.

Periodically shaving them with a sharp blade should be done with great care, lest the surrounding or underlying skin is cut and infec­tion introduced. People with diabetes, poor circulation, or other- . wise prone to infections should not attempt this since serious infection and gangrene could result.

A more conservative but nonetheless effective approach is to scrape or abrade away the area with an emery board, pumice stone, or one of the instruments available for this purpose. Corns may be too tender to allow this, but hot soaks will help soften corns and calluses and make this easier. Salicylic acid preparations, available in plaster and liquid forms, are helpful in softening thick stubborn areas.

Liquid salicylic acid preparations should be applied to the corn or callus and covered with adhesive tape. The plaster is applied with the adhesive side down and taped in place. This may be left in place for several days if necessary. When the tape is removed, the area should be soaked in hot water and any soft, dead skin scraped away. The liquid or plaster is then reapplied and another cycle begun.

If used regularly, this procedure will normally control trouble­some corns and calluses. It can be done easily and safely at home, but remember that the acid should only be applied to thickened areas. The surrounding normal skin will be much less resistant to the effects of the acid, and irritation may occur if it is improperly applied. Treatment should be stopped if any irritated or cracked areas develop, either in or around the corn or callus.

It should be noted that paring or abrading corns and calluses is of temporary, symptomatic benefit only. Measures to eliminate the development of the lesion at its source are much more likely to produce permanent benefits though this may take some time.

Soft corns are prevented by keeping the space between the toes clean and especially dry. Alcohol and tincture of iodine help dry the area and kill germs. Soft corns can often be controlled or eliminated by inserting foam rubber, lamb's wool, or some other material between the ends of the toes. Shoes that do not pinch the toes together should be worn.