Foot callus is one of those conditions that can and can not be overlooked.
Why am I starting off this page with silly sentences?
Well in some ways we actually need hard skin and in other ways, it becomes a very troublesome problem.
What is foot Callus?
Sometimes called “hard skin”, callus is actually a normal body response to pressure.
What happens is that the body senses that pressure is being built up in a particular area, so it layers down hard skin to compete with that pressure. The problem comes in the fact that this new layer of hard skin now acts as pressure. So the body puts down more hard skin…and the cycle continues.
In a way, the body is protecting itself from external forces which may damage it. The process can easily be seen with people who work a lot with their hands.
My hands do a lot of instrument holding- the tools of my trade. Initially, when I first started working, I had blisters on the underneath of my fingers. Then as time increased those same areas started to build up with hard skin. My fingers are not sore anymore and it is actually helpful to do the job.
When callus becomes a problem
Hard skin only becomes a problem when it is mixed with conditions that either:
1- Makes the callus worse- hyperkeratosis
2- Makes the patient more at risk- e.g. Diabetes (in some Diabetics that have reduced circulation or reduced sensation)
3- Causes the patient to be in pain.
Apart from these points, hard skin can be managed simply and doesn’t seem to bother most people.
If left long enough and with other factors being at work, hard skin can progress into corns. Hard skin can even be covering corns and home treatments then will not work.
Again, if hard skin is left long enough, it can crack. This is most common in the heels, where cracks are called fissures.
Pictures can tell a thousand words, so here are the commonest places that hard skin can develop.
Under the big toe joint. This is very common and sometimes highlights a reduced movement through that joint. Or similarly that when a bunion is present (as seen slightly in the picture) the foot tends to roll off that big toe joint so that your body “cheats” in achieving the required movement that it needs.
callus under the big toe
One of the most commonest presentations:
callus under the foot
This is on the ball of your foot, joints 2-4. It is usually a sign of excessive pronation because the big toe joint and the little toe joint have been lifted out of the way- no hard skin. The 2-4 joints are taking most of the pressure which is not what they were designed for so the body has laid down hard skin in response to this.
Under the big toe joint, but the next joint up. A very commonplace for hard skin development. However, the site can also be problematic because there is so little fatty padding around that area breakdowns/ ulceration are common in susceptible people.
callus under the big toe
Apart from the really poor job of debriding the hard skin from the toe, we can see maceration. Maceration is where the tissues are white, soft, and soggy because of the excessive pressure that is being placed into an area that does not want that pressure. It is a sign of problems to come if not dealt with properly.
More maceration in the next picture. Under the little toe joint this time. This tells us that the patient is favoring leaning to the outside of their foot. Why? Usually a biomechanical problem, but sometimes it is because there is something wrong with the other leg and this one is compensating for it. Again, maceration is not a good thing and this one is quite deep
Callus getting worse. Some people have called the dark area in the hard skin a “bruise”. That term is correct, however, what is a problem is that the term bruise is soft and doesn’t convey the message that there is a problem:
When there are dark patches within the hard skin it means that pressure has been so great that it has disrupted and broken the tissue underneath the callus. Blood has seeped into the area and dried. Now if that has happened there could be an ulcer under that hard skin- because the pressure is still there building up and still hitting the tissues under the callus.
Dry blood usually means a problem.
Your body is telling you that a problem exists and we need to figure out how to stop this from occurring because if there is no ulcer there now, there will be one in the future.
But with all of these hard skin types and maceration…how on earth do we treat it?
Treating Foot Callus
Foot calluses do not have to be treated all the time. there is a question of whether the treatment actually makes the problem worse because you are making the area susceptible to tenderness again.
In the cases of the pictures in the Calluses 101 most, if not all of them needed to be treated.
There are only 2 ways to treat foot callus
1. Professional Care of foot calluses
Now this means a Chiropodist/ Podiatrist. Only for the reason that they should test you and examine you before they treat you. Why, well here is a case that we had [can be queezy]:
A patient who was completely neuropathic (they couldn’t feel anything in their feet) went to a beauty spar to have their hard skin reduced. The staff reduced the hard skin with a “carrot scrapper” type tool and went to work. When the floor was full of blood, they still worked because the patient never said anything. He wouldn’t because he was neuropathic to start with. When they realized that bits of muscles were on the show they stopped. 2 weeks later the patient was in the hospital with blood poisoning.
When the hard skin becomes excessive/ painful/ too much, then it is needed that you see a health professional. What they should do is the following:
1. Debride the area with a scalpel blade which doesn’t hurt because the hard skin has no nerve. You get a better job done, it’s neater and you can find everything if there is a problem.
2. Figure out why you have hard skin in the first place. Kinda easy and simple idea. but we know why it is there (pressure) so that pressure needs to be taken away with either:
1- Insoles. These are not orthotics, they are pressure redistribution insoles which gives the high-pressure areas a bit of a break. Also, they are useful for “adding fatty padding”. When you have boney feet you have very little shock absorption, so these will add that for you.
2- Orthotics. Only needed if there is a biomechanical problem that is causing your hard skin or if there is one focal area where the hard skin is building up to problematic proportions. Check out our Orthotics 101 section here.
3- Shoes. Advice on shoe wear. Sometimes shoes cause a host of problems because they are not the right size, are not fitted right, have seams that rub, and a whole lot more. A good health professional will check them. Also to note is that slippers can cause calluses because they have very little of anything in them even though they “feel nice and soft”.
If the cause is not figured out then you will have the calluses for some time. They might not go entirely with the treatment given, but it will/ should slow down their growth.
2. careful Home Care
You can actually do something with your calluses at home. But with everything, there are warnings to each of the treatments.
1. Use of a foot file. Most people will balk at this idea, but it is because they have done it wrong.
When your feet are nice and dry then use the file and then wash the file after each use to get the hard skin out from the grooves. Filing when wet does very little.
This will only work if your calluses have been reduced first or they are very mild.
2. Use moisturizing cream. If you use it on hard skin then it will soften up the hard skin but it will not reduce it. Creams with Urea have a mild reducing effect.
3. Style change. Footwear and activities are usually what cause hard skin. make sure that you have the right footwear for the right activity. If you wear high-heels a lot and you are getting hard skin build-up on the balls of your foot, then reduce the heel or find a more cushioning shoe.
Not Very Good Treatment Methods…At All.
Corn Plasters. Ahh, that old treatment method. Well for a start you do not have a corn, and secondly, the “medicated” ones have an acid in them which will do more harm than good.
Fleecy Foam. Also called mole foam, it is a very thin sheet of soft material. Unfortunately, this will do nothing to a pressure-related problem because it tackles shear forces (ones that rub) rather than pressure forces.
Graters/ Blades. Too many patients have come to us to fix them up from a home-related DIY self-care. These can be dangerous for many reasons- you have to be agile, know when to stop, the callus is usually small and diffuse which large metal implements can’t handle.
Sanding. This is only useful for dry hard skin that is very minimal and you keep on top of it on a regular basis. If you tried it on larger patches 1- it burns, 2- it’s completely inefficient, 3- it will not take down the calluses effectively. Unfortunately, many health professionals use this instead of a blade which is very bizarre, unless they are not allowed to use a blade?!
But that is all the treatments that are 1 effective and 2 been the most proven to work. If you are unsure then see a health professional.