What is the management for thickened callus (hyperkeratosis) on the feet?

Management of Thickened Callus on the Feet

Professional debridement by a podiatrist combined with appropriate footwear and pressure redistribution is the most effective approach for managing thickened callus on the feet. 1

Assessment and Diagnosis

• Hyperkeratosis (callus) presents as hard, thickened areas of skin typically located:

  • Under metatarsal heads
  • On tips of toes
  • Between toes
  • On pressure points of the feet

• Differentiate between types:

  • Regular callus: diffuse thickened area
  • Corn (heloma): hard, yellow area with a central nucleus/plug of keratin
  • Inflamed callus: appears red and may be painful

Treatment Algorithm

1. Professional Debridement

• First-line treatment for significant calluses
• Should be performed by a trained podiatrist using manual debridement or paring techniques 1
• Shows immediate and significant improvements in skin quality and associated foot pain 2
• Caution: Avoid overdebridement as it can make skin susceptible to increased tenderness and blistering 1

2. Home Management Options

• For mild to moderate calluses:

  • Urea-based products (40%) - Apply twice daily to affected areas 3

    • Mechanism: Gently dissolves intracellular matrix, loosening horny layer of skin
    • Particularly effective for hyperkeratotic conditions

  • Self-management debridement:

    • Use emery board or nail file after soaking feet in warm water 1
    • Only for mild calluses; thicker or painful calluses require professional care

3. Address Underlying Causes

• Footwear modifications:

  • Ensure proper fit (not too tight or too loose) 1
  • Internal width should equal foot width at metatarsal phalangeal joints
  • Shoes should be 1-2 cm longer than foot
  • Evaluate fit while standing, preferably at end of day 1

• Pressure redistribution:

  • Use cushioning insoles or orthoses to reduce pressure on callused areas 1
  • Assessment of weight distribution to identify pressure points 1

4. Preventive Measures

• Regular foot care routine:
  • Daily inspection of feet
  • Regular washing with careful drying, especially between toes
  • Application of emollients for dry skin (avoid between toes) 1
  • Avoid barefoot walking indoors or outdoors 1
  • Daily change of socks 1

Special Considerations

• Diabetic patients: Callus removal is particularly important as it can reduce peak pressures by approximately 26%, potentially preventing ulceration 4

• Neurovascular hyperkeratosis: A rare but debilitating form where nerve endings and blood vessels become prominent in the epidermis, making debridement painful and causing bleeding 1

• Recurrent corns: In severe cases that don't respond to conventional treatment, surgical options like split-thickness sole skin grafting may be considered for recalcitrant lesions 5

Pitfalls and Caveats

1. Avoid chemical agents or plasters for self-removal of corns and calluses unless specifically prescribed 1

2. Do not use sharp instruments at home for callus removal to prevent injury and infection

3. Beware of over-treatment - some degree of callus formation is protective, especially for those who walk barefoot regularly 6

4. Regular monitoring is essential - untreated calluses can lead to:

   • Pain and mobility limitations
   • Blisters forming under thickened tissue
   • Painful cracks developing in the skin 1
   • Increased risk of ulceration in diabetic patients 4

By following this structured approach to callus management, patients can experience significant improvements in foot comfort, mobility, and overall quality of life.