What are the treatment options for corns and calluses?

Treatment Options for Corns and Calluses

The first-line treatment for corns and calluses is professional debridement by a podiatrist using a scalpel or blade, followed by pressure redistribution through appropriate footwear and cushioning to prevent recurrence. 1

Evaluation and Assessment

• Evaluate calluses for:

  • Location and appearance
  • Pain level
  • Signs of inflammation
  • Presence of cracks or fissures
  • Any underlying blisters 1

• Differentiate from plantar warts by gentle paring with a scalpel:

  • Corns and calluses show uniform thickened skin
  • Warts reveal soft, granular, elongated mounds of dermis projecting into the epidermis 2

Treatment Algorithm

1. Professional Treatment

• First-line approach: Professional debridement by a podiatrist using a scalpel or blade 1

  • Provides immediate relief by removing thickened tissue
  • Caution against overdebridement which can increase tenderness

• After debridement:

  • Apply emollients and non-adherent dressings to protect debrided skin
  • Use urea-based creams to keep skin soft and prevent recurrence 1, 3

2. Topical Treatments

• Urea preparations: FDA-approved for hyperkeratotic conditions including corns and calluses 3

  • Promotes normal healing and debridement of hyperkeratotic lesions
  • Particularly effective where healing is retarded by local infection or necrotic tissue

• Salicylic acid preparations: Apply thoroughly to affected area and cover overnight 4

  • Skin should be hydrated for at least five minutes prior to application
  • Wash off in the morning
  • If excessive drying occurs, apply bland cream or lotion

3. Pressure Redistribution

• Prescribe orthotic interventions to reduce excess callus:

  • Toe silicone or (semi-)rigid orthotic devices 5
  • Gel insoles for non-diabetic patients 1

• Proper footwear selection:

  • Shoes should be 1-2 cm longer than the foot
  • Internal width equal to the foot at the metatarsal phalangeal joints
  • Rounded toe box 1

4. Surgical Interventions (for refractory cases)

• For patients with non-rigid hammertoe with nail changes or excess callus:
  • Consider digital flexor tendon tenotomy after non-surgical options fail 5
  • Surgery should only correct the underlying mechanical stresses causing the lesions 6

Special Considerations for Diabetic Patients

• Never use chemical agents or plasters to remove corns and calluses in diabetic patients 1
• Avoid self-treatment; professional care is essential
• More frequent monitoring and assessment is warranted due to risk of complications 1
• Daily foot inspection, including between toes, is crucial 5, 1
• Avoid walking barefoot, in socks without footwear, or in thin-soled slippers 1

Follow-up Care

• Schedule follow-up in 1-3 weeks to assess treatment response 1
• Regular maintenance debridement may be necessary to prevent recurrence
• Continue use of orthotics and proper footwear for prevention 1

Warning Signs Requiring Immediate Attention

• Purulent discharge or spreading redness suggesting infection
• Severe pain unresponsive to initial treatment
• Signs of systemic illness
• Discoloration suggesting deep tissue infection or necrosis 1

The treatment of corns and calluses should address both symptomatic relief and correction of underlying mechanical causes. While most cases can be managed conservatively with proper footwear and professional debridement, persistent cases may require more advanced interventions like orthotic devices or, rarely, surgical correction.