What is the treatment for corns vs calluses?

Treatment of Corns vs Calluses

Professional debridement by a podiatrist is the primary treatment for both corns and calluses, with corns requiring more precise removal of the central keratin plug and calluses needing broader paring of thickened skin. 1, 2

Key Differences in Pathology

Corns have a hard, yellow nucleus or plug of keratin that extends downward in a cone-shaped point, causing sharp pain that patients describe as walking on a small stone. 1, 2

Calluses are broader areas of thickened, hard skin without a central core, typically less painful than corns. 2

Treatment Algorithm

Step 1: Professional Debridement (First-Line for Both)

• Manual debridement or paring with a scalpel by a trained podiatrist is the primary treatment for both corns and calluses. 1, 2
• For corns, the central keratin plug must be carefully removed to provide pain relief. 1
• For calluses, broader paring of the hyperkeratotic tissue is performed. 2
• After debridement, apply emollients and non-adherent dressings to protect the debrided skin. 2, 1

Critical pitfall: Avoid overdebridement, as this makes underlying skin susceptible to increased blistering and tenderness. 2

Step 2: Address Underlying Mechanical Causes

• Properly fitting footwear with adequate toe box width and height reduces pressure and friction. 1, 2
• Toe separators or silicone orthotic devices redistribute pressure between toes for soft corns (heloma molle). 1
• Therapeutic shoes or custom-made insoles are indicated when foot deformity or pre-ulcerative signs are present. 2
• Padding to redistribute mechanical forces helps prevent recurrence. 3, 4

Step 3: Topical Keratolytic Therapy (Adjunctive)

• Urea-based creams (≥10%) are FDA-approved for hyperkeratotic conditions including corns and calluses. 5
• Apply to affected areas to reduce keratin thickness between professional debridement sessions. 5
• For children under 1 year, restrict urea application to once daily on limited areas like palms and soles. 2

Step 4: Prevention Strategies

• Daily foot inspection, especially between toes, to identify early lesions. 1, 2
• Daily washing with careful drying between toes prevents moisture buildup. 1, 2
• Never walk barefoot, in socks only, or in thin-soled slippers, whether at home or outside. 2
• Apply emollients to lubricate dry skin, but not between the toes. 2

Special Populations

Diabetic Patients or Those with PAD

• More conservative debridement approach is essential due to higher complication risk. 1, 2
• Never use chemical agents or plasters to remove corns or calluses. 2
• Corns and calluses are considered pre-ulcerative lesions in patients with PAD and require aggressive preventive management. 2
• Referral to a foot care specialist for ongoing preventive care and surveillance every 1-3 months. 2
• Therapeutic footwear is mandatory for high-risk patients. 2

Patients with Epidermolysis Bullosa

• Extra conservative debridement is required, as overdebridement increases blistering risk. 2
• Pressure redistribution and cushioning are particularly important to prevent hyperkeratosis development. 2

When Surgery May Be Considered

• Surgery is rarely indicated and only when conservative measures fail after adequate trial. 3, 4
• Surgical intervention must specifically correct the abnormal mechanical stresses causing the lesion. 3, 4
• Digital flexor tenotomy may be considered for toe corns when conservative treatment fails in high-risk diabetic patients with hammertoes. 2

Common Pitfalls to Avoid

• Never allow patients to self-treat with chemical corn removers or plasters, as this increases infection and ulceration risk. 2
• Do not cut corns or calluses at home—professional care is essential. 2
• Avoid applying moisturizers between toes, as this increases maceration risk. 2
• Lesions will recur if underlying mechanical forces are not addressed—footwear modification is not optional. 3, 4