How do I treat corns and calluses?

Treatment of Corns and Calluses

Manual debridement or paring with a scalpel by a trained podiatrist is the primary and most effective treatment for both corns and calluses. 1, 2

Understanding the Difference

• Corns have a hard, yellow nucleus or plug of keratin that extends downward in a cone-shaped point, causing sharp pain that patients often describe as walking on a small stone or pebble 2, 3
• Calluses are broader areas of thickened, hard skin without a central core, typically less painful than corns, and require broader paring of the hyperkeratotic tissue 2
• Corns between toes (heloma molle or soft corns) differ from hard corns (heloma durum) on weight-bearing surfaces, with the former being more prone to moisture and friction 3

Treatment Algorithm

Step 1: Professional Debridement (First-Line)

• Scalpel debridement by a trained podiatrist is the cornerstone of treatment for removing the hyperkeratotic tissue and central keratin plug in corns 1, 2
• If the area is too painful or too thick for self-management with an emery board or nail file, blade or scalpel debridement by a podiatrist is required 1, 3
• After debridement, apply emollients and non-adherent dressings to protect the debrided skin 1, 2, 3
• Be conservative with debridement depth to avoid making underlying skin susceptible to increased tenderness or complications 1

Step 2: Address Underlying Mechanical Causes

• Properly fitting footwear with adequate toe box width and height is essential to reduce pressure and friction that causes recurrence 2, 3, 4
• Toe separators or silicone orthotic devices redistribute pressure between toes for soft corns 2, 4
• Therapeutic shoes or custom-made insoles are mandatory when foot deformity or pre-ulcerative signs are present 1, 2
• Padding to redistribute mechanical forces can prevent recurrence 5

Step 3: Topical Keratolytic Agents (Adjunctive)

• Salicylic acid 6% can be applied to the affected area at night after washing, with the skin hydrated for at least five minutes prior to application 6
• The medication is washed off in the morning, and if excessive drying or irritation occurs, a bland cream or lotion may be applied 6
• Urea topical preparations are FDA-approved for debridement and treatment of hyperkeratotic conditions including corns and calluses 7
• Once clearing is apparent, occasional use maintains remission 6

Special Populations Requiring Modified Approach

High-Risk Patients (Diabetes, Peripheral Arterial Disease)

• A more conservative debridement approach is essential due to higher complication risk in diabetic patients or those with PAD 2, 4
• Corns and calluses are considered pre-ulcerative lesions in patients with PAD and require aggressive preventive management 2, 4
• Referral to a foot care specialist for ongoing preventive care and surveillance every 1-3 months is mandatory for high-risk patients 2, 4
• Therapeutic footwear is mandatory, not optional, for high-risk patients 2

Critical Safety Warnings and Pitfalls

• Never allow patients to self-treat with chemical corn removers or plasters, as this dramatically increases infection and ulceration risk, especially in diabetic patients 1, 4
• Do not cut corns or calluses at home—professional care is essential 2
• Avoid applying moisturizers between toes, as this increases maceration risk 2, 4
• Excessive repeated application of salicylic acid will not increase therapeutic benefit but could result in increased local intolerance and systemic adverse effects such as salicylism 6
• Overdebridement can make underlying skin susceptible to increased blistering and tenderness 1

Prevention Strategies

• Daily foot inspection, especially between toes, to identify early lesions before they become symptomatic 2, 4
• Daily washing with careful drying between toes prevents moisture buildup that contributes to soft corns 2, 3, 4
• Never walk barefoot, in socks only, or in thin-soled slippers, whether at home or outside 2, 4
• Apply emollients to lubricate dry skin, but not between the toes 2, 4
• Select socks that improve ventilation; silver-fibered cotton socks conduct heat away from feet, reducing sweating and friction 1

When Conservative Treatment Fails

• For non-rigid hammertoe with nail changes, excess callus, or pre-ulcerative lesions on the apex or distal part of the toe, consider digital flexor tendon tenotomy after full evaluation of non-surgical treatment options 1
• Surgery should only be considered after conservative measures have failed and should be aimed at correcting the abnormal mechanical stresses 5
• The lesions will usually disappear following removal of the causative mechanical forces 5