Treatment of Corns and Calluses
Professional manual debridement by a trained podiatrist is the primary treatment for both corns and calluses, followed by topical keratolytics and pressure redistribution strategies. 1
Understanding the Difference
Corns have a hard, yellow central keratin plug extending downward in a cone shape, causing sharp pain often described as "walking on a small stone," while calluses are broader areas of thickened skin without a central core and are typically less painful. 1 This distinction matters because corns require precise removal of the central plug, whereas calluses need broader paring of hyperkeratotic tissue. 1
Treatment Algorithm
First-Line: Professional Debridement
- Manual debridement or paring with a scalpel by a trained podiatrist is the cornerstone of treatment. 1, 2
- After debridement, apply emollients and non-adherent dressings to protect the debrided skin. 1, 2
- For severe or painful cases, blade debridement under professional care is recommended. 2
Second-Line: Topical Keratolytics
Salicylic acid 15-26% is the most evidence-based topical agent:
- Apply daily after removing the thick keratin layer, with occlusion if possible. 3
- Continue for 3-4 months for optimal effect. 3
- The FDA-approved formulation (6%) should be applied at night after washing, covered overnight, then washed off in the morning. 4
- Hydrate the skin for at least 5 minutes before application to enhance penetration. 4
Urea 10% cream is an effective alternative:
- Apply three times daily to dissolve the intracellular matrix and promote shedding of scaly skin. 5
- FDA-approved specifically for hyperkeratotic conditions including corns and calluses. 6
Other keratolytic options with lower-quality evidence include:
- Cantharidin 0.7% solution applied every 3 weeks up to four times. 3
- A combination of 1% cantharidin, 30% salicylic acid, and 5% podophyllin showed 79.2% success in one session with only 1.4% recurrence. 7
- Trichloroacetic acid 50-80% solution applied weekly for up to 8 weeks. 3
Third-Line: Pressure Redistribution
Footwear modifications are essential to prevent recurrence:
- Properly fitting shoes with adequate toe box width and height reduce pressure and friction. 1, 2
- Toe separators or silicone orthotic devices redistribute pressure between toes for soft corns. 1
- Therapeutic shoes or custom-made insoles are indicated when foot deformity or pre-ulcerative signs are present. 1
Special Populations: Diabetic Patients and Those with PAD
A more conservative debridement approach is mandatory due to higher complication risk. 1, 2
- Corns and calluses are considered pre-ulcerative lesions in patients with PAD and require aggressive preventive management. 1
- Referral to a foot care specialist for ongoing preventive care and surveillance every 1-3 months is recommended. 1
- Therapeutic footwear is mandatory for high-risk patients. 1
- Never allow these patients to use chemical corn removers or plasters, as this increases infection and ulceration risk. 1
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. 1
- Apply emollients to lubricate dry skin, but not between the toes to avoid maceration. 1
Critical Pitfalls to Avoid
- Never allow patients to self-treat with chemical corn removers or plasters—this increases infection and ulceration risk. 1
- Do not cut corns or calluses at home—professional care is essential. 1
- Avoid applying moisturizers between toes, as this increases maceration risk. 1
- Avoid soaking feet in a bath for prolonged periods, as this can worsen xerosis. 5
- Excessive repeated application of salicylic acid will not increase therapeutic benefit but could result in increased local intolerance and systemic salicylism. 4
When to Escalate Care
Seek urgent evaluation by a foot care specialist if: