Thursday, 17 July 2014

Corns and Callus (hard skin) - The causes and treatments.

Corns and callus (hard skin) are common foot complaints dealt with every day in the podiatry clinic, and it's not just the older population either.  With the new year comes new gym memberships, resolutions to take more exercise and start to think about getting in shape for the summer holidays!

What causes hard skin?

Hard skin occurs on areas of high pressure.  Excessive pressure (or as podiatrists call it - Ground Reaction Force) causes the skin to lay down extra layers to protect the structures underneath.  So what can cause excessive pressure in the foot?  A number of factors will influence the pressure on your feet.
  1. Footwear or a lack of it.
  2. Deformities within the foot.
  3. Flooring (links in with a lack of footwear).
  4. A persons weight.

Footwear

We wear footwear, be it shoes, trainers, boots, sandals, flip-flops etc, as a main purpose to protect the foot from external structures such as stones, glass fragments and rough surfaces.  However, the type of footwear, the materials used to manufacture the footwear and a persons activities whilst wearing the shoes will influence pressure and hard skin build-up.

A good pair of shoes should provide you with sufficient 'shock-absorbency' for your activity, and remain comfortable for the full duration.  If the footwear lacks shock-absorbency, then your foot will take the impact of every step, rather than the shoe, increasing the risk of hard skin.

Running trainers will have more cushioning in the sole and insole than a standard pair of gents leather lace-up shoes with a leather sole, as the purpose of the two types are for completely different activities.  Using the wrong shoes for the wrong activity will impose prolonged excessive forces on the structures within the foot.

 High-Heels may 'look good' from a fashion perspective, but place most of the weight from the body through the forefoot.

A complete lack of footwear will result in a general increase of thickened skin over most the bottom of the foot (also known as the plantar surface).  In some cultures they don't wear shoes at all, but you are more likey to find the ground is more giving, and not concrete!

 

Foot Deformities

One of the most common foot deformity I come across is bunions (or Hallux AbductoHalgus as they are correctly called in the podiatry world).


(The Manchester Scale for Grading Hallux Valgus)


Where do feet with 'Bunions get hard skin?  The most common place people with bunions get hard skin is on the side of the joints on the big toes.

As the big toe points away from the centre of the body, more often than not the inside arches  of the foot drop.  This limits the amount the big toe will bend upwards when walking.  As a result the foot rolls slightly inwards to reduce the pressure and keep the movement as smooth as possible.  This results in excess pressure on the inside of the foot, increasing the thickness of the skin at certain pressure points. 

Flooring

Over the last 10+ years, hardwood flooring has become increasingly popular in the UK.  Many people walk bare-foot around the home, which is just as bad for the feet as wearing shoes with no cushioning in the sole.  A worn carpet, with little or no underlay will give very little cushioning to the foot, and also increase pressures.

Weight

A over-weight person will have increased pressure placed on the bottom of the feet.  This will be compounded with foot deformities, bad footwear and hardwood flooring.  As well as pressure on the feet, additional pressure will be placed on the joints in the feet, knees, hips, etc, increasing the risk of osteo-arthritis (the 'wear and tear' condition ). 

Other factors which can cause hard skin are dry skin disorders, biomechanical disfunctions of the foot and muscular problems causing the foot to land, move, and take off in an unorthodox method.

Hard skin is a result of something not functioning or being supported correctly, not a diagnosis of a condition!

How can I treat hard skin?

Hard skin can be treated in a number of ways.  The most common way to treat hard skin is to reduce it using either a foot-file  or one of the many devices on the market at the moment (home treatments) or professionally reduced by a Podiatrist, who will use a scalpel to carefully shave off layers of hard skin until soft pliable skin remains.




Can I prevent it from reoccurring?

Hard skin will keep coming back if the underlying problems causing it in the first place are not addressed.  Good shoes with soles / insoles which absorb and distribute the pressure, rather than have it absorbed by the foot.  If you have a foot deformity, be it a bunion, or stiff joints, a custome made insole should help absorb or deflect pressure from the vulnerable areas of the foot.

If you have excessively dry skin, then regular applications of moisturiser should help keep your skin supple, soft and flexible.  Moisurisers containing 10% urea will help build a 'water-proof' type barrier on your skin, which will help your body 'retain' it's natural moisurising oils, rather than keep simply putting moisure back in.  To help get the most out of a moisuriser, after applying it, wrap your foot in cling-film for about 20-30 minutes (remain seated during this time -don't try to walk around!).

If you don't see any improvement within a few applications, seek advice from your local friendly podiatrist, dermatologist or your doctor.

What causes corns?

Corns are simply very concentrated areas of hard skin / callus forming a small lump or mound on the outer surface of the skin.  Just like callus, they are caused by pressure, but usually appear on areas of extra pressure, such as boney prominences of the foot.

There are three basic types of corns which podiatrists see on a daily basis.

Hard corns


Hard corns more often than not appear under the joint of the greater toe and the small toe, as these are common areas of increased pressure in unbalanced feet. 


The other common areas are on the upper joints of toes with deformities where the joint is pressing on footwear.


These can also occur on the ends or 'apex' of toes, where deformities have caused the digits to bend at the end. This results in excessive pressure against the end of the toe, rather than be distributed evenly across the bottom of the foot.



Interdigital or 'soft' corn

An interdigital corn occurs between toes, usually on areas where the toes are pressing against each other.  This can be as a result of ill-fitting footwear or foot-deformities.

Seed corn

The seed corn is very similar to the hard corn for locations it occurs on the foot, except it is much smaller.  They are extremely small in size, and can look like small 'millet' seed that you see in a bird cage!  These are often described as a feeling of 'having a small stone or fragment of glass' in the foot.  These occur mainly on the bottom of the foot, and between areas of pressure.

How can I treat corns?

Corns, like callus, need to be reduced and cut out from the skin, along with any hard skin surrounding them.  Corn plasters can contain a mild acid, which softens / damages the surrounding skin until the central skin will drop off, or can be 'pulled off'. It's always best to get an 'expert' opinion before trying any treatment yourself, especially if you are diabetic.

Once your foot abnormality has been identified, treatments can vary from gently filling them down with an emery board or applying corn plasters  through to having them professionally removed by a podiatrist.

Can I prevent corns from reoccurring?

Some corns only need one treatment by your friendly podiatrist, and can go away for years.  If a corn has been caused by ill-fitting shoes, then the footwear has to be re-thought.  Recurrence of corns on the bottom of the feet can be prevented, or slowed down with an insole to deflect pressure away from the areas of build-up, thus reducing pressure.

Corns can look similar to verrucas? How can I tell the difference?

Hard corns and verrucas can look similar and should be examined by your friendly podiatrist or doctor.  They will be able to identify whether you have a corn or a verruca and advise you on the best treatment plan for you.

Seasons!

Corns and callus can be seasonal and can occur as you change your footwear to suit the weather.  During the winter, boots with thick, shock absorbing insole and plenty of toe space are kinder to your feet.  As spring and summer comes along, so does the sandals with thin soles, or the ballet pumps and flip-flops where your toes are gripping the the shoe to hold them on. 

To summarise!

Corns and callus are caused by excessive pressure, be it externally such as footwear or hard flooring, or internal changes to the feet such as bunions.  Remove the pressure and you will prevent the recurrence.  Professional help from your podiatrist is normally more effective than an over-the-counter treatment.  Diabetics should always have any foot abnormalities checked by a podiatrist as soon as possible.  Expensive footwear does not necessarily make it 'good' footwear.

Look after your feet and keep mobile!  We get old because we become inactive, we don't become inactive because we get old!

Thank you for making time to read my blog.  More to follow soon!

1 comment:

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