Removing calluses from the feet: myths and realities

Calluses under the feet are common sources of pain and frustration. There is often a misconception that these can be treated, as many people assume that they can simply be cut off. This article will discuss what can actually be done to provide treatment and dispel some of the myths surrounding your treatment.

Calluses on the bottom of the foot come from a natural process designed to protect the skin on the foot from excessive pressure. This excessive pressure can come from several sources. Externally, the pressure can come from simply walking or standing on the ground, whether one has shoes on or not. The shoe itself can even be a source of external pressure, although this is usually seen as a result of calluses on the top of the toes (which is the same type of condition as a callus). Internally, the pressure can come from the bones under the skin. If the bones are abnormally prominent due to an abnormality in the structure of the foot (such as a bunion or flat foot), or if the skin and padding under the bone are abnormally thin, then the pressure on the skin over them will increase. The skin is often irritated by internal and external pressure sources at the same time, where external pressure from walking combined with internal pressure from prominent bones or thin skin creates a reaction in the skin tissue. This reaction causes the skin to form a thickened outer layer of keratin-based cells, which collapse to form multiple layers.

Over time, a callus (also called hyperkeratosis) develops as the skin becomes excessively thick at the pressure point. This callus, if thick enough, can be painful as the original normal skin layer at the bottom of the callus is damaged by pressure from the layer that covers it. What was once a simple skin protective measure can become a source of pain and skin damage if the growth progresses far enough. Sometimes the callus grows inward toward the base layer of the skin, resulting in the formation of a thick, hard core that tunnels inward (but does not break through the skin). This is also called intractable plantar keratosis and is often mistaken for a wart. Eventually, sweat and other skin glands can fill with keratin material, forming a small pinpoint callus called a porokeratosis. This type of callus does not need to have a prominent bone underneath for it to form and is usually not painful.

Callus treatment is often misunderstood and can actually be somewhat complicated. The most common form of treatment is the simple shaving of the callus by oneself, a pedicurist or a podiatrist. The act of thinning the tough skin will make it more comfortable to walk on and reduce pain. However, the cause of the callus will still exist, and the callus will eventually return in a month or two. This causes a great deal of confusion for some people, who simply associate a callus with a temporary skin growth, and not something directly related to the structure and activity of their foot. Using special shoe pads or foot supports to reduce pressure on the bottom of the foot can help limit the growth of a callus, when used in combination with shaving calluses and properly fitting shoes. Unfortunately, these will not remove the callus permanently and will only serve to help reduce the overall thickness of the callus when it grows back. Even prescription shoe inserts (orthoses) will not permanently reduce calluses, although they do reduce the weight of the calloused area better than store-bought insoles by being custom-fitted to a cast of the foot.

It should be noted that diabetics should never attempt to manage their calluses on their own. Due to the bad feeling of diabetes, diabetics who trim their calluses or have an inexperienced family member try it at home could lead to injury and infection from an accidental cut to normal skin.

Some people assume that a callus can be burned, like a wart or other skin growth. The use of chemicals, lasers, cold treatment, and electricity to destroy skin growths is very common and often effective for other types of skin disorders. Unfortunately, these techniques do not work as well on callus tissue, because callus growth is continuous and is not based on the simple presence of abnormal skin cells that can be removed. Callus tissue is normal tissue, and any destructive procedures against this tissue will only be temporarily successful until skin growth begins again and the callus re-forms. The only exception to this is porokeratosis, which can be removed if the underlying gland and gland duct are destroyed.

Surgical treatment is the next level in corn care. This is another area where there is a lot of confusion and myths about treatment. In short, calluses cannot be cut or otherwise surgically removed with the expectation that the callus will not return. The new skin that grows after surgery will continue to form a callus and, when combined with a surgical scar, can be even more painful than the original callus. The only exception, again, is porokeratosis, which can be successfully removed surgically. The only way to permanently get rid of a callus is to get rid of the prominence of the underlying bone and make sure your shoes fit well and are well-cushioned to compensate for any thinning of the skin and tissue over these bones. There are a multitude of bones in the foot that can cause enough prominence to irritate the skin, and many ways to resolve the pressure through bone surgery. Procedures may include lifting bones that lean too far toward the bottom of the foot, removing extra bones that form naturally during development (very common), shaving or removing bone spurs or loose bone fragments, or even the total removal of the foot part. the bone causing the pressure. Procedures may be needed to correct the general deformity causing the pressure, such as a bunion or arch abnormality. Healing times will vary and depend on whether the bone was simply shaved or removed, or the position of the bone was moved. These procedures generally successfully remove callus formation if done correctly, although there is a risk that the foot’s pressure point will simply shift to the next bone. Orthoses are often used after surgery to prevent this from happening.

As you can see, caring for calluses is not simply about shaving or cutting away the hard tissue. In reality, this myth does not work well, and bone surgery is necessary to prevent callus care from becoming an exercise in regular skin maintenance through regular shaving and shoe inserts. This can provide complete relief for some. For others, surgery is needed to break the ongoing cycle of pain.