Foot callus is one of those conditions that can and can not be overlooked.
Why am I starting off this page with silly sentences?
Well in some ways we actually need hard skin and in other ways it becomes a very troublesome problem.
First off, what actually is it?
Sometimes called "hard skin", callus is actually a normal body response to pressure.
What happens is that the body senses that pressure is being built up in a particular area, so it layers down hard skin to compete with that pressure. The problem comes in the fact that this new layer of hard skin now acts as pressure. So the body puts down more hard skin...and the cycle continues.
In a way the body is protecting itself from external forces which may damage it. The process can easily be seen with people who work a lot with their hands.
My hands do a lot of instrument holding- the tools of my trade. Initially when I first started working, I had blisters on the underneath of my fingers. Then as time increased those same areas started to build up with hard skin. My fingers are not sore anymore and it is actually helpful to do the job.
When Callus Becomes A Problem
Hard skin only becomes a problem when it is mixed with conditions that either:
1- Makes the callus worse- hyperkeretosis
2- Makes the patient more at risk- e.g. Diabetes (in some Diabetics that have reduced circulation or reduced sensation)
3- Causes the patient to be in pain.
Apart from these points, hard skin can be managed simply and doesn't seem to bother most people.
If left long enough and with other factors being at work, hard skin can progress into corns . Hard skin can even be covering corns and home treatments then will not work.
Again, if hard skin is left long enough, it can crack. This is most common in the heels, where cracks are called fissures.
Pictures can tell a thousands words, so here are the most commonest places that hard skin can develop:
Under the big toe joint. This is very common and sometimes highlights a reduced movement through that joint. Or similarly that when a bunion is present (as seen slightly in the picture) the foot tends to roll off that big toe joint so that your body "cheats" in achieving the required movement that it needs.
Under the big toe joint, but the next joint up. A very common place for hard skin development. However the site can also be problematic because there is so little fatty padding around that area breakdowns/ ulceration are common in susceptible people.
Apart from the really poor job of debriding the hard skin from the toe, we can see maceration. Maceration is where the tissues are soft and soggy because of the excessive pressure that is being placed into an area that does not want that pressure. It is a sign of problems to come if not dealt with properly.
Callus getting worse. Some people have called the dark area in the hard skin a "bruise". That term is correct, however what is a problem is that the term bruise is soft and doesn't convey the message that there is a problem.
When there are dark patches within the hard skin it means that pressure has been so great that it has disrupted and broke the tissue underneath the callus. Blood has seeped into the area and dried. Now if that has happened there could be an ulcer under that hard skin- because the pressure is still there building up and still hitting the tissues under the callus.
Dry blood usually means a problem. Your body is telling you that a problem exists and we need to figure out how to stop this from occurring because if there is no ulcer there now, there will be one in the future.
More maceration. Under the little toe joint this time. This tells us that the patient is favoring leaning to the outside of their foot. Why? Usually a biomechanical problem, but sometimes it is because there is something wrong with the other leg and this one is compensating for it.
Again, maceration is not a good thing and this one is quite deep.
One of the most commonest presentations. This is on the ball of your foot, joints 2-4. It is usually a sign of excessive pronation because the big toe joint and the little toe joint has been lifted out of the way- no hard skin. The 2-4 joints are taking most of the pressure which is not what they were designed for so the body has laid down hard skin in response to this.
But with all of this hard skin types and maceration...how on earth do we treat it?
Ah ha! Here is where my next page comes into it's own. Here is the Callus Treatment Page.