Corns & Calluses

WHAT ARE CORNS & CALLUSES?

Corns and calluses are your body’s response to friction or pressure against the skin. If your foot rubs inside your shoe, the affected area of skin thickens. Of if a bone is not in the normal position, skin caught between bone and shoe or bone and ground builds up. In either case, the outer layer of skin thickens to protect the foot from unusual pressure. In many cases, corns and calluses look bad but are not harmful. However, more
severe corns and calluses may become infected, destroy healthy tissue, or affect foot movement. But with your doctor’s help, corns and calluses can be controlled.

WHERE DO CORNS & CALLUSES FORM?

A corn or callus is a thickening of the outer layer of skin on your foot. Corns usually grow on top of the foot, often at a toe joint. Calluses spread on the bottom of the foot or on the outer edge of a toe or the heel.

Corns
Corns can range from a slight thickening of skin to a painful, hard bump. They often form on top of buckled toe joints (hammer toes). If your toes curl under, corns may grow on the tips of the toes. You may also get a corn on the end of a toe if it rubs against your shoe. Corns also grow between toes, often between the first and second toes.

Calluses
A callus may spread across the ball of your foot. This type of callus is usually due to a problem with a metatarsal (the long bone at the base of a toe, near the ball of the foot). A pinch callus may grow along the outer edge of the heel or the big toe. Some calluses press up into the foot instead of spreading on the outside. A callus may form a central core or plug of tissue where pressure is greatest.

Your Physical Exam

Your doctor will check your feet for skin changes, such as red areas, blisters, and warts. He or she will also look for corns and calluses. If you have a buckled toe joint, your doctor may test its flexibility. He or she may also look for a misaligned bone or collapsed joint. An x-ray may be taken to pinpoint a suspected bone problem. Your doctor may check for corns between your toes.

TREATING CORNS & CALLUSES

If your corns or calluses are mild, reducing friction may help. Different shoes, moleskin patches, or soft pads may be all the treatment you need. In more severe cases, treating tissue buildup may require your doctor’s care. Sometimes orthoses (custom-made shoe inserts) are prescribed to reduce friction and pressure.

Change Shoes
If you have corns, your doctor may suggest wearing shoes that have more toe room. This way, buckled joints are less likely to be pinched against the top of the shoe. If you have calluses, wearing a cushioned insole, arch support, or heel counter can help reduce friction.

Visit Your Doctor
In some cases, your doctor may trim away the outer layers of skin that make up the corn or callus. For a painful corn, medication may be injected beneath the built-up tissue.

Wear Orthoses
Orthoses are specially made to meet the needs of your feet. They cushion calluses or divert pressure away from these problem areas. Worn as directed, orthoses help limit existing problems and prevent new ones from forming.

IF YOU NEED SURGERY

If a bone or joint is out of place, certain parts of your foot may be under too much pressure. This can cause severe corns and calluses. In such cases, surgery is often the best way to correct the problem.

Outpatient Procedures
In most cases, surgery to improve bone position is an outpatient procedure. Your doctor may shave or cut away excess bone. Sometimes tendons or ligaments are cut to reduce tension on a bone or joint. Your doctor will talk with you about the procedure that is best suited to your needs.

Bunions

A Problem With Your Big Toe

Your big toe is the hardest-working toe. Every time your foot pushes off the ground, this toe supports most of your body’s weight. Because this toe is so critical to movement, any problem with it can make walking or even standing painful. A bunion (excess or misaligned bone in the joint) is one of the most common toe problems. In addition to causing pain, a bunion changes the shape of your foot, making it harder to find shoes that fit. But you don’t have to hobble for the rest of your life. Bunions can be treated. With your doctor’s help, your feet can feel and look better.

WHAT CAUSES BUNIONS?

Although they may develop on the fifth (little) toe, bunions usually occur at the base of the big toe. Bunions are often caused by incorrect foot mechanics. The foot may flatten too much, forcing the toe joint to move beyond normal range. In some cases, joint damage caused by arthritis or an injury produces a bunion. And some people are born with the tendency to develop bunions. If you’re at risk for developing a bunion, wearing high-heeled or poorly fitting shoes makes the problems worse. A bunion is a bony bump, usually near the joint at the base of the big toe.

Types of Bunions

Positional (mild) bunions arise from the growth of new bone. 
Structural (severe) bunions result when the joint at the base of the toe shifts position. Many bunions are a combination of both types.

Positional Bunions
As new bone grows, the joint enlarges. The stretches the joint’s outer covering. Force created by the stretching pushes the big toe toward the smaller ones. Eventually, the inside tendons tighten, pulling the big toe farther out of alignment.

Structural Bunions
When the angle between the bones of the first and second toes is greater than normal, the big toe slants toward the smaller ones. In severe cases, this may also cause the second and third toes to buckle.

Physical Exam


To determine the best treatment for your problem, your doctor may ask if and when your bunion causes pain. Your doctor may also test how far and how smoothly the affected joint moves. To see if incorrect foot mechanics is causing your problem, your doctor may watch how your feet rotate and flatten as you walk.

Testing

X-rays may be taken of your foot to show the position of the big toe joint. Your doctor may also want to see whether the bunion is affecting other bones in your foot. To see how well a joint works and to learn if movement causes pain, your doctor may move the joint back and forth. 

HOW ARE BUNIONS TREATED?

If a bunion is not painful or severe, your doctor may recommend that you wear a different style of shoes. Or you may be prescribed custom-made shoe inserts (orthoses)  to control incorrect foot mechanics. For painful or severe bunions, outpatient surgery may be recommended. After surgery, you’ll soon be on your way home and ready for recovery.

Shifting Soft Tissue

To realign the affected joint, any tight tendons on the inside of the toe are released (cut). New bone that makes up the bunion is shaved away.

Shifting Bone

The most common bunion surgery reduces the angle between the first and second toes. Bones in the big toe joint are realigned and the bunion is shaved away. Ligaments and tendons around the joint may be tightened to hold it properly in place.

Removing Bone

If a structural bunion is severe, a piece of bone is removed from the first metatarsal (the long bone behind the big toe joint). Once repositioned, this bone may be held in place with a pin or a screw. Any new bone that makes up a bunion is shaved away.

AFTER SURGERY

Bunion surgery can both reduce pain and improve the appearance of your foot. For best results, see your doctor as scheduled and follow all recovery instructions.

Healing Takes Time

Your foot will be bandaged after surgery. If soft tissues were shifted, you may be given a splint to limit foot movement for a while. In such cases, the majority of healing should occur within a few weeks. If bone was cut, you may need to wear a surgical shoe or your foot may be placed in a cast. Depending on the extent of the repair, healing may take several months.

Arthritis

WHAT IS ARTHRITIS?

Degenerative arthritis is a condition that slowly wears away joints (the link where bones meet and move). In the beginning, you may notice that the affected joint seems stiff. It may even ache. As the joint lining (cartilage) breaks down, the bones rub against each other, causing pain and swelling. Over time, bone spurs (small pieces of rough or splintered bone) develop, and the joint’s range of motion becomes limited. But movement doesn’t have to cause pain. The effects of arthritis can be reduced. Talk with your doctor about developing a treatment plan to meet your needs.

WHICH JOINTS ARE AFFECTED?

Your feet pound the pavement every day. They support and propel your body as you move through life. Such constant use takes a toll. Aging, the wear and tear of daily use, and injury—these are the common causes of arthritis. Many people eventually develop some arthritis in their feet.

The Big-Toe Joint

When arthritis affects your big toe, your foot hurts when it pushes off the ground. Arthritis often appears in the big-toe joint along with a bunion (a bony bump at the side of the joint).

OTHER JOINTS

When arthritis affects the rear or midfoot joints, you feel pain when you put weight on your foot. Arthritis may affect the joint where the ankle and foot meet. It may also affect other joints nearby.

Physical Exam

To learn the cause of your joint problem, your doctor asks about your medical history. He or she also examines your feet for skin changes and swelling. The range of motion in any joint affected by arthritis may be tested as well. With a simple hands-on test, your doctor can find out how far a joint moves before pain occurs.

Imaging Tests

You may have an imaging test to check the condition of a joint. X-rays show damage to bone, and magnetic resonance imaging (MRI) can show damage to the joint lining. To evaluate how smoothly a joint works, your doctor may move the joint back and forth.

TREATING ARTHRITIS

If your symptoms are mild, medications may be enough to reduce pain and swelling. For more severe arthritis, surgery may be needed to improve the condition of the joint.

Medications

Your doctor may prescribe medications—pills or injections—to limit pain and swelling. Ice, aspirin, or ibuprofen may help relieve mild symptoms that occur after activity.

Surgery

To ease movement and reduce pain, your doctor may trim damaged bone. If arthritis is severe, the joint may be fused or removed.

Surgery

If the bone is not damaged too badly, your doctor may simply shave away bone spurs. Any excess growth related to a bunion may also be trimmed.

Fusing Joints

If damage is more severe, your doctor may fuse the joint to prevent the bones from rubbing. Afterward, staples or screws may hold the bones in place so they heal properly. In some cases, the joint may be removed and replaced with an implant.

AFTER SURGERY

During the early stages of recovery, your foot is likely to be bandaged and immobilized for a while. For best results, follow up with your doctor as scheduled. These visits help ensure that your foot heals properly.

As You Heal

After surgery, you’ll be told how to care for your incision and how soon to begin walking on the foot. Until the foot can bear weight, you may need to walk with crutches or a cane.

For surgery on the big toe, your foot may be splinted to limit movement for several weeks. Despite this, you should be able to walk soon after surgery.

For surgery on rear or mid-foot joints, you may need to wear a cast or surgical shoe. These joints are fairly large, so full recovery may take a few months. Once the bone has healed, any staples or screws may be removed.