Corns and Callus
The Highlights
Corns and callus are two different types of excessive hard skin formation in response to excessive mechanical stress (friction) on the skin cells.
Diagnosis is key - our team can quickly and easily identify these problems and explain the factors relevant to you for why they are happening.
Our team are experts in treating these conditions through painless scalpel debridement and advising on how to reduce the friction on the skin through good footwear, foot orthoses (specialist insoles) and improving the skin's health through the right urea-based creams.
What is it and what are the symptoms?
Corns and callus are what we call "hyper-keratotic lesions" which simply means a mass of over-accumulated hard keratin material that our skin is largely composed of. They represent the most common skin complaints people see us for by a country mile and although often very painful, they are very easily treated and in most cases, with the right strategies, can either be massively delayed from recurring or cured altogether.
Callus represents a layer / sheet of hardened skin which may be over a small area or very wide-spread (such as across the ball of the foot or the heel borders). It may sometimes also form cracks which, at their worst, can split and be very painful. Corns are made of the same material (keratin) but they form a circular / conical shape and can be especially painful as they grow. People often mistakenly think of corns as having a "root". In reality they are better thought of as "growing inward" - as more compacted hard skin form they become deeper and, in the extreme, may lead to ulceration and infection in the underlying skin (as such if you have health problems like diabetes, rheumatoid arthritis or circulation issues, DO NOT avoid getting treatment for corns and callus as these can quickly escalate). Like with callus, corns tend to form at pressure points but may occasionally exist elsewhere due to skin trauma like stepping on a thorn or nail in the past.
Why does it happen?
Corns and callus (both made of the same hardened keratin but in different forms) are, in simplistic terms, the skins reaction to too much mechanical stress, shearing stress in particular (pressure + friction). When this happens there is an increase in low-grade inflammatory activity which changes the way cells in the skin called corneocytes develop. And because these cells don't develop normally they essentially develop a "sticky" quality and clump together into what we would see visually as corns and callus.
What are the treatment options?
Getting the correct diagnosis here is super important - pretty much on a weekly basis we see patients with fungal infections which look like dry skin and mislead them to apply moisturisers which make the problems worse not better! Same problem with mistreating verruca that are actually corns and so on. Many of these conditions, although common, can have subtle features and are often misdiagnosed by patients or even other healthcare providers - see the experts! Once the diagnosis is sorted we can move on to what we do about it:
Improving the skins "coefficient of friction" i.e. reducing the shear stress causing the corns or callus and improving moisture levels is very important for normal skin cell development and improvement of these problems. We highly recommend a cream/emollient which contains urea - the reasons being are that urea attracts water molecules to it and also encourages the skin to "help itself" by improving its own moisture-retention abilities and it's ability to defend against multiple forms of bacteria and fungus. 10%-20% urea is suitable as a daily moisturiser for most people but speak to the experts (we like to think that's us!) fist to see what is appropriate for you.
Gentle debridement of hard skin with an emery board / foot file can be helpful for maintenance alongside a good cream but for many people this will not be enough. This is where we come in. As Podiatrists, we have extensive experience in what's called sharp debridement - the use of scalpels to skilfully remove corns and callus and get the skin in a much better position to be maintained. We often hear our patients compliment us on how thorough and yet gentle we are during this process which is something we take immense pride in.
We can also offer expert advice and treatment on other strategies to decrease the recurrence of corns and callus - this includes the use of specialist padding and/or the creation of bespoke silicon devices for toes, it can also include footwear tips and foot orthoses (specialist insoles) which we can make in-house or via our lab partners to fit specifically to your feet and effectively offload pressure from problem areas in the long-term.
