Corns and calluses are common foot conditions that result from repeated pressure, friction, and mechanical stress. While they share similarities, their management varies depending on severity, location, and underlying causes. Effective treatment involves a combination of conservative care, orthotic support, and, in some cases, surgical intervention.

Understanding Corns and Calluses

Callus formation is usually a response to mechanical pressure, shear forces, and friction. Removing the physical irritation can allow the skin to return to a soft and pliable state. Corns (clavus) are localised keratinised areas that develop in response to prolonged pressure, often forming in characteristic concentric circles.

In some cases, underlying deformities such as exostoses may contribute to persistent corns and calluses. Surgical intervention may be necessary when these abnormalities cause significant discomfort.

Conservative Management

The first step in treating corns and calluses is to minimise mechanical pressure. Effective conservative treatments include:

  • Debridement: Removing the thickened layers of skin can alleviate pressure and pain.

  • Emollient Therapy: Applying moisturisers helps soften the skin and reduce irritation.

  • Redistributive Padding & Orthotics: Using silicone toe protectors, felt padding, and insole bases can redistribute pressure and prevent recurrence.

  • Enucleation: Temporarily reduces pain, particularly in younger patients, but requires regular maintenance.

For persistent corns, continuous debridement may lead to repetitive trauma, making other interventions necessary.

Orthotic Management

Orthotic devices are useful in preventing and managing corns and calluses. These include:

  • Silicone orthodigital splints: Easy to mould and replace.

  • Digital Tubifoam and Silipos sleeves: Offer cushioning and reduce pressure.

  • Insoles for plantar redistribution: Can significantly reduce symptoms, though they may not completely prevent callus build-up.

Correcting biomechanical issues such as excessive pronation with orthotics can reduce the recurrence of corns and calluses. However, symptom improvement has only been noted anecdotally.

Medication and Keratolytics

Topical treatments can aid in the breakdown of keratinised skin:

  • Salicylic Acid: Available in collodion, solution, or paste, effectively removes thickened skin but should be applied carefully to avoid irritation.

  • Emollients under occlusion: Hydrate and soften keratoses over time.

  • Vitamin B12 & Sclerosing Agents: Used to break down fibrous tissue in stubborn cases.

Surgical Management

Surgical options are considered when conservative measures fail. They include:

  • Skin Excision: Removing corns associated with underlying dermal issues such as bursae or cysts. This is particularly effective for non-weight-bearing areas.

  • Correction of Fixed Deformities: Digital deformities contributing to corns may require surgical correction.

  • Metatarsal Elevation Osteotomies: Address overload pressure on metatarsal heads, though incorrect elevation can lead to further complications.

  • Forefoot and Hindfoot Realignment: Surgical correction may be necessary for severe biomechanical abnormalities contributing to callosity formation.

Case Study: Excision of an Intractable Corn

A 63-year-old male presented with a painful, persistent corn under his right foot, previously treated unsuccessfully. Upon excision, a 1.5 cm cyst was identified beneath the hyperkeratotic lesion. Histological analysis confirmed an epithelial-lined cyst with fibrosis. Following removal, the patient experienced complete resolution of symptoms.

Soft Tissue Pain and Associated Conditions

Inflammatory soft tissue problems can develop due to repetitive strain and improper biomechanics. While conservative management is preferred, severe tendon injuries may require surgical repair.

Conclusion

Effective management of corns and calluses involves a combination of debridement, pressure redistribution, orthotic intervention, and topical treatments. Early intervention can prevent chronic tissue changes, while surgical options remain a last resort for intractable cases. Proper footwear, biomechanical correction, and preventive care are essential in reducing recurrence and maintaining foot health.