A callus (tyloma) foot is marked by the formation of thick, hardened skin most often on the medial edge of the hallux. The rough layers are gradually developed over a period of time to protect the skin from constant exposure to friction or pressure.
While not strictly limited to the foot, it is common to find calluses on the palms of the hands and knuckles, as a result of activities that generate excessive force on the skin such as manual labour.
This type of repeated impact stimulates the epidermis cells, accelerating the thickening of dead skin cells on the surface in an attempt to protect the soft tissues lying underneath the skin. This physiological response of the skin is referred to as hyperkeratosis.
A callus presents itself in the form of a dispersed region of hard growth without definite borders, with slight discolouration that causes the affected skin to look white, yellow or brown. Some calluses, termed as intractable plantar keratosis, might develop a painful inner core called as a nucleation.
The factors leading to the development of a callus could be either internal or external.
The internal factors include pre-existing biomechanical problems of the foot that cause an abnormal dispersion of pressure during walking or running; this pressure tends to be concentrated mostly on the medial side of the hallux or the heel, forming a callus in the process.
A host of other foot conditions also originate from poor biomechanics such as hallux valgus and hammertoes. These foot deformities ultimately increase the friction of the skin with the hard inner surface of the shoes worn by the patient, causing the skin to become hardened over a period of time.
External factors such as wearing tight-fitting shoes, prolonged standing and any type of repetitive activity that exerts continuous pressure on a specific part of the hands or feet, can also lead to the development of calluses in that region.
Calluses rarely pose any imminent risks to a healthy person; however, for a patient suffering from a condition such as diabetes, a callus foot could lead to far more serious complications in the long-term. This makes the removal and treatment of calluses of the utmost importance.
A diagnosis can be made only after a detailed clinical assessment involving palpation of the affected area to detect bony presences underneath the callus, which should be followed by an X-ray for confirmation.
In order to spot biomechanical defects of the foot, a thorough evaluation of the patient’s gait would have to be conducted and a treatment plan devised accordingly.
To provide symptomatic relief, a sharp debridement of the callus could be performed by a qualified health professional to reduce the hyperkeratotic tissues in the region and to even out the skin surface.
Topical medication, containing 40% salicylic acid, may also be recommended to cut through and dissolve the thickened skin.
To eliminate any possible external sources of friction to the hardened skin surface, comfortable footwear would have to be worn at all times by the patient.
Underlying foot postural problems can be treated through the regular use of custom made foot orthotics such as MASS4D®, which will correct the distribution of pressure in the foot and reduce any excess pressure to allow the callus to heal.
By supporting both functional pronation and healthy supination, the foot is held in its optimal posture. This support allows for proper weight distribution and relief for areas previously suffering from friction and rubbing.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.