Calluses and Corns - 3
Relieve the pressureRelieve the pressureYou can relieve pressure on your feet by using pads, modifying your shoes, or applying digital sleeves (toe splints). For people who have difficulty reaching their feet, permanently adjusting a shore is the easiest and most effective way of relieving pressure on a callus.
Whats's more, pads applied to a shoe adhere better than ones applied to the skin, so you don't have to reapply them quite so often. One other consideration : applying adhesive pads directly to the foot can irritate the skin. This potential irritation can be avoided by applying the pad to the shoe instead.
The most versatile padding is adhesive moleskin,a product that is found in most pharmacies and can be cut to the necessary shape and size.Shoe modifications to relieve pressureBy some estimates, one out of four people would benefit from modifying their footwear.
For those with foot pain or difficult to fit feet, that percentage is usrely higher. Some very simple shoe modifications, such as stretching or padding, to relieve pressure points can have tremendous benefits.
A podiatrist or certified pedorthist can provide invaluable advice in this regard.Shoes with removable insoles are best for making modifications. often, after the shoes have been worn for a few weeks, an imprint of the foot can be seen on the insole. This imprint makes it easier to determine the best location to place padding.
Because many insoles compress in areas of pressure, placing a pad for a painful forefoot callus is done simply by finding the dented area of the insole and padding around it-not on it.
Relieving pressure with moleskin is achieved by applying shaped pads cut to size. Horseshoe pads, donut pads, or parallel strips of padding around the painful area work very well in distributing pressure away from the affected area.
When it is not obvious where to pad the shoe, there is a simple trick for locating the proper area and applying padding:Mark the painful area on the skin with a dot of lipstick and then step into the shoe without a sock.Make sure the skin contacts the shoe by pressing on the shoe with your fingers.
When the shoe is removed, the pressure area will be obvious by the lipstick mark.
Place padding around (not on) the lipstick mark.Placing padding directly on the skin can be done periodically or in an emergency to temporarily offload pressure on a callus. But for long-term relief, it is best to pad the shoes instead.
Not only will the padding last longer, but you are less likely to develop a skin rash or tear the skin. Unless directed by a doctor, you should not use any adhesive products on your skin if you have diabetes, a circulation disorder, or skin that is especially fragile, sensitive, or thin.
Shoes that do not have removable insoles can also be modified, but it is much more difficult to do so.
As a general rule, shoes that don't have removable insoles aren't going to be cushioned or supportive as those that do.If it is necessary to purchase a more supportive insole to add to the shoe, that insole will fit better into the shoe if the original insole is first removed.
But simple modifications can be made with comercially available adhesive pads to just about any shoe if necessary.There is also a comercially available forefoot sleeve that looks like a sock for the forefoot.
The slip -on fabric sleeve has a large gel pad in the forefoot that can offer grest cushioning. The forefoot sleeve works especially well when wearing slippers, sandals, or shoes that do not have adequate chushioning.
Reference:Great Feet For Life: Paul Langer, DPM
Calluses and Corns - 2
Very large, thick calluses can occasionally develop on the feet. They are most commonly found around the heel or under the big toe joint. Occasionally they become so thick and dry that the skin cannot stretch when weight is placed on the foot. When this happens, the skin cracks open, resulting in bleeding and painful fissures that are vulnerable to infection and difficult to heal. See a doctor if you have fissured skin that is painful or bleeding, especially if you have poor circulation, diabetes, or a history of poor healing.
If the fissured skin is not painful or bleeding, you can treat yourself by following these daily steps:
Wash the skin with warm soap and water.
Use a pumice stone to gently reduce the thick callus over time.
Apply an exfoliating cream
For persistent or severe cracks, treating twice a day may be necessary. For the most stubborn cases, apply the lotion and then cover the cracked skin with a plastic wrap or a commercially available moisturizing neoprene wrap. Sleeping with the wrap in place for two to three consecutive nights can work wonders. Some over-the-counter "skin glue" products have recently become available. They are applied to the cracked skin, helping seal out infection and promote healing. Any crack that has not healed within one week of self-treatment should be seen by a doctor.
if untreated, corns and calluses-and sometimes blisters-can become open sores, or ulcers. If the pressure that caused the callus persists, eventuallly the skin and soft tisue beneath the callus can break down, resulting in an open sore. These sores are often referred to as pressure ulcers. They can masquerade as painful (or sometimes painless) red calluses. Pressure ulcers on the feet are a concern because the pressure decreases blood flow. Walking or wearing shoes can prolong the healing process.
Like calluses, ulcers occur in area where the skin is subjected to excessive pressure or friction. This is why most mpressure ulcers are found on the bottom of the forefoot. People with diabetes, poor circulation, and numbness in the feet are especially vulnerable to pressure ulcers. Poor hygiene, poor nutrition, and poorly fitting shoes can also be contributing factors. But sometimes even wearing slippers or going barefoot around the house can lead to pressure ulcers.
The absence of pain is not always a good sign. a significant complicating factor of many pressure ulcers is the inability to feel the pain they cause. Sufferers may not even be aware that an ulcer is forming on their feet. Those with a " high pain threshold" or decreased sensation should visually inspect their feet daily.
Seed Corns (porokeratosis)
Some calluses can develop a hard center much like a seed or a small stone in the skin. This type of callus is known as a seed corn or, more formally, porokeratosis. Seed corns are especially painful and difficult to treat, and they can be easily mistaken for plantar warts. It is best to have these calluses evaluated and treated by a podiatrist.
Three Steps To callus Care
The safest and surest self-care for calluses involves the three following steps:
2. Reduce the Thickness of Callus
Regular, gentle use of a pumice stone is safer than shaving the callus with sharp cutting tools. rubbing the callus with a pumice stone for one minute after bathing three to four times a week is an effective way for most people top reduce the thickness of a callus.
Reference: Great Feet For Life: Paul Langer, DPM
Plantar warts are found on the plantar surface (bottom) of the foot and are caused by a virus. They are often confused with calluses and are not properly treated. Even when correctly identifies, they can be resistant to treatment. Some plantar warts are small, rounded, solitary lesions, while others involve large patches of skin from roughly two to four inches across.
- Plantar warts can be difficult to treat because of their location on the bottom of the foot. The skin on the bottom of the foot is twice as thick as the skin on other parts of the body. This thicker skin allows the wart to penetrate deeper and prevents topical medications from reaching all of the wart.
Warts can also be somewhat unpredictable. They can take weeks or months to resolve, sometimes spreading even during aggressive treatment. And they can disappear on their own, without treatment. Treating plantar warts takes patience and persistence and sometimes requires changing or combining different treatment methods. For these reasons, always have a doctor evaluate a suspected wart before treating it yourself.
- Most over-the-counter wart treatments contain salicylic acid. Liquid wart treatments contain 17 percent of the acid, and medical patches contain 40 percent.
Do not pick at warts with your fingers. The viral tissue can embed itself in the skin around the fingernails and cause warts on the fingers as well.
For warts resistant to over-the-counter treatment, your doctor may use mopre aggressive treatments. Such treatments include removing the wart with laser treatment, prescribing medications, or freezing (and killing) the wart with liquid nitrogen. A study published in 2002, however found thaty simply covering a wart with a patch of duct tape was as effective as treating with liquid nitrogen.
- Recently a refrigerant spray has become available to remove warts on the hands or tops of the feet by "freezing" them, but it is expensive, the kits are probably less effective than other treatments.
And they can damage healthy skin if misused.
For reasons we don't understand, children and teenagers tend to be able to resolve warts more quickly than adults. It is suspected that, as it ages, the immune system becomes less effective at fendinmg off the virus that causes warts. It is not unusual for plantr warts to persist even after years of aggressive treatment.
- Reference: Great Feet for Life: Paul Langer, DPM
Calluses and Corns
Calluses and Corns are thick patches of skin. Calluses on top of or between the toes are often referred to as corns. In this section, the term Callus is used to refer to both Corn and Calluses. Calluses are often confused with warts, but a wart is caued by a virus entering the skin. A callus is caused by excessive pressure or friction. A callus usually appears as a path of hard, dry skin that is the same color as the skin around it. Unlike a wart, skin lines can be seen in the skin of a callus.
Calluses aren't always easily identified and treated. If, after one or two weeks of self-treatment, a suspected callous has not improved, you should have it evaluated by a medical professional. Some skin lesions can mimic a callus. And sometimes a callus can obscure an injury to the skin or underlying structures.
Remember that calluses are always caused by pressure or friction.They do arise randomly. They will only go away if the source of pressure or friction is addressed. Skin defends itself from injury by producing thicker layers, but those thicker layers can then become irritated and painful if the pressure or friction that created them persists. Pumicing, trimming, cutting or even surgically removing a callus will not lead to long-term relief if you don't stop the pressure or friction that caused it in the first place.
- A number of conditions can cause pressure or friction sufficient enough to cause a callus. They include the atrophy (shrinking) of soft tissue, deformities, bony prominences (bumps), and pressure from shoes that are too small or too narrow.
Callus on the toes are often caused by changes in the alignment of the toes, which occurs with hammertoes and bunions. Changes in alignment make the toes rub together or against a shoe, creating friction. Wearing shoes that are too narrow for your feet can also cause calluses on the toes, especially between the toes. To treat calluses on the toes you must first minimize or eliminate the rubbing. This can be done by padding the toes with gel or foam toe spaces or, even better, by wearing shoes that fit properly.
Though uncommon, calluses can break down into open sores or ulcers. They can also become infected. Have your primary care doctor or podiatrist look at any callus that becomes red, painful, or bleeds as soon as possible.
Calluses on the bottom of the foot are most often found on the ball of the foot, or forefoot. These calluses are usually caused by excessive pressure on the forefoot bones. This pressure can develop when the protective fat pads on the bottom of the foot shrink or when hammertoes cause the metatarsal bones to press down against the bottom of the foot.
Arthritis can also cause calluses opn the forefoot, because it limits joint motion and can lead to the development of bony protrusions. Most forefoot calluses can be addressed by simply distributing pressure in the shoe through modifications to the insoles.
- Calluses on the end of the toes, especially the middle three toes, are common. These calluses are often caused by hammertoes. The contracting toes begin to bear weight on the tips instead of the bottoms of the toes, resulting in calluses. Using crest pads or toe splints, can help align the toes and minimize the formation of calluses.
The pressure that causes calluses can also cause pressure-related injuries to the skin, soft tissues, joints, and bones beneath them. Places on the foot that stick out, such as bony prominences and joints, are common locations for calluses and, therefore, for pressure related injuries. Redness that surrounds a painful callus, for example, can be a symptom of bursitis.
Bursitis is an inflammation of the bursa, or fluid filled sac, that lies between the skin and the bone. Bursitis of the feet is most commonly seen on the tops of hammertoes or the sides of bunions. Redness around the callus can also be a sign of underlying infection, so it should not be ignored.
Pressure on the joints of the bottom of the foot can cause capsulitis, or inflammation of the joint capsule (the tissue that surrounds the joint). Capsulitis is most common in the second toe joint of the forefoot and is often seen in combination with hammertoes and bunions.
Some calluses have irregularly shaped areas of dark red or purple. This is often a sign that the pressure on the underlying soft tissue has caued some bleeding under the skin. Although usually painless, the bleeding is an early warning that the callus could progress to an open sore or ulcer. Discolored calluses are especially worrrisome for those with diabetes, neuropathy, or circulation disorders.They should be examined by a podiatrist or general practitioner.
Reference: Great Feet For Life: Paul Langer, DPM
Skin Changes Associated with Blood Flow
If the flow of blood to the lower legs and feet changes, the color and texture of the skin may also change. Changes in blood flow can also increase the risk of certain types of skin conditions . In fact, many skin changes of the feet and lower legs can be the first signs of developing blood flow disorder. Below are a few of the more common conditions associated with changes in blood flow.
Purpura (also called cherry angioma or senile angioma) is a rash of brownish red, bright, red, or purple spots that may gradually change to brown over time. The small spots are actually sites of tiny, ruptured blood vessels. They can be caused by an allergic reaction, anemia, or a systemic condition such as vascular disease, but most often are simply a normal part of aging.
- VENOUS STATIS DERMATITIS
Venous statsis dermatitis is an inflammation of the skin that can occur with varicose veins or swelling in the lower legs or feet. The circulation of blood through affected areas is slowed, causing itching and redness, and brown patches. Shiny, thin, weakened skin may also result. This thin and weakened skin is vulnerable to tearing and heals slowly. In severe case, the skin can break down, forming weeping open sores called venous statis ulcers. Treatments for venous statis dermatitis include wearing compression stockings, periodically elevating the legs, exercising, and treating sores that may be present.
- HEMOSIDERIN DEPOSITS
Hemosiderin deposits are painless brown patches of skin that form on the lower legs. They can occur when the legs swell, constricting and backing up the flow of blood. The backed-up blood flow deposits iron in the skin, causing the brown spots. Treatment is directed at controlling the swelling. The discolored skin, however, is harmless and often remains for years.
- RAYNAUD'S DISEASE/PHENNOMENON
Raynaud's disease/phenomenon is a vascular condition in which small blood vessels in the fingers and toes spasm, causing changes in temperature and color changes to the skin. The disease can also cause numbness and pain. In the most severe cases, Rayanaud's disease/phenomenon can lead to gangrene.
The vascular spasms can be set off by stress or weather changes and can cause the skin to appear white, blue, or red, depending on what stage it is in. (Those who have experienced prolonged exposure to cold or frostbite are vulnerable to a similar condition called chilblain, or perino.)
Raynaud's disease/phenomenon should be diagnosed by a physician. Keeping the skin warm in the primary treatment. Wearing warm socks and shoes and avoiding cold exposure to the feet often keeps symptoms in control. Prescription medications that increase blodd flow may also be used to treat severe cases.
FRAGILE OR " THIN" SKIN
peripheral vascular disease (also known as peripheral artery disease, or PAD), thyroid disorders, and long-term use of oral steroids can cause the skin to become thin and fragile. Affected skin often has a texture like rice paper and is easily injured. Even a slight bump can severely bruise or tear the skin. Bruises and the smallest tears can take weeks to heal. Those with fragile skin have to be extremely careful walking barefoot or breaking in new shoes and should visually inspect their feet and lower legs every day. Cuts or skin tears usually heal slowly and should be covered and checked regularly to ensure that they do not become infected.
Reference: Great Feet For Life: Paul Langer, DPM