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from Foot Disorders, 2nd edition, Nicholas J. Giannestras, page 427 (Calluses, Clavi and Keratoses): Calluses are found on any portion of the forefoot where there is abnormal pressure or excessive friction. They are formed as a... See more » from Foot Disorders, 2nd edition, Nicholas J. Giannestras, page 427 (Calluses, Clavi and Keratoses): Calluses are found on any portion of the forefoot where there is abnormal pressure or excessive friction. They are formed as a defense mechanism of the skin to protect it from excessive irritation and/or blistering. They can be found under any of the metatarsal heads, on the medial aspect (means inner side) of the first metatarsal head (bunion) area, the lateral aspect of the fifth metatarsal head area (the outer side of the foot – bunionnette side), on the dorsal surface (top) of a toe or toes or on the tips of the toes. The clavus, a synonym for the corn, is found on the toes wherever there is an underlying bony prominence upon which pressure is exerted by the shoe. The clavus is nothing more than a localized response of the skin to abnormal pressure from without against a bony prominence from within. The body has an almost infinite ability to protect itself from abuse and trauma. The body functions in three different and apparently totally unrelated ways. The body functions a) mechanically, b) chemically, and c) electrically. The mechanical way the body protects itself to local pressure and irritation is for the skin to thicken locally. Depending on where this thickened skin is, we call it a callus (on hands or undersurface of the feet) or corns (usually on the toes). The thickened skin is a result of increased metabolic or chemical activity within the cells of the skin resulting in thickened skin to better withstand the local stress. The electrical response to pressure and irritation mediates the pain that results. There is a combination of electrical and chemical activity that mediates the pain perception. It is the pain response that is most important in the body's protective mechanism. Without pain, the part is not rested and protected and the trauma and irritation continues until the body part is destroyed. This is what happens in diabetes with peripheral neuropathy, and in spinal cord damage and other diseases causing loss of protective skin sensation. What to do: 1. The first thing to do is to ascertain why there is increased pressure over the place where the callous or corn is developing. There is only one way to get rid of the pain and the callous or corn - remove the pressure. Both the corn or callous and the pain are friends - friends that are trying to help us. It is the localized increase in pressure that is the enemy to be removed. There are two directions that the pressure can be relieved, inside and outside of the skin. Surgery can remove the inside half of the pressure by removing the bony prominence. Shoe modifications can remove the outside half of the pressure by making more space or softness over the bony prominence. 2. The best help in overcoming the localized pressure is determined by the cause. If the cause is pointed-toe shoes, the best remedy is to buy shoes that give more space for the toes and feet. If the cause is a deformed foot, the best help is reconstructive surgery to remedy the deformed foot or toes. 3. Palliative or symptomatic treatment is often used but never cures. What palliative or symptomatic treatment means is that something is done to make it feel better without dealing with the cause of the problem. Trimming corns or callouses is the time-honored symptomatic treatment. It does give some degree of relief until the skin grows the callous or corn back again at which time the pain and discomfort returns. The reason it feels better is that there is less pressure in proportion to the amount of callous removed. However not having removed the cause of the pressure, the same cause - the pressure - results in the same effect - the pain and callous or corn. Corn pads and soft padding has variable success to relieve the pain. The problem with padding is that it takes up space and tends to aggravate the problem because the pressure is increased in proportion to the size of padding. A corn pad is usually more successful because it shifts the site of the pressure. Getting the pressure off See less »

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This is one of a number of Counseling Sheets giving information about common conditions and what you can do about it, Calluses are found on any portion of the forefoot where there is abnormal pressure or excessive friction. They are formed as a defense mechanism of the skin to protect it from excessive irritation and/or blistering. Black Hills Health and Education Center is a medical wellness resort and spa that assists guest in making lifestyle changes that result in gaining control of lifestyle related health issues

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