Corns and Calluses
Corns and Calluses
20 Ways to Smooth and Soothe
You can have the strength of Hercules and the wits of Zeus, but if your feet hurt, you've got an Achilles' heel. Indeed, painful corns and calluses can sweep you right off your feet—the hard way.
These ugly little bumps and lumps are a veritable trash heap of discarded—but hardly forgotten—dead skin cells, the result of friction and irritation between your feet and your shoes or even between adjacent bones on the same foot.
"Calluses are your body's way of protecting you from pressure," says Neal Kramer, D.P.M., a podiatrist from Bethlehem, Pennsylvania. "When the pressure gets extreme, the callus gets thicker and thicker. If it develops a hard core, it becomes a corn. Soft corns, which form between toes and remain soft from foot perspiration, happen when two bones from adjacent toes become overly friendly. The skin between them thickens in an attempt to protect you from the constant pressure."
"People can live with calluses more easily than with corns," says Richard Cowin, D.P.M., director of Cowin's Food Clinic in Libertyville, Illinois. "If you get painful corns on your toes, it's like having a bad toothache. It can ruin your day." To start your day—every day—on the right foot, heed these tips.
Stay away from sharp instruments. First and foremost, say the experts, don't play surgeon. Resist the temptation to pare down corns and calluses with razor blades, scissors, or other sharp instruments.
"Bathroom surgery is extremely dangerous," says Circleville, Ohio, podiatrist Nancy Lu Conrad, D.P.M. "It can lead to infections and worse. I've seen so many horrible things happen to people who thought they could be their own surgeons." And diabetics should never treat their own foot problems (see "When to Keep Your Hands Off Your Feet," on page 168).
Approach medicated pads with caution. If you use corn plasters or other over-the-counter salicylic-acid products, which come in liquid, salve, and disk form, religiously follow the advice of New York City podiatrist Suzanne M. Levine, D.P.M., clinical assistant podiatrist at Mount Sinai Hospital there. Apply them only to the problem area, not surrounding skin. If treating a corn, first put a doughnut-shaped non-medicated pad around the corn to shield adjacent skin. Never use such a product more than twice a week, and see a doctor if there's no sign of improvement after two weeks.
Better yet, avoid them completely. Dr. Kramer says unequivocally, "I don't recommend corn plasters or any other over-the-counter medications. Those things are nothing more than acid, which doesn't know the difference between corns and calluses and normal skin. So although they may work on your corn or callus, they will also eat away normal skin, causing burning or even ulcers."
Enjoy a good soak. "Your corn pain may be coming from a bursa, a fluid-filled sac that becomes inflamed and enlarged at the site between the bone and the corn," says Dr. Levine. "For temporary relief of the pain, soak your feet in a solution of Epsom salts and warm water. This will diminish the size of the bursa sac and take some pressure off the nearby sensory nerves. But be aware that if you put your feet back into tight shoes, the bursa will soon swell up again to its painful size."
Have a tea party. If you have a lot of callused tissue, Dr. Levine recommends that you soak your feet in very diluted chamomile tea. The tea will both soothe and soften hard skin. Although the brew will stain your feet, it comes off easily with soap and water.
Be a little abrasive. Before treating a callus, soak your foot in comfortably hot water for several minutes. Then, says Dr. Cowin, use a callus file or pumice stone to lightly abrade the area and rub off the top layers of skin. Finish by applying some hand cream, such as Carmol 20, which contains 20 percent urea and helps dissolve hard skin. If you have bad calluses, make this part of your daily routine after showering or bathing.
But the doctor cautions you not to use abrasive action on hard corns, because that will make the area very tender and more painful than it was before.
Bag your callus. For a large or cracked callus, especially on the heel, try this suggestion from Marvin Sandler, D.P.M., chief of podiatry surgery at Sacred Heart Hospital in Allentown, Pennsylvania. On a piece of foil or waxed paper, mix equal amounts of Whitfield's Ointment and hydrocortisone cream, both of which can be purchased without a prescription. Apply to the foot at night. Place a plastic bag over the foot and then a sock. Leave in place until morning. Then rub off as much callus as you can with a coarse towel or firm brush. Do this regularly to control a difficult heel callus.
Take five aspirin tablets—but don't swallow them. Another way to soften tough calluses, says Dr. Levine, involves crushing five or six aspirin tablets into a powder. Mix into a paste with a half teaspoon each of water and lemon juice. Apply this to the hard-skin spots on your foot, then put your foot into a plastic bag and wrap a warm towel around everything. The combination of the plastic and the warm towel will make the paste penetrate the hard skin. Sit still for at least 10 minutes. Then unwrap your foot and scrub the area with a pumice stone. All that dead, hard, callused skin should come loose and flake away easily.
Work fast. It's best to take action when a corn first takes shape, says Frederick Hass, M.D., a general practitioner in San Rafael, California. At that point, your corn is a hardening small circle of skin that produces little or no pain. You should immediately gently massage the area with lanolin to soften the corn and make it less responsive to pressure. And then pad the area to relieve pressure.
Give 'em space. Because soft corns are caused by bones from two adjacent toes rubbing together, says Dr. Cowin, "you need to put something soft there to separate the toes. You can buy toe separators or toe spacers, which are simply little pieces of foam that you place between the toes."
Be a lamb. Or use good-quality lamb's wool between toes, suggests Elizabeth H. Roberts, D.P.M., professor emeritus of the New York College of Podiatric Medicine in New York City. But don't get the coarse type found in beauty parlors. Draw the strands into a thin, even layer, and wrap it loosely around one of the toes. Remove the wool before bathing.
MEDICAL ALERT
When to Keep Your Hands Off Your Feet People with diabetes or any kind of reduced feeling in their feet should never treat themselves, says Neal Kramer, D.P.M. Diabetes affects tiny blood vessels throughout the body, including those in the feet. That leads to decreased circulation and a tendency for wounds not to heal or resist infection. "Anyone with a circulation disorder is okay if his skin remains intact," says Dr. Kramer. "But if he gets any kind of cut or opening in the skin, it becomes very dangerous. And anyone who can't feel pressure or pain very well may not know he cut himself or may not realize the full severity of an injury and could wind up with a nasty infection." |
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Mark D. Sussman, D.P.M., a podiatrist in Wheaton, Maryland, advises against using cotton between the toes because it will harden and cause increased irritation—just the opposite of what lamb's wool does.
Make horseshoes. To cushion corns, says Dr. Roberts, don't use corn pads with an oval opening. The oval will cause pressure on the surrounding area, making the corn or callus bulge into the opening. If you've got that type of pad, cut a wedge out of it to make a horseshoe shape. Position the pad far enough behind the corn so that as you walk—if your foot slides forward in your shoe—the pad won't rub against the corn it is supposed to protect.
Get spot relief. Even better than a corn pad, says Dr. Roberts, is a spot-type Band-Aid, which also has the advantage of a sterile gauze center. But avoid bandages that must be wrapped completely around the toe. The bulk may lead to irritation and discomfort.
Pad the area. An easy way to take pressure off a callus, says Dr. Roberts, is to place a little gauze or absorbent cotton over the area, then cover it with a thin piece of moleskin. She recommends removing the covering each night, as well as when bathing, so the skin can breathe and so excessive moisture doesn't accumulate under the pad.
When you remove the moleskin, be sure to hold the skin of the sole of your foot taut while you slowly pull the moleskin back toward the heel. If you pull quickly or in the opposite direction, you risk tearing the skin.
Customize your insoles. Dr. Sussman recommends this easy way to modify insoles to relieve pressure on calluses: Buy a pair of foam-rubber insoles and wear them for a week. Your calluses will leave impressions, indicating the areas of greatest stress and showing you the areas around which each insole needs to be built up to even out the pressure.
If the callus is in the middle of the ball of the foot, cut 1/8-inch-thick foam or felt into two strips (each 1/2 inch wide by 2 inches long). Glue them on either side of the depression. Take another strip (2 inches wide by 2 inches long), and position it behind the depression. If the callus is off to one side, use appropriate combinations of strips. When you wear the insoles, the pads will redistribute weight away from the callus and provide relief.
Stretch your shoes. Sometimes relief of a painful, hard corn can be had by stretching your shoes to remove the pressure that caused the friction. Your shoemaker can do the stretching, or you can take this home approach from Dr. Sandler. Apply Stella's Stretch All or another leather-stretching solution to your shoes. This allows the leather fibers to stretch while you are walking. Apply the solution many times, and walk in the shoes (while the leather is still wet) until the shoe becomes comfortable.
Go to a bar. For calluses at the base of the foot, you can modify your shoes by getting your shoemaker to attach a rubber, or leather metatarsal bar to the sole of the shoe, says Dr. Sandler. It's placed so that the ball of your foot rocks over the bar without pressing on the bones in that area. Be sure to replace the bar when it becomes worn down.
Be careful though—these bars can catch on stairs, carpets, or curbs and cause you to trip. For this reason they may not be suitable for older folks. The elderly may be better off with a safer but less effective bar that is flat and continuous with the sole. Remember, however, that these bars do not prevent the metatarsal bones from pressing painfully against the inside of your shoe, so you may need a removable inlay there.
Be well-heeled. "I see a lot of problems in women because of high heels," says Dr. Conrad. "I've heard good shoe fitters say that any pump has to be fit short and narrow to keep it on. And that's true. Oxfords, on the other hand, have a tie that holds the shoe on and keeps the back of the foot firmly in the shoe. That keeps the foot from slipping forward and putting pressure on the forefoot as you walk. With a pump, your foot slides right to the forepart of the shoe, jamming everything together in a space that is too small."
To avoid problems, says Dr. Cowin, wear well-fitting shoes that don't have exceptionally high heels. "Men aren't too much of a problem; you can get them to wear pretty good shoes. With women, I recommend midheight heels rather than high ones for work. For special occasions, high heels won't hurt, but for everyday situations lower shoes are better."
"If you must wear high heels," adds Dr. Levine, "look for ones with extra cushioning in the forefoot area, or have your shoemaker put extra foam cushioning there. And if you have bad calluses on the backs of your heels, avoid open-backed shoes until the area heals."
And get a proper fit. "The most important thing when buying a shoe is fit," says Terry L. Spilken, D.P.M., a podiatrist in New York City and Edison, New Jersey. "Whether a shoe costs $20 or $200, if it doesn't fit correctly, it's going to give you problems. Make sure it's the proper length; you want a thumb's-width distance from the end of your longest toe to the end of your shoe. (And your longest toe isn't necessarily the big toe.) You should have enough width across the ball of the foot and enough room in the toe box so there's no pressure across the toes.
"Look for natural materials, like leather, that breathe. And remember that it's just as harmful for the foot to get a shoe that's too big as one that's too small. If the shoe's too big, the foot will slide in it and cause friction. And the friction of the skin rubbing can cause a callus or corn just as easily as a tight shoe that pinches."
Calluses: Who needs 'em? Maybe you do. Sometimes a little callus is good. "People who go barefoot a lot develop calluses across their soles," says Hass. "And that's desirable. They protect the skin from rough terrain or ground heat. If sufficiently developed and toughened, they can even ward off cutting by sharp objects. These calluses are rarely painful."
Sometimes a callus develops as a safeguard against an ingrowing toenail. As the sharp-edged nail bites into the adjoining tissue, the skin thickens and hardens to prevent further intrusion.
Should you develop this kind of callus, you must leave it in peace, says Dr. Hass. If it proves painful, get temporary relief by soaking the foot in warm, soapy water, but do not ever attempt to hone it. If it becomes too painful, consult a doctor to have the ingrowing nail fixed.
PANEL OF ADVISERS
Nancy Lu Conrad, D.P.M., is a private practitioner in Circleville, Ohio. She specializes in footwear for children, as well as in sports medicine and orthopedics.
Richard Cowin, D.P.M., is director of Cowin's Foot Clinic in Libertyville, Illinois, where he specializes in the practice of minimal incision and laser foot surgery. He is a diplomate of the American Board of Podiatric Surgery and the American Board of Ambulatory Foot Surgery.
Frederick Hass, M.D., is a general practitioner in San Rafael, California. He is on the staff of Marin General Hospital in Greenbrae. He is also author of The Foot Book and What You Can Do about Your Headaches.
Neal Kramer, D.P.M., is a podiatrist in private practice in Bethlehem, Pennsylvania.
Suzanne M. Levine, D.P.M., is a podiatrist in private practice and clinical assistant podiatrist at Mount Sinai Hospital in New York City. She is author of My Feet Are Killing Me and Walk It Off.
Elizabeth H. Roberts, D.P.M., has spent more than 30 years as a prominent podiatrist in New York City, where she is professor emeritus at the New York College of Podiatric Medicine. She is author of On Your Feet.
Marvin Sandler, D.P.M., is a podiatrist in Allentown, Pennsylvania. He is chief of podiatric surgery at Sacred Heart Hospital in Allentown and author of Your Guide to Foot Care.
Terry L. Spilken, D.P.M., is a podiatrist in private practice in New York City and Edison, New Jersey. He is on the adjunct faculty of the New York College of Podiatric Medicine in New York City. He is also the author of Paddings and Strappings of the Foot and The Dancer's Foot Book.
Mark D. Sussman, D.P.M., is a podiatrist in Wheaton, Maryland. He is coauthor of How to Doctor Your Feet without the Doctor and The Family Foot-Care Book.
