Plantar corns are a very painful foot condition that can lead to ulceration if left untreated.
Friction and Plantar Callus (or Callous) and Plantar Corns - Diagnosis
This is a common problem, which can cause a burning pain on the bottom of the foot. The problem can be neatly divided into two, which often cross over.
The first problem is that the foot is not quite doing its job properly. The most common reason for this is for the reasons outlined previously. The foot muscles way be too weak, or shoes might stop normal function, but the end result is that the forefoot becomes loaded in certain areas with either higher pressures or more commonly, for longer in the gait cycle than usual. The soft tissues of the skin struggle to cope with the increased shear that occurs over the metatarsal head and the skin hardens to protect the area. Sadly, it can build up to a level where instead of being protective it starts to irritate and cause pain, probably because the tissue becomes to stiff to deal with the stretching than normal skin does under shear stresses. Points of more vertical forces tend to produce corns.
The second problem is that rather than the forces being abnormal, the soft tissues become abnormal. Resent biomechanical studies have shown that as we age our soft tissues under the balls of our feet become a little thicker and stiffer. This is particularly true under the 1st and 2nd metatarsal heads. As pointed out earlier these areas are under more force than other areas in normal functioning feet. As a consequence the stiff skin can’t deal with shear as well.
For most people it is a combination of the above, as toe deformities tend to cause the padding in the forefoot to slip forward, and the aging process decreases our ability to deal with the increase in the forefoot shear stresses that result in from the forefoot weakening. The combination of these two common problems is particularly risky in diabetic patients who may also have a poor blood supply and loss of feeling in the forefoot. High glucose levels in the blood also damage the soft tissues themselves causing for fragile skin and weakening forefoot muscles further. In such people callus can lead to ulcers.
Friction and Plantar Callus (or Callous) and Plantar Corns - Treatment
Traditionally, callus would receive chiropody treatment. It can bring relief but only for a while, but may cause the callus to build up quicker. Recent studies are being to indicate that non-painful callus should be left alone or treated with some moisturiser such as urea base foams or creams, rather than pared away.
If callus is painful is can be removed, but attempts should be made to reduce the stresses causing it. Cutting it away alone is not a successful treatment, as it will just keep coming back. Great for chiropodist’s bank balance but not for you!
Insoles, exercises, appropriate shoe advice and skin care are approaches necessary to make painful corns and callus better.