HARD SKIN & CORN

Cracked heels

 

Cracked heels are a common foot problem in New Zealand as we are a barefoot, jandal loving country. They are often referred to as heel fissures. Cracked heels are commonly caused by dry skin, made more complicated if the skin around the heel is thick and callused. For most people this is a nuisance and a cosmetic problem but when the fissures or cracks are deep, they are painful to stand on and can bleed - in severe cases they can become infected.

 

Treatment

 

Applying an 20-30% urea based moisturising cream twice daily is really important to get on top of this problem. A foot file or pumice stone can be used to reduce the thickness of the hard skin if done regularly (twice a week in the summer). Avoid open backed shoes or thin soled shoes.

 

Never try to reduce the hard skin yourself with a razor blade, a pair of scissors or any tools from your shed. There is a risk of an infection developing and taking too much off.

 

The podiatric treatment of cracked heels may involve the following:

• Firstly investigating the cause of the problem, so this can be addressed

• Painlessly removing the hard thick skin by debriding it with a scalpel blade and filing the hard skin using a podiatric drill with a special attachment (often the splits will not heal if the hard skin is not removed). This may need to be done on a regular basis. Regular maintenance may be the best way to prevent the problem.

• Sometimes strapping may be used to 'hold' the cracks together while they heal (a maintenance program after this to prevent recurrence is very important).

• Prescription and advice regarding the most appropriate moisturizer or emollient.

• Advice about footwear and self-care of the problem.

• Insoles may be used to alter the way you walk to prevent the thick skin from developing (these are indicated in cases of heel callus and are not suitable for all cases).

• A heel cup may be used to keep the fat pad from expanding sideways. This is worn in the shoe and can be very effective at prevention if used regularly.

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Corns and callus

 

What are corns and callus and what causes them?

When we walk or stand, our body weight is carried first on the heel and then on the ball of the foot where the skin is thicker to withstand the pressure. When this pressure becomes excessive, some areas of skin thicken and form corns and callus, as a protective response to the friction of skin rubbing against a bone, shoe or the ground. 

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Callus is an area of thickened, hard skin on the the foot it occurs where there is an area of pressure/mechanical stress. It is usually symptomatic of an underlying problem such as a bony deformity, a particular style of walking or inappropriate footwear. Some people have a natural tendency to form callus because of their skin type. Elderly people have less fatty tissue in their skin and this can lead to callus forming on the ball of the foot, knuckles and tips of toes.

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Corns are caused by pressure or friction over bony areas, such as a joint, and they have a central core which may cause pain if it presses on a nerve. There are five different types of corns, the most common of which are ‘hard’ and ‘soft’ corns:

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• Hard corns – these are the most common and appear as a small area of concentrated hard skin up to the size of a small pea usually within a wider area of thickened skin or callus. This may be a symptom of the feet or toes not functioning properly

• Soft corns – these develop in a similar way to hard corns but they are whitish and rubbery in texture and appear between the toes where the skin is moist from sweat or from inadequate drying

• Seed corns – these are tiny corns that tend to occur either singly or in clusters on the bottom of the foot and are usually painless

• Vascular/neurovascular corns – these are corns that have both nerve fibres and blood vessels in them. They can be very painful and can bleed profusely if cut

• Fibrous corns – these arise when corns have been present for a long time and are more firmly attached to the deeper tissues than any other type of corn. They may also be painful

 

What are the treatments?

Please do not try to cut corns yourself, especially if you are elderly or have diabetes. 

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Always consult a podiatrist for advice before using commercially available products. In particular, be careful about using corn plasters, as they contain acids than can burn the healthy skin around the corn, leading to serious problems such as infection. Home remedies, like lamb’s wool around the toes, are also potentially dangerous. People with diabetes, poor circulation or a reduced immune system should never self-treat, but instead seek advice from a podiatrist.

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A podiatrist will be able to skilfully remove corns painlessly, apply padding or insoles to relieve pressure or fit corrective appliances for long-term relief. For callus, your podiatrist will also be able to remove hard skin, relieve pain and redistribute pressure with soft padding, strapping or corrective appliances that fit easily into your shoes. The skin should then return to its normal state.

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Elderly people can benefit from padding to the ball of the foot, to compensate for any loss of natural padding. Urea based emollient creams delay callus building up and help improve the skin’s natural elasticity. Your podiatrist will be able to advise you on the best skin preparations for your needs.

You may also need to wear more supportive or wider fitting footwear to reduce pressure on the affected area.

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How can I prevent them?

If you have corns or callus, you can treat them yourself occasionally by gently rubbing with a pumice stone or a foot file when you are in the bath and applying  moisturising cream to help soften thickened skin a little at a time, or relieve pressure between the toes with a foam wedge. Do not self-treat if you have diabetes, poor circulation or a reduced immune system. Instead seek help from a podiatrist.

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When should I see a podiatrist?

If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional.