Corns (Clavus)

Background
A corn (also termed clavus) is a thickening of the skin due to
intermittent pressure and frictional forces. These forces result in
hyperkeratosis, clinically and histologically. The extensive
thickening of the skin in a corn may result in chronic pain,
particularly in the forefoot; in certain situations, this thickening may
result in ulcer formation. The word clavus has many synonyms and
innumerable vernacular terms, some of which are listed in the Table
below; these terms describe the related activities that have induced
clavus formation.
Synonyms for clavus include callosity, a hyperkeratotic
response to trauma; corn, heloma, or a circumscribed
hyperkeratotic lesion that may be hard (ie, heloma durum) or soft
(ie, heloma molle); and callous, callus, or a diffusely hyperkeratotic
lesion. Localized callosities of the soles, which do not resolve, are
termed plantar callus, heloma, tyloma, keratoma, or plantar corn.
When callosities occur over one or more lateral metatarsals, they
are termed intractable plantar keratoses. [1] 
Corns are often seen in athletes and in patient populations
exposed to uneven friction from footwear or gait abnormalities,
including elderly persons, diabetic patients, and
amputees. [2] Abnormal foot mechanics, foot deformities, high
activity level, and more serious conditions such as peripheral
neuropathy also contribute to the formation of corns. [3] Corns are
associated with considerable morbidity secondary to pain;
fortunately, many treatment and preventative options are available
that provide a high rate of mitigation. [4] 
Clinically, all these lesions look like hyperkeratotic or
thickened skin. Maceration and secondary fungal or bacterial
infections are a common overlying feature in heloma molle and
diabetes. Plantar helomas tend to have a central keratin plug,
which, when pared, reveals a clear, firm, central core. The most
common sites for clavus formation are the feet, specifically the
dorsolateral aspect of the fifth toe for heloma durum, in the fourth
interdigital web of the foot for heloma molle, and under the
metatarsal heads for calluses. Clinically, three types of corns have
been described. The first is a hard corn, or heloma durum, notable
for its dry, horny appearance. It is found most commonly over the
interphalangeal joints. The second is a soft corn, or heloma molle,
described as such because of its macerated texture secondary to
moisture. It is generally found in interdigital locations.  [5, 6] The third
type is a periungual corn, and this type occurs near or on the edge
of a nail. [7] Note the image below.

Epidemiology
Frequency
United States
Corns are one of the most common foot conditions in the United
States, particularly amongst older patients. It is a common disorder
because of the frequency of usage of occlusive footwear and
participation in repetitive activities, such as running.
International
Corns are common worldwide. Any weight-bearing human is
susceptible to the development of corns.
Race
An epidemiological study evaluating the prevalence of foot
conditions amongst a diverse sample of adults from the
northeastern United States revealed a significant difference in rates
of corns amongst ethnic groups. African Americans had a
significantly higher rate of corns and calluses compared with non-
Hispanic white and Puerto Rican participants (70% vs 58% vs
34.1%). [43] 
Sex
Amongst elderly populations, both men and women have been
reported to wear shoes too narrow for their feet. Women have been
reported to wear shoes that are also shorter than their feet. Both
narrow and short footwear can lead to the development of corns, in
addition to foot deformities. [44] They are more common in women
than in men because of this use of occlusive and poorly fitted
footwear.
Age
Hyperkeratotic lesions of the foot (including corns and calluses)
have been reported to affect 20-65% of people aged 65 or
older. [43, 45, 46]  
Anyone can have a clavus, but most individuals acquire the risk
factors for clavus formation after puberty because of the onset of
traumatic footwear use, repetitive motion injuries, and progressive
foot deformities.

Etiology
Both hard and soft corns are caused by pressure from unyielding
structures. [5] Abnormal mechanical stress may be intrinsic or
extrinsic. Intrinsic factors include foot deformities (eg, hammer toe,
bunion) [27] ; abnormal foot mechanics (acquired or hereditary); and
peripheral neuropathy. Extrinsic factors include poorly fitting
footwear and heavy activity (athletics).
A 2005 study conducted by Menz et al reported that in older
populations, plantar pressures are significantly higher under
callused regions of the foot. [28] These data support the idea that
increased pressures are related to a hyperkeratotic response and
that the target for treatment should be eliminating excess
pressures on the foot.
Conditions associated with clavus formation include the following:
 Advanced patient age
 Amputation (ie, stump callosities)
 Use of a brace or orthopedic stabilizing product
 Bulimia nervosa [17] 
 Costa acrokeratoelastoidosis [29] 
 Doxorubicin toxicity [30] 
 Keratoderma palmaris et plantaris
 Obesity
 Pachyonychia congenita [31] 
 Sensory neuropathies, including neuroborreliosis
 Tethered spinal cord syndrome [32] 
 Vascular occlusion syndromes [33] 
 Warts (ie, verruca vulgaris) [34] 
Faulty mechanics play a role. Irregular distribution of pressure and
repetitive motion injury (especially in athletes) are believed to be
the main inciting causes; however, inappropriately shaped or
constrictive footwear in the presence of bony prominences (eg,
talar bone prominences [35] ) may exacerbate corn formation.
Furthermore, some disorders may alter the shape or sensation of
the soles of the feet. Bony prominences and faulty foot mechanics
then allow clavus formation to continue. [36, 37, 38, 39, 40] 
 Rheumatoid arthritis [41] : About 17% of patients with
rheumatoid arthritis present with intractable foot pain. Chronic
arthritis leads to foot deformities and consequent callus
formation. Bleeding into callosities in patients with rheumatoid
arthritis may be a sign of rheumatoid angiitis.
 Diabetes mellitus with associated peripheral neuropathy [42] :
In patients with diabetes, chronic callosities in the presence of
neurovascular deterioration may lead to ulcerations and
superinfections.
 Obsessive-compulsive disorder (pseudo-knuckle pads)
 Ectopic nail

Pathophysiology
Corns are the result of mechanical trauma to the skin
culminating in hyperplasia of the epidermis. Most commonly, friction
and pressure between the bones of the foot and ill-fitting footwear
cause a normal physiological response—proliferation of the stratum
corneum. One of the primary roles of the stratum corneum is to
provide a barrier to mechanical injury. Any insult compromising this
barrier causes homeostatic changes and the release of cytokines
into the epidermis, stimulating an increase in synthesis of the
stratum corneum. When the insult is chronic and the mechanical
defect is not repaired, hyperplasia and inflammation are
common. [26] With corns, external mechanical forces are focused on
a localized area of the skin, ultimately leading to impaction of the
stratum corneum and the formation of a hard keratin plug that
presses painfully into the papillary dermis, which is known as a
radix or nucleus. [6, 8]
The shape of the hands and feet are important in corn (clavus)
formation. Specifically, the bony prominences of the
metacarpophalangeal and metatarsophalangeal joints often are
shaped in such a way as to induce overlying skin friction. As corn
formation ensues, friction against the footwear is likely to
perpetuate hyperkeratosis. Repetitive motion can produce
callosities, as would be seen in musicians. [22] 
Toe deformity, including contractures and claw, hammer, and
mallet-shaped toes, may contribute to pathogenesis. Deformity of
the feet from underlying conditions such as rheumatoid arthritis can
contribute to clavus formation. [23] Bunionettes, ie, callosities over
the lateral fifth metatarsal head, may be associated with neuritic
symptoms due to compression of the underlying lateral digital
nerves. Furthermore, Morton toe, in which the second toe is longer
than the first toe, occurs in 25% of the population; this may be one
of the most important pathogenic factors in a callus of the common
second metatarsal head, ie, an intractable plantar keratosis.
Long-term or repetitive motion may also induce clavus formation, as
is seen in computer users and text messengers (ie, "mousing"
callus). [24] Callosities can also form from excessive leg crossing.  [25]

Diagnostic Considerations
Other considerations include the following:
 Hypertrophic lichen planus
 Interdigital neuroma
 Lichen simplex chronicus
 Palmoplantar keratoderma
 Keratosis punctata of palmar creases
 Porokeratosis plantaris discreta
 Porokeratosis palmoplantaris et disseminatum
 Non-Herlitz junctional epidermolysis bullosa
Differential Diagnoses
 Acanthosis Nigricans
 Acrokeratoelastoidosis
 Arsenical Keratosis
 Atypical Fibroxanthoma
 Atypical Mole (Clark Nevus or Dysplastic Nevus)
 Black Heel (Calcaneal Petechiae)
 Calcinosis Cutis
 Callus
 Dermatologic Manifestations of Neurologic Disease
 Gout and Pseudogout
 Melanocytic Nevi
 Nongenital Warts
 Poroma
 Warty Dyskeratoma

Laboratory Studies
No routine laboratory tests are necessary to evaluate a patient with
corns (clavus).[6] Diabetes mellitus, tertiary lues, and other causes
of neuropathy should be excluded.
Blood glucose testing is required when paring of a clavus reveals an
ulcer or when diabetes mellitus is suspected. In the setting of
neuropathy, neuroborreliosis should be considered, and testing is
performed with Lyme titers. Rheumatoid factor testing for
deformities consistent with rheumatoid arthritis may be indicated.
Also see Lyme Disease and Rheumatoid Arthritis.
Imaging Studies
Imaging studies are required in clavus patients only to detect
underlying bony abnormalities. Studies may include radiography
and, occasionally, CT scanning of the affected area with bone
window settings. [51] Radiographs of the feet in a weight-bearing
position are useful for identifying bony prominences and the
presence of underlying pathology contributing to foot
pain. [34] However, a physical examination may be sufficient to
evaluate smaller toe abnormalities. [34]
Other Tests
Pedobarographic studies are pressure assessments that may be
used in clavus patients to detect an altered distribution of foot
pressure.
Procedures
Dermoscopic examination before and after trimming can be helpful
with the differential diagnosis of plantar warts, corns, calluses, and
healed warts. The translucent central core known as a nucleus may
be visualized more easily in a corn using dermoscopy.  [49] 
Biopsy of the lesions reveals hyperkeratosis and, occasionally,
mucin deposition. Paring of the corn can relieve pressure
temporarily. Biopsy may be helpful in considering some of the other
differential diagnoses, such as warts. Additionally, biopsy can be
performed to differentiate clavus from porokeratosis palmoplantaris
et disseminatum or discreta. These disorders occur in those aged
20-40 years who have hyperkeratotic plaques on the palms and
soles. Biopsy shows a cornoid lamella.
Histologic Findings
Corns demonstrate epidermal hyperplasia with a thick and compact
stratum corneum. Whereas calluses demonstrate only
orthokeratosis, parakeratosis may be present in corns, and biopsy
specimens demonstrate an endophytic cup shape. The granular cell
layer may be decreased or absent. [8, 9] The dermis may occasionally
show fibrosis with hypertrophied nerves and scar tissue replacing
subcutaneous fat. 
Treatment & Managemen
Medical Care
When treating hard corns (clavi), the primary objective is to debulk
or pare the lesion without drawing blood. Treatment should be
aimed at reducing symptoms such as pain and discomfort with
walking. Paring of the lesions immediately reduces pain. Following
preparation of the skin with alcohol or iodine, a No. 15 surgical
blade can be used with or without anesthesia to gradually remove
sequential layers of keratin. [6] Once the etiology of the foot
pressure irregularity is determined, attempts at pressure
redistribution should be made. The final treatment goals are to
remove the central keratin core for short-term pain relief and to
reshape the skin to provide long-term prevention of excess
friction. [7, 8] Regular debridement in high-risk populations, such as
diabetic patients, may decrease the incidence of ulceration and,
consequently, the need for surgical intervention.  [52] 
The use of orthotics and conservative footwear with extra toe
space are often beneficial. When all else fails, surgery may be
performed.
If abnormal dermatoglyphics or pinpoint bleeding is seen, wart
therapy is initiated. If normal dermatoglyphics are noted, salicylic
acid compounds and orthotics may be beneficial. Relief of
symptoms may be achieved by thinning and cushioning of the
involved lesions.
Paring of the lesions immediately relieves pain, especially with
helomas. Lesions may be maintained in this state if the patient uses
short soaks and pumice stone debridement at home. Debridement
may be enhanced with the use of keratolytic agents, such as ureas,
alpha-hydroxy acid (eg, glycolic, malic, or lactic acid), or beta-
hydroxy acid (eg, salicylic acid). [53] Garlic extracts have also been
described as being helpful. [54] 
Self-adhesive pads are most effective for reducing thick lesions,
whereas lotions, creams, and medicaments in petrolatum are best
for maintenance. Most salicylic acid compounds are 10-17%. High
concentrations of salicylic acid (eg, 40%) may lead to severe
maceration, and in patients with diabetes, it may lead to frank foot
ulcerations. [55] Intralesional triamcinolone and topical vitamin A
acid compounds also may reduce localized hyperkeratosis.
Triamcinolone can lead to localized hypopigmentation.  [56] 
A statistically significant reduction in pain at 6 months with
complete and partial resolution rates of 26% and 50%, respectively,
were seen with electrosurgery compared with resolution rates of
4% and 28%, respectively, with sharp debridement in one study.  [57] 
Soft corns are often difficult to treat because they develop from
underlying pressures in between the fourth and fifth digit, caused by
bony prominences. [5] Soft corns are best treated with properly
fitting footwear and better foot hygiene in order to decrease the
likelihood for infection. Applying an antifungal or antibacterial
powder after washing the area and using lamb’s wool or a toe
spacer are additional techniques used to treat soft corns.  [8] A good
option in patients with coexisting dermatophytosis complex is 20%
aluminum chloride hexahydrate solution (Drysol).
Reduced friction may be accomplished with the use of silicone-lined
sleeves on the toes, padding, and, in select cases, silicone  [58] or
collagen injections [6] over the bony prominence in question.
Surgical Care
Surgery to remove the bony prominences is indicated only if all
conservative measures fail. [6, 7, 27] Surgical procedures include
bunionectomy, syndactylization, osteotomy, and
arthroplasty. [5, 27] Long-term improvement for lateral fifth-toe corns
and interdigital corns has been achieved with partial and complete
condylectomy.[27] 
Chronic foot pain despite conservative therapy is the number one
indication for surgery.
Hallux valgus correction may aid in reduction of painful callosities
over the long term. [60] 
Surgical corrections for claw, hammer, and mallet toes are simple
procedures.
Shaving of prominent condyles of bony prominences may be
beneficial, particularly on the fifth digit.
Arthroplasty of the fifth toe interphalangeal joint also may be
performed.
Metatarsal condylectomy or chevron osteotomy may be performed
to relieve metatarsal head pressure. [71] 
Mann and DuVries described the use of a combination of
arthroplasty and condylectomy. This combination results in 95%
clearance, with only a 13% occurrence of transfer lesions.  [72] 
When thinning of the plantar fat pads is contributory to the
formations of callosities, injectable silicone can be used on the
soles underneath the callosities and corns to reduce pressure-
related callous formation.
Description of excision followed by either grafting, use of flaps, or
grafting using split-thickness graft with or without a collagen/elastin
matrix graft has been described as effective in a single resistant
case. [72]
Consultations
If patients do not respond to conservative treatment, further
evaluation by a podiatrist or orthopedic surgeon is recommended.
Extensive orthoses are available to help remove mechanical
stresses on the foot, and an orthopedist or podiatrist should be
consulted.
An orthopedist and a podiatrist also can be helpful in adjusting
abnormalities of gait or pressure distribution.
In cases of suspected arthritis, a rheumatologist can be consulted.
Dermatologists are best consulted to assess for the possibility of
other disorders in the differential diagnosis, especially warts and
keratoderma.
Diet
Weight loss may reduce pain from corns and improve biomechanics
in patients who are obese.
Activity
Patients are advised to reduce or eliminate certain mechanical
forces or motions. However, certain activities, particularly work
related, may be unavoidable or patients may be reluctant to make
the necessary changes.
Adjustment of the footwear and the use of special insoles aid in the
maintenance of full mobility and eliminate the need for activity
limitation.
Prevention
Deterrence and prevention includes the use of corn pads, web
spacers, and properly fitting shoes
(see Pathophysiology and Medical Care). Patients can treat their
corns at home using a pumice stone to regularly debulk the lesion
after a shower, when the skin is soft.
Long-Term Monitoring
Follow-up care is important to ensure control of the hyperkeratosis
because patients may require regular, repeated applications of
keratolytic agents in conjunction with careful paring.
Patients with special health concerns, including diabetic patients,
amputees, and elderly persons, may require more frequent follow-up
visits in order to decrease the likelihood of a more catastrophic
complication, particularly secondary bacterial infection, from the
initial lesion.
Numerous contributory factors may result in thickened skin on the
feet. Factors such as occupation, athletic pursuits, footwear,
underlying bony abnormalities, and problems with general health
may contribute to clavus formation.
Etiologic factors must be carefully assessed before treatment can
be given.
Symptomatic relief can be achieved by thinning the hyperkeratotic
lesions and by using cushions or insoles, which reduce pressure on
the affected areas.
Surgery can be an adjunctive treatment in those patients with
intractable clavus formation and chronic foot pain.
Using a combination of modalities and reducing the pressure of
footwear ultimately reduces the appearance and discomfort of the
clavus.
Corns (Clavus) Medication
Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to
prevent complications.
Debridement may be enhanced with the use of keratolytic agents,
such as ureas, alpha-hydroxy acid (eg, glycolic, malic, or lactic
acid), or beta-hydroxy acid (eg, salicylic acid). The use of these
agents is not recommended in pregnant women and young children.
Most salicylic acid compounds are 10-17%. High concentrations of
salicylic acid (eg, 40%) may lead to severe maceration and frank
foot ulcerations in patients with diabetes. Self-adhesive pads are
most effective for reducing thick lesions, whereas lotions, creams,
and medicaments in petrolatum are best for maintenance.
Intralesional triamcinolone and topical vitamin A acid compounds
also may reduce localized hyperkeratosis. Triamcinolone may be
injected during pregnancy because of its limited absorption;
however, it can lead to localized hypopigmentation. Topical vitamin
A derivatives are not intended for use in women who are pregnant
or intending to become pregnant because their safety ranges from
category C to category X.
A combination product to be applied by physicians consisting of 1%
cantharidin, a vesicant, mixed with 30% salicylic acid and 5%
podophyllin has been described as effective for most people after
just one session. [68] 

Keratolytic agents

Class Summary
These agents cause the cornified epithelium to swell, soften,
macerate, and then desquamate. Commonly used agents include
urea, alpha-hydroxy acids (eg, lactic acid, glycolic acid), and beta-
hydroxy acids (eg, salicylic acid).

Salicylic acid topical (Clear Away, Compound W, Dr. Scholl's Corn

Removers)
• View full drug information

Topical salicylic acid is a keratolytic, bacteriostatic, and fungistatic

agent. Its main clinical use is as a keratolytic agent and as an agent
that increases the percutaneous absorption of combined drugs by
removing the stratum corneum. The keratolytic activity results from
solubilization of the intercellular ground substance in the stratum
corneum and shedding of the scales, which are bound by it.
Salicylic acid topical can be compounded in petrolatum at any
percentage and is usually used at 5-20%, beginning with a lower
percentage. It can be purchased over the counter as a liquid or pad
preparation, ranging from 17-40% (multiple companies make these).
It can be irritating or cause blistering.

Ammonium lactate (AmLactin, Lac-Hydrin, Lactinol)

• View full drug information

Ammonium lactate may loosen the adhesion of the keratinocytes in

the stratum corneum, thereby thinning the skin. Ammonium lactate
provides beneficial effects on dry skin and severe hyperkeratotic
conditions. It is indicated for moisturizing and softening dry, scaly
skin.

Urea (Aquadrate, Calmurid, Carmol, Nutraplus)

• View full drug information

Urea is a a keratolytic, bacteriostatic, bactericidal, and fungistatic

agent. It is topical treatment for dry skin and ichthyosis and is also
used as a skin moisturizer. Urea promotes the hydration and
removal of excess keratin in conditions of hyperkeratosis.
Corticosteroids
Class Summary
These drugs have anti-inflammatory properties and cause profound
and varied metabolic effects. Corticosteroids modify the body's
immune response to diverse stimuli. 

Triamcinolone (Aristospan, Kenalog IV, Trivaris)

 View full drug information

An injectable version of triamcinolone is available in concentrations
of 3-40 mg/mL. Generally, this compound is diluted to 1-4% for
injection into lesions, such as a clavus.
Retinoids
Class Summary
These agents are not specifically approved for use in corn (clavus)
therapy. Only tretinoin has been shown to be useful for clavus
therapy in the topically applied form. These agents cause the skin
to peel by loosening of keratinocyte adhesion. Irritation and
discomfort are limiting adverse effects. 
Tretinoin topical (Atralin, Avita, Refissa)

 View full drug information

Tretinoin topical inhibits microcomedo formation and eliminates
lesions. It makes keratinocytes in sebaceous follicles less adherent
and easier to remove. It is available as 0.025%, 0.05%, and 0.1%
creams and 0.01% and 0.025% gels.

REFERENCE

• Mann RA. Pain in the foot. 1. Evaluation of foot pain and

identification of associated problems. Postgrad Med. 1987 Jul.
82 (1):154-7, 160-2. [Medline].
• Cheon JJ, Uhm JY, Kang GH, Kang EG, Kim SY, Chang SS.
Evaluation of the dermatologic life quality among cleanroom
workers in a secondary battery factory. Ann Occup Environ
Med. 2016. 28 (1):39. [Medline].
• Freeman DB. Corns and calluses resulting from mechanical
hyperkeratosis. Am Fam Physician. 2002 Jun 1. 65(11):2277-
80. [Medline].
• Farndon L, Concannon M, Stephenson J. A survey to investigate
the association of pain, foot disability and quality of life with
corns. J Foot Ankle Res. 2015. 8:70. [Medline].
• Murphy GA. Lesser Toe Abnormalities: Corns (Helomata and Clavi).
Canale ST, ed. Canale: Campbell's Operative Orthopaedics.
10th. St. Louis, Mo: Mosby; 2003. 4063-5.
• Singh D, Bentley G, Trevino SG. Callosities, corns, and calluses.
BMJ. 1996 Jun 1. 312(7043):1403-6. [Medline]. [Full Text].
• Snider RK. Corns and Calluses. Greene WB, ed. Essentials of
Musculoskeletal Care. 2nd ed. Rosemont, Ill: American
Academy of Orthopaedic Surgeons; 2001. 437-41.
• DeLauro TM, DeLauro NM. Corns and Calluses. Wolff K, Goldsmith
LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, eds.
Fitzpatrick's Dermatology in General Medicine. 7th ed. New
York, NY: McGraw-Hill; 2008. 97.
• Kennedy CTC, Burd DAR. Mechanical and Thermal Injury. Burns T,
Breathnach SM, Cox N, Griffiths CE, eds. Rook's Textbook of
Dermatology. 7th ed. London, England: Blackwell Science;
2004. 22.
• Viegas SF, Torres FG. Cherry pitter's thumb. Case report and
review of the literature. Orthop Rev. 1989 Mar. 18 (3):336-8.
[Medline].
• Villano PA, Ruocco V, Pisani M. The cameo engraver's corn. Int J
Dermatol. 1990 Jul-Aug. 29 (6):424-5. [Medline].
• Scott MJ Jr, Scott NI, Scott LM. Dermatologic stigmata in sports:
weightlifting. Cutis. 1992 Aug. 50 (2):141-5. [Medline].
• Mishriki YY. Skin commotion from repetitive devotion. Prayer
callus. Postgrad Med. 1999 Mar. 105 (3):153-4. [Medline].
• O'Goshi KI, Aoyama H, Tagami H. Mucin deposition in a prayer
nodule on the forehead. Dermatology. 1998. 196 (3):364.
[Medline].
• Maharaj D, Naraynsingh V. Cigarette lighter thumb. Am J Med.
2001 Apr 15. 110 (6):506. [Medline].
• Kanerva L. Knuckle pads from boxing. Eur J Dermatol. 1998 Jul-
Aug. 8 (5):359-61. [Medline].
• Daluiski A, Rahbar B, Meals RA. Russell's sign. Subtle hand
changes in patients with bulimia nervosa. Clin Orthop Relat
Res. 1997 Oct. 107-9. [Medline].
• Koh D, Jeyaratnam J, Aw TC. An occupational mark of screwdriver
operators. Contact Dermatitis. 1995 Jan. 32 (1):46. [Medline].
• Heyl T, Raubenheimer EJ. Sucking pads (sucking calluses) of the
lips in neonates: a manifestation of transient leukoedema.
Pediatr Dermatol. 1987 Aug. 4 (2):123-8. [Medline].
• Gibbs RC. "Vamp disease". J Dermatol Surg Oncol. 1979 Feb. 5
(2):92-3. [Medline].
• Vaseenon T, Intharasompan P, Wattanarojanapom T,
Theeraamphon N, Auephanviriyakul S, Phisitkul P. Foot and
ankle problems in Muay Thai kickboxers. J Med Assoc Thai.
2015 Jan. 98 (1):65-70. [Medline].
• Patruno C, Napolitano M, La Bella S, Ayala F, Balato N, Cantelli M,
et al. Instrument-related Skin Disorders in Musicians.
Dermatitis. 2016 Jan-Feb. 27 (1):26-9. [Medline].
• Hirao M, Ebina K, Shi K, Tomita T, Noguchi T, Tsuboi H, et al.
Association between preoperative pain intensity of MTP joint
callosities of the lesser toes and fore-mid-hindfoot deformities
in rheumatoid arthritis cases. Mod Rheumatol. 2017 Jan. 27
(1):50-53. [Medline].
• Goksugur N, Cakici H. A new computer-associated occupational
skin disorder: Mousing callus. J Am Acad Dermatol. 2006 Aug.
55 (2):358-9. [Medline].
• Cox NH, Finlay AY. Callosities of crossed-leg sitting. Int J
Dermatol. 2009 Nov. 48 (11):1266-7. [Medline].
• Williams ML, Elias PM. Enlightened therapy of the disorders of
cornification. Clin Dermatol. 2003 Jul-Aug. 21(4):269-73.
[Medline].
• Coughlin MJ, Kennedy MP. Operative repair of fourth and fifth toe
corns. Foot Ankle Int. 2003 Feb. 24(2):147-57. [Medline].
• Menz HB, Zammit GV, Munteanu SE. Plantar pressures are higher
under callused regions of the foot in older people. Clin Exp
Dermatol. 2007 Jul. 32(4):375-80. [Medline].
• Erkek E, Koçak M, Bozdoğan O, Atasoy P, Birol A. Focal acral
hyperkeratosis: a rare cutaneous disorder within the spectrum
of Costa acrokeratoelastoidosis. Pediatr Dermatol. 2004 Mar-
Apr. 21 (2):128-30. [Medline].
• Manalo FB, Marks A, Davis HL Jr. Doxorubicin toxicity.
Onycholysis, plantar callus formation, and epidermolysis.
JAMA. 1975 Jul 7. 233 (1):56-7. [Medline].
• Oriba HA, Lo JS, Bergfeld WF. Callused feet, thick nails, and white
tongue. Pachyonychia congenita. Arch Dermatol. 1991 Jan.
127 (1):113-4, 116-7. [Medline].
• Wollina U, Mohr F, Schier F. Unilateral hyperhidrosis, callosities,
and nail dystrophy in a boy with tethered spinal cord
syndrome. Pediatr Dermatol. 1998 Nov-Dec. 15 (6):486-7.
[Medline].
• Robbins JM, Ballew KK, Lowery CR, Husni EA. Asymptomatic
occlusive arterial disease. A case report. J Am Podiatr Med
Assoc. 1985 Nov. 75 (11):616-8. [Medline].
• Coughlin MJ. Common causes of pain in the forefoot in adults. J
Bone Joint Surg Br. 2000 Aug. 82(6):781-90. [Medline].
• Verbov JL, Monk CJ. Talar callosity--a little-recognized common
entity. Clin Exp Dermatol. 1991 Mar. 16 (2):118-20. [Medline].
• Oztekin HH, Boya H, Nalcakan M, Ozcan O. Second-toe length and
forefoot disorders in ballet and folk dancers. J Am Podiatr Med
Assoc. 2007 Sep-Oct. 97 (5):385-8. [Medline].
• Baccouche D, Mokni M, Ben Abdelaziz A, Ben Osman-Dhahri A.
[Dermatological problems of musicians: a prospective study in
musical students]. Ann Dermatol Venereol. 2007 May. 134 (5 Pt
1):445-9. [Medline].
• Gambichler T, Uzun A, Boms S, Altmeyer P, Altenmüller E. Skin
conditions in instrumental musicians: a self-reported survey.
Contact Dermatitis. 2008 Apr. 58 (4):217-22. [Medline].
• Verma SB, Wollina U. Callosities of cross legged sitting: "yoga
sign"--an under-recognized cultural cutaneous presentation.
Int J Dermatol. 2008 Nov. 47 (11):1212-4. [Medline].
• Darvall WA. Flash dancing and spine bumps. Med J Aust. 1984 Apr
28. 140 (9):568. [Medline].
• Lemont H, Ravick A. Hemorrhage within plantar callus. A
cutaneous sign of rheumatoid angiitis. J Am Podiatry Assoc.
 1980 Jan. 70 (1):22-5. [Medline].
• Murray HJ, Young MJ, Hollis S, Boulton AJ. The association
between callus formation, high pressures and neuropathy in
diabetic foot ulceration. Diabet Med. 1996 Nov. 13 (11):979-82.
[Medline].
• Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB.
Prevalence of foot and ankle conditions in a multiethnic
community sample of older adults. Am J Epidemiol. 2004 Mar
1. 159(5):491-8. [Medline].
• Menz HB, Morris ME. Footwear characteristics and foot problems
in older people. Gerontology. 2005 Sep-Oct. 51(5):346-51.
[Medline].
• Black JR, Hale WE. Prevalence of foot complaints in the elderly. J
Am Podiatr Med Assoc. 1987 Jun. 77(6):308-11. [Medline].
• Benvenuti F, Ferrucci L, Guralnik JM, Gangemi S, Baroni A. Foot
pain and disability in older persons: an epidemiologic survey. J
Am Geriatr Soc. 1995 May. 43(5):479-84. [Medline].
• Habif TP. Warts, Herpes Simplex and other Viral Infections.
Clinical Dermatology: A Color Guide to Diagnosis and Therapy.
4th ed. St. Louis, Mo: Mosby; 2004. 374-5.
• Mann RA, DuVries HL. Intractable plantar keratosis. Orthop Clin
North Am. 1973 Jan. 4(1):67-73. [Medline].
• Bae JM, Kang H, Kim HO, Park YM. Differential diagnosis of
plantar wart from corn, callus and healed wart with the aid of
dermoscopy. Br J Dermatol. 2009 Jan. 160(1):220-2. [Medline].
• Kurvin L, Volkering C. [Diagnosis and treatment of warts, corns,
and clavi]. MMW Fortschr Med. 2007 Mar 8. 149 (10):31-3.
[Medline].
• Dainichi T, Honma Y, Hashimoto T, Furue M. Clavus detected
incidentally by positron emission tomography with computed
tomography. J Dermatol. 2008 Apr. 35 (4):242-3. [Medline].
• Sage RA, Webster JK, Fisher SG. Outpatient care and morbidity
reduction in diabetic foot ulcers associated with chronic
pressure callus. J Am Podiatr Med Assoc. 2001 Jun. 91(6):275-
9. [Medline].
• Thomas JR 3rd, Doyle JA. The therapeutic uses of topical vitamin
A acid. J Am Acad Dermatol. 1981 May. 4 (5):505-13. [Medline].
• Dehghani F, Merat A, Panjehshahin MR, Handjani F. Healing effect
of garlic extract on warts and corns. Int J Dermatol. 2005 Jul.
44 (7):612-5. [Medline].
• Foster A, Edmonds ME, Das AK, Watkins PJ. Corn cures can
damage your feet: an important lesson for diabetic patients.
Diabet Med. 1989 Dec. 6(9):818-9. [Medline].
• George WM. Linear lymphatic hypopigmentation after intralesional
corticosteroid injection: report of two cases. Cutis. 1999 Jul.
64 (1):61-4. [Medline].
• Bevans JS, Bosson G. A comparison of electrosurgery and sharp
debridement in the treatment of chronic neurovascular,
neurofibrous and hard corns. A pragmatic randomised
controlled trial. Foot (Edinb). 2010 Mar. 20(1):12-7. [Medline].
• Balkin SW. Injectable silicone and the foot: a 41-year clinical and
histologic history. Dermatol Surg. 2005 Nov. 31(11 Pt 2):1555-
9; discussion 1560. [Medline].
• Richards RN. Calluses, corns, and shoes. Semin Dermatol. 1991
Jun. 10(2):112-4. [Medline].
• Nagel A, Rosenbaum D. Vacuum cushioned removable cast
walkers reduce foot loading in patients with diabetes mellitus.
Gait Posture. 2009 Jul. 30 (1):11-5. [Medline].
• Cordoro KM, Ganz JE. Training room management of medical
conditions: sports dermatology. Clin Sports Med. 2005 Jul.
24(3):565-98, viii-ix. [Medline].
• Stephenson J, Farndon L, Concannon M. Analysis of a trial
assessing the long-term effectiveness of salicylic acid plasters
compared with scalpel debridement in facilitating corn
resolution in patients with multiple corns. J Dermatol. 2016
Jun. 43 (6):662-9. [Medline].
• Balkin SW. Silicone injection for plantar keratoses. Preliminary
report. J Am Podiatry Assoc. 1966 Jan. 56(1):1-11. [Medline].
• Field LM. Letter: injectable silicone for painful interdigital
neurovascular clavi and verrucae. Dermatol Surg. 2006 Dec.
32(12):1535. [Medline].
• Narins RS, Beer K. Liquid injectable silicone: a review of its
history, immunology, technical considerations, complications,
and potential. Plast Reconstr Surg. 2006 Sep. 118(3
Suppl):77S-84S. [Medline].
• Brousseau-Foley M, Cantin V. Digital and interdigital corns: a
report of two cases with use of hyaluronic acid gel filler. J Am
Podiatr Med Assoc. 2014 Jul. 104(4):413-6. [Medline].
• McDowell BA. Carbon dioxide laser excision of benign pedal
lesions. Clin Podiatr Med Surg. 1992 Jul. 9 (3):617-32.
[Medline].
• Akdemir O, Bilkay U, Tiftikcioglu YO, Ozek C, Yan H, Zhang F, et
al. New alternative in treatment of callus. J Dermatol. 2011
Feb. 38 (2):146-50. [Medline].
• González-Ramos J, Sendagorta-Cudós E, González-López G, Mayor-
Ibarguren A, Feltes-Ochoa R, Herranz-Pinto P. Efficacy of
 botulinum toxin in pachyonychia congenita type 1: report of
two new cases. Dermatol Ther. 2016 Jan-Feb. 29 (1):32-6.
[Medline].
• Dockery GL, Nilson RZ. Intralesional injections. Clin Podiatr Med
Surg. 1986 Jul. 3(3):473-85. [Medline].
• Lee KB, Park JK, Park YH, Seo HY, Kim MS. Prognosis of painful
plantar callosity after hallux valgus correction without lesser
metatarsal osteotomy. Foot Ankle Int. 2009 Nov. 30 (11):1048-
52. [Medline].
• Atlan M, Naouri M, Lorette G, Estève E, Zakine G. [Original
treatment of constitutional painful callosities by surgical
excision, collagen/elastin matrix (MatriDerm(®)) and split
thickness skin graft secured by negative wound therapy]. Ann
Chir Plast Esthet. 2011 Apr. 56 (2):163-9. [Medline].