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What is a callus on the foot? What causes it and why might someone choose to remove it?
Think of calluses as “reactive” growths. They represent areas of the epidermis that have thickened as a result of repetitive mechanical friction or shearing forces on the skin.
They form as a result of overproduction of keratin due to repetitive shearing forces, friction or pressure. The skin thickens evenly in these areas of mechanical stress. They are most often found under the metatarsal heads. When they become large enough, they can be painful at times from the increased pressure.
I personally recommend the use of manual callus removers. I understand the ease and speed of use an electric remover can offer. However, there is a risk of being too aggressive with these removers. If cracks or openings in the skin are introduced there is a risk of infection.
Please share how to use a callus remover properly, breaking it down one step at a time. For each step, please briefly explain why it's an important step.
The most important thing to remember about calluses is that they do not necessarily have to be removed as they are technically not a sign of disease and are not harmful. They develop as a result of the mechanical stress our skin is under and likely intended to develop to help or protect the skin from outside forces. That being said, they can become painful at times. Treatment is usually focused on symptomatic relief. Prevention takes into consideration better fitting shoes or orthotics.
By understanding that these are “reactive” growths it helps to understand that ill fitting shoes or posture. Although one can attempt to remove a callus, the reality is that it will grow right back fairly quickly if the underlying triggers for their development are not addressed.
The most common treatment options include mechanical or chemical exfoliation.
Mechanical methods include utilizing an emery board or pumice stone. First, soak the lesion for about 15 to 20 minutes in warm water. Then, use the pumice stone or emery board to ‘sand down” the lesion until it is thin enough to relieve the discomfort with applied pressure.
The use of topical keratolytics can help to dissolve the callus and keep it under control. Applying salicylic acid plasters in a 40% concentration can help thin out the thickened skin. Salicylic acid comes in adhesive medicated disks that can be applied directly to the callus. These are changed on a daily basis. Before applying a new disk be sure to take an emery board or pumice stone to gently exfoliate the macerated area produced by the salicylic acid. The salicylic acid works by breaking apart the keratin to help soften and make it easier to scrape. After exfoliating, apply a new disk and repeat this process daily. Although salicylic acid can be found in different concentrations, the 40% is ideal for calluses.
Urea 40% can also be used to help soften and thin out a callus.
The most important step to take, however, is prevention of new callus development. If the factors that led to the development of the callus are not addressed, the reality is that a new callus will develop relatively quickly.
Consideration to ill fitting footwear, changes in our anatomy that may require the use of foam or pressure redistributing pads or cushions, and moleskin are amongst a number of options available to help reduce ill distributed pressure or friction that results in callus development.
How often should you remove calluses?
Ideally once a callus is removed steps are taken to avoid its regrowth. Aside from addressing underlying triggering factors, the use of salicylic acid 5% containing lotions routinely or urea 40% lotions can help reduce the likelihood of calluses developing rapidly. Otherwise, removal is usually pursued based on symptoms of pain, tenderness or irritation.
Is it okay to leave calluses? Are there any benefits to leaving them?
It is reasonable to leave non-tender, non-painful calluses alone. The removal itself can leave a sensitive or raw area behind that can take time to heal. If you have underlying diabetes there is also a risk of infection associated with removal that cannot be ignored.