Advice on Foot Care

Callused feet and toes are common in runners and many times go unnoticed. But, a callus on the heel or the big toe can cause a lot of pain for a runner. The callus can develop an even more painful blister underneath and can limit performance or simply decrease the enjoyment of run. Some rub the area with a pumice stone, some apply cremes and others take a razor blade to the offending callus. Unfortunately, the callus always returns.

Callus tissue is a build of dead skin in response to pressure or friction. The medical term for callus is hyperkeratosis (hi – per – care – uh – toe – sis). A callus is actually a bone problem and a foot mechanics problem, not a skin problem. A foot deformity will cause excess pressure to that area from the shoe or the ground. The body’s natural defense mechanism will kick in and start building up the top layer of skin in response to the excess pressure. This is a protective response from the body in an attempt to prevent the pressure from wearing down the skin layers and resulting in an open sore. The problem is that as long as there is pressure, the body will continue to build up the skin. The continual build up of dead skin can become excessive and painful.

In runners, the most common places for callus buildup are at the inside of the heel, the area around the big toe and the ball of the foot. Calluses can appear on top of the toes or in between the toes. In these cases, the callus tissue is called a corn. The calluses can be thickened, dry, scaly, yellow, red, tender and even flakey. Runners are much more susceptible to the development of callus tissue because of the amount of stress, pressure and repetitive micro-trauma their feet endure.

The first step to treatment is finding out the cause of the callus. Do you have a foot deformity? Do you have a bunion or a hammertoe? Any type of deformity that rubs on the shoe will result in callus formation. Do you have abnormal mechanics? For example, pronation. If your feet roll in excessively, it is common to have callus development at the inside of the heel and at the big toe. Do you have ill-fitting shoes? Without abnormal mechanics or a foot deformity, an ill-fitting shoe can cause rubbing and irritation. A shoe too tight at the toe area will cause callus formation on the little toe and the big toe. If the heel area of the shoe is too loose and the heel is slipping, callus development can occur at the back of the heel.

Once the problem is identified, the first step is to treat the cause. This is not always possible. It is not recommended to surgically correct a bunion because of an annoying callus. You should find shoes to accommodate any foot deformities, and make sure all running shoes fit correctly. Most people wear shoes which are a half of a size too small, make sure your shoes are the proper size. Also, place your hand in your running shoe and look for lumps and bumps, areas of thickened stitching or gluing. Any of these things could cause excess pressure and callus development. Avoid cotton socks and make sure you have socks which wick moisture. Consider buying socks made of acrylic, polypropylene or small fiber wool. Cotton socks lose their shape when moist and tend to fold and bunch easily, contributing to both callus and blister development. If you think your have abnormal rotation in your feet, visit a podiatrist and see if you need a pair of custom made orthotics. Can’t afford custom orthotics? Try a pair of sport orthotics from your local sporting goods store. These pre-fabricated sport orthotics can help control motion and decrease callus development.

Once the problem is identified and either accommodated or eliminated, it is time to direct attention to the callus itself. It is not recommended to trim calluses yourself. Very large, hard calluses or calluses with painful cores (termed intractable plantar keratosis – IPK) should be trimmed by a podiatrist. It is not necessary to have all calluses trimmed. A small amount of callus is protective to the skin and the bony areas it is covering. Cutting, trimming and shaving this tissue is only recommended when there is tenderness, surrounding redness, a core or a history of blister formation in the area. Even then, the callus should not be trimmed down completely, a small layer should be left for protection. If the callus does not cause pain, is not red, is not tender and doesn’t hinder performance, leave it alone. Remember, the callus is there due to excess pressure or friction and if this pressure isn’t identified and dealt with, even after trimming, the callus will return.

To keep callus tissue down, try creams with salicyclic acid or exfoliators specifically for callus tissue. If you do use a pumice stone, use it daily. A monthly, aggressive pumicing may just irritate the surrounding tissue and you will most likely not make much progress or decrease the callus thickness.

Identifying the cause and minimizing the pressure, in combination with the use of a pumice stone and callus reducing cream on a regular basis, will give the best results.

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