 Like Corns, a callus is
a protective thickening of
the skin created by Mother Nature, that develops as a result of abnormal recurrent
friction and pressure. Most calluses
are found on the ball of the
foot, although they may form
elsewhere including the
heels.
Its job is to act as defense mechanism,
to, insulate and
protect the balls of the feet
and other areas on the feet against the abnormal bony
pressure put upon it.
Footwear is commonly blamed
for the formation of calluses,
but more often than not, the
truth is calluses are most usually caused
by a Morton's Toe which affects how the
bones in our forefoot are formed and how they bear
our bodies' weight. When one or more of these bones
are misformed, other bones are then forced to bear an
excessive amount of weight. Calluses are then formed to help
these other bones support this excessive weight on the ball of the feet.
The patient will normal
complain of a
Burning Pain on
the ball of the foot, a
condition that has
generally spanned
anywhere from a few weeks,
to a number of
years. Or the patient might
complaint that they have
a "stone bruise
type of
feeling."
They will claim they
think they have a
pebble in their
shoe. Such a sensation
is common
and is also commonly
caused by a
misalignment of the 2nd-5th
metatarsal
bones; and there may or
may not be any sign of callus tissue.
PLEASE NOTE!! CALLUSES
ARE FREQUENTLY MISTAKEN
FOR WARTS.
A week rarely passes
when someone does not come
into my office with a complaint
that quickly tells me that they
have misdiagnosed their condition.
If a family physician has performed
a little surgery on this area, the
callous is usually compounded by
the formation of scar tissues, and
of course the patient is in considerable
pain. It is not unusual for
someone to tell me: "Doctor,
I've had these warts on my feet
for 30 years." You can imagine how
surprised they are when I tell them
that they most probably never had
warts and never suffered from warts.
It takes a while for me persuade them,
but once they had accepted the
fact that the warts were indeed calluses,
they were most eager to learn
what could be done about them.
Like Corns, conservative
therapy of callus is done
by "trimming" the callus
which only gives temporary relief
and does nothing to effect the
underlying bone problem. You
see if you just trim the calluses
away you are doing nothing
about the real problem, and
Mother Nature is adamant about
providing her defenses. Remember
you can't fool her !
Professional Treatment
As always it is my philosophy
that "foot surgery
should be a last resort".
Because of that we have
created a treatment protocol to
treat this problem initially without
the need of surgery.
We have learned that besides
the callus there is almost
always an associated Bursitis
causing some of the pain,
and an associated strain
of many of the tiny muscles
in the feet, especially
on the ball of the feet.
By using a great deal of
Physical Therapy you can
rehabilitate
these painful areas. Besides
that you must also take
the strain off the front of
the foot with proper padding and
strapping. Finally once the patient
is feeling better we fabricate
an Orthotic which
will rebalance the forefoot to
its most ideal position.
In the rare case where these
procedures don't resolve
the problem, we have available
two minimal traumatic surgeries
to help the condition. In
order for you to understand
the logic behind these surgeries
you must sit through your
first anatomy lesson. Here
we go!
Once the metatarsal bones
have fallen out of place,
there is a certain amount
of contracture or Hammering of the Toes
to become tight
or bulge. If the toes are
pulled back, then chances
are that the metatarsal
heads are painfully depressed
and that there is a burning
sensation on the ball of
the foot. The action between the
toes and metatarsal heads are
closely intertwined. You will
see that this is so if you take your
hand and push hard against the
ball of your foot. This pressure,
known as retrograde force,
will cause your toes to come
down, a condition that is more pronounced
in cases where people have
hammer toes. If the toes can be brought
down to a normal position, this
in turn will allow the metatarsal
heads to pop up, thus taking
the pressure off
the ball of the foot.
SURGERY
When a person has a large
diffused callus with burning
(throughout the second and
fifth metatarsal heads),
we can alleviate his problem
by performing a relatively
simple but highly effective bit
of ambulatory surgery. It
involves putting a local anesthetic under
the skin on top of the foot
and releasing the abnormal
pressure on the tight tendons
(sometimes we also have to release
the pressure at the joint capsule). Once
this has been done, the toes will
come down, which allows the
metatarsal heads to come up, so
that the foot may be more properly
realigned. At this stage, Mother
Nature once again steps in
and attempts to reattach these tight
tendons over a period of 3 to
6 months. The patient is given simple
exercises to do to stretch out
the tendons, and after the surgery,
leaves the office wearing
a bandage inside his shoe.
While this is a highly effective
procedure, it will not always
get rid of the callus tissue
that has formed and I never
fail to make a point of
this, although the patient rarely
decides against the procedure
on that account. What he
will generally say is: "Look,
I can live with a little callus
tissue. It's the pain I
want to get rid of."
Moving on to the second
procedure, in cases of more
severely depressed metatarsal
bone, we begin by performing
a minute incision into what's
called the neck of the metatarsal
bone; with a side-cutting burr,
we cut right across
the neck of the metatarsal
bone, allowing that part of
the bone to move up and down; hence
getting the pressure off of
the ball of the foot. With the aid
of a little local anesthetic, it
is a quick, relatively painless procedure.
Afterwards, we do not put
a cast on the foot, do not
insert wires or tell the patient
that he will have to walk around
on crutches. Rather, we encourage
them, or even insist that
he put his own shoe back on and
walk around in it, which is the
actual secret in achieving a
rapid recovery. With only a minimum
amount of discomfort, Mother
Nature will take care of
the situation in short order (usually
six to eight weeks) and
during that time, the patient
is able to perform the vast
majority of their normal activities.
Of course, we do not mean
to suggest that they should go
dancing, skiing, or try to play tennis, golf
or bowl, during this recuperative
period since the bone is
broken, but they are free
to work or perform normal chores
around the house, and may
resume any normal, reasonable
activity.
There are many highly successful
non-surgical treatments
for calluses that give long
term relief by treating
the abnormal bone pressure.
Foot surgery for calluses is
rare and should always be used as
a last resort, but if needed, it
is done using minimal incision techniques,
in the comfort and privacy
of our Clinic.
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