Managing Corns and Calluses in the Elderly

(2/24/09)-It is estimated that the average person will walk the equivalent of three times around the earth in a lifetime. Can you imagine the wear and tear this puts on the 26 bones, 33 joints and over 100 tendons, ligaments and muscles that make up the foot?

A survey for the American Podiatric Medical Association reported 53 percent of respondents had foot pain so severe that it hampered their daily function. On average, people develop pain in their 60s, but it can start as early as the 20s and 30s. Yet, except for women who get regular pedicures, most people don't take much care of their feet.

(4/21/02)-One of the most painful and disabling conditions found in the elderly relates to foot and toe problems. It is estimated that about 7.5 million Americans consult physicians with these problems. The figures we see quoted are nearly four million for corns and calluses.

Many individuals complain about their feet, never consult a physician, and try over the counter remedies, so that these figures many not represent the total population of individuals with these problems. Incidentally, when you are evaluating a nursing home for your loved one, please make sure that the home has a podiatrist coming in at least once a month to examine and treat any foot problems that the residents may be encountering.

Chapters in the book Aging and the Skin (Raven Press, 1989) indicate that the elderly are susceptible to the development of corns and calluses as result of a lower rate of epidermal cell production and decreased mean epidermal cell size. This expresses itself in a thinner, flatter epidermis, which, along with the age-related atrophy or displacement of the plantar fat pad, contributes to the formation of lesions. The outer membrane of the foot evolves into a tough layer of cells, mainly called keratinocytes. This layer begins to thicken due to irritation and pressure when walking. It is the thickening in certain spots that become corns or calluses. The site distinguishes the two.

It is not difficult to make a diagnosis of these problems if a person calls it to the doctor’s attention. The doctor may also observe the individuals gait, foot alignment or looks for conditions that may be irritating to the foot or for that matter looks at the sole of the foot.

Corns

The technical name for corns is helomata. They are considered cone-shaped lesions in which the core tends to be harder than the outer surface. A 1998 study by Munro and Steele (J Am Podiatr Med Assoc., 88:242-248) of individuals over 65 years of age, indicated an incidence rate of 10% in men and 27% in women. Others have identified corns as an independent risk factor for falls in the elderly. Causes of corns include:

1. Decreased adipose tissue (from aging or diabetes mellitus)
2. Bony abnormalities (hammertoes, hallux valgus, pes cavus deformity, medial sesamoiditis)
3. Ill-fitting shoes
4. Abnormal gait pattern
5. Combination of these factors.

(Adopted from Managing corns, calluses, and plantar warts by Singer and Briskin, Family Practice Recertification, Feb. 2002;24:57-64.)

Corns are classified into four categories:

1. Hard corns (helomata durum) develop over a bony prominence such as the middle top of the toe.
2. Soft corns (helomata molle) develop between the toes. They are moist and white, gray or yellow.
3. Seed corns (helomata miliare) develop on the non-weightbearing arch of the foot. Usually associated with seams in stockings or shoe irregularities.

Treatment of corns involve conservative measures including protecting the area of the corn with padding, shoe modification, corn removal with topical agents or shaving of the corn with appropriate instrument. Persistent corns may warrant the attention of a professional (Podiatry medicine).

According to Drs. Singer and Briskin, both on medical staff of UCLA School of Medicine, " OTC keratolytic preparations containing 17% salicylic acid (Duofilm, Fungo, Mosco, etc.) can be applied at home to remove corns. Patients should be instructed to remove white, dead superficial tissue once or twice a week with a pumice stone, nail file, or other debriding device but cautioned to pare away only nonsensitive tissue. In our experience, these OTC agents provide only limited short-term relief." (italics added)

Calluses

Calluses are usually found under the metatarsal heads of the forefoot or on the heel of the foot. They are the result of pressure or friction and are usually gray or yellowish in color. Causes can be either structural or functional, creating areas of increased friction or pressure on soft tissue in the cushioned metatarsal fat pad during walking.

There are three types of calluses:

1. Deep calluses, which form at points of greater pressure under the metatarsal heads.
2. Pinch calluses, which form on the outside of the interphalangeal joint of the great toe.
3. Heel calluses, which form during irritation between the calcaneus and the shoe. (This type of callus is not uncommon in heavy people who wear shoes that are loose fitting.)

Treatment of calluses is straightforward and similar to treatment of corns i. e. protect the area, palliative debridement, shoe modification, foot orthoses etc. The earlier the treatment, the less severe the condition will be and the more comfortable you will be when walking. Make it part of your physical examination to have the treating physician check your feet. It may prevent serious complications in the future.

References:

Singer AM, Briskin G. Managing corns, calluses, and plantar warts. Family Practice Recertification 2002; 24(2):57-64.

Munro BJ, Steele JR. Foot-care awareness. A survey of persons aged 65 years and older. J Am Podiatr Med Assoc 1998; 88:242-248.

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE
"How to Select a Nursing Home"

by Harold Rubin, MS, ABD, CRC, guest lecturer
updated February 24, 2009

e-mail: hrubin12@nyc.rr.com

http://www.therubins.com