Pressure or irritation causes focal hyperkeratotic lesions of the skin of the foot. The cause of these lesions can be external (poorly fitted shoe) or internal (bunion). These areas of epidermal accumulation are defined as calluses. Calluses serve a protective function and should not be treated if they are not painful. Calluses grow outward but are soon pushed inward by continued pressure and become corns. Corns also develop in areas of scarring and between toes. Corns are classified as hard or soft. Hard corns are seen over bony protuberances where the skin is dry. Soft corns are seen between toes where the skin is moist. Corns may be painful or painless, but pressure on the corn usually produces pain. Corns interrupt the normal dermal lines and can thus be differentiated from calluses. Hard corns may resemble warts; however, when pared, warts bleed and corns do not. Soft corns resemble tinea, which often leads to misdiagnosis and mistreatment. 23 and 4
Treatment of symptomatic lesions consists of paring with a no. 15 blade scalpel and application of a pad on or around the lesion to relieve pressure. Avoiding constrictive footwear is also important. Keratolytic agents are advocated by some authors but are thought to be too toxic and better avoided by others. Patients should be referred to a podiatrist, since therapy includes repeated paring and possibly surgery to correct any underlying source of pressure. 23 and 4
Keratotic lesions may be an indication of more severe underlying disease, deformity, local foot disorder, or mechanical problem. Other causes of keratotic lesions include syphilis, psoriasis, arsenic poisoning, rosacea, lichen planus, basal cell nevus syndrome, and, rarely, malignancies. 3
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