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Callus fundamentals

Calluses are a build-up of hard skin and are generally found beneath the weight bearing surfaces on the bottom of the foot. Some degree of callus formation on the sole of the foot of an active person is normal and generally does not cause any problems for a patient. Callus formation can also occur around the periphery of the heels, which can lead to fissuring of the callus, which can become quite painful. Some people use the terms "corns" and "calluses" interchangeably.

How is this caused?

Calluses are generally caused by an uneven distribution of weight, generally on the bottom of the forefoot or heel that leads to a build-up of hard skin. Calluses can be caused by wearing improperly fitted shoes and, in rare instances, an abnormality of the skin causing a build-up of callus tissue. When calluses become too thick, they become painful.

How is this treated?

Properly fitted, supportive shoes with good shock-absorbing soles can help to alleviate pressures on the bottom of the foot which can eventually lead to the build-up of callus. People who have problems with calluses should definitely avoid hard soled or leather soled shoes that do not cushion the bottom of the foot. The use of over-the-counter cushion pads or insoles can also be helpful to eliminate pressure points that can lead to a painful callus. At times, more expensive, custom-made insoles may be necessary. You should also limit the amount of time spent barefoot, since walking barefoot can also cause a build-up of calluses.

Calluses are generally treated conservatively by scraping and/or trimming the build-up of hard tissue and some attempt to re-distribute weight bearing forces away from the callused area.

You should never use sharp objects to cut calluses since injuries can occur and are particularly dangerous in patients with diabetes. This "bathroom surgery" is strongly discouraged and can lead to serious problems. People with calluses are encouraged to soak their feet in lukewarm, soapy water for 10-15 minutes, followed by using a pumice stone to gently file away the build-up of hard tissue. Certain medicated creams and lotions are also helpful in breaking down callus tissue and keeping the skin soft and pliable. When conservative treatment for calluses is not successful, special custom-made inserts are used to even out weight bearing forces on the bottom of the foot to prevent abnormal callusing. In rare instances, surgical procedures may also be performed in order to change the position of the bone so that callusing ceases.

What are the risks of treatment?

Risks include nerve injury, infection, and stiffness of the joints, and onset of a new callus in a different area of the foot.

How do I prepare for surgery?

Always ask your surgeon for complete pre-operative instructions. Typically, these may include:

  • Complete any pre-operative tests or lab work prescribed by your doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time. If your surgery is being done at Cleveland Clinic, call:
    • Main Campus: 216.444.0281
    • Beachwood: 216.839.3500
    • Strongsville: 440.878.3400
    • Marymount: 216.518.3200
  • Refrain from eating or drinking anything after midnight the night before surgery.

Are there exercises I can start now prior to surgery?

In preparation of any foot/ankle surgery, upper body strengthening is encouraged in order to prepare for crutch/walker use after surgery.

What do I need to do the day of surgery?

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Refrain from taking diabetic pills or insulin on the morning of surgery.
  • Do not wear any jewelry, body piercings, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.

What happens during surgery?

Your foot will be initialized in the preoperative area by someone from the surgical team. In the operating room, you will be met by a nursing team and the anesthesia team. You have several anesthetic options:

  • General: Completely asleep and breathing through a tube
  • Epidural/Spinal: Numb from the waist down, or
  • Local: Numbing medicine just above the surgical site

Epidural/Spinal and Local are usually combined with sedative medication so you can rest comfortably during the procedure. Once you are anesthetized, the surgery is initiated.

What happens after surgery?

It is not unusual to experience numbness, tingling, and burning sensations in your foot or ankle. You should elevate your foot above your heart for 48 hours after the procedure, in order to relieve pain and these sensations. If this does not resolve the problem, your cast or surgical dressing may be too tight, and you may need to call your doctor. Avoid prolonged sitting or standing, and refrain from putting weight on the operative site unless given permission by your doctor.

Your doctor will give you pain medication, which may cause nausea or constipation. Eat lightly on the day of surgery.

If you are wearing a cast, do not put anything in the cast and keep the cast clean and dry. If you are itching beneath the cast, take Benadryl and blow cool air down the cast with a hair dryer.

Ask your surgeon for complete post-operative instructions.

How long is the recovery period after surgery?

Based upon the extent of your surgery, it will take approximately 6 weeks to 3 months to recover.

Rehab after surgery

Foot and ankle surgery rehabilitation can be done at home, or, may require formal physical therapy.

How can I manage at home during recovery from the procedure?

After the first 48 hours of foot elevation, you can usually gradually return to most activities. However, the use of crutches or a walker will be required. At some point, your physician will allow you to wean off the crutches/walker to more "normal" activities. Typically, the dressing placed at the time of surgery is left intact until your first postoperative visit. The surgical dressing cannot get wet. Therefore, baths are encouraged. If one chooses to shower, then an "over-the-cast" bag is necessary.

How frequently should I schedule follow up appointments with my doctor following surgery?

Follow-up visits are scheduled by your surgeon.

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