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Corns and calluses
Pressure hyperkeratosis: and how to tell whether it is really a plantar wart.
Corns and calluses are the same response of the skin to repeated pressure: the horny layer thickens to defend itself. A callus is diffuse and superficial, typical of the sole; a corn is more circumscribed and has a hard central core pressing downwards, and that is what hurts when walking.
The cause is almost always mechanical: tight or heeled footwear, altered foot posture, toe deformities, activities that concentrate load at one point. This is why removing the thickening without removing the pressure does not solve it: the skin rebuilds it, because it is doing its job.
The useful dermatological part, though, is something else, and concerns a frequent error: a painful corn may in fact be a plantar wart, and the two are not treated the same way. Two signs help. First: a wart interrupts the skin lines, which curve around it, whereas in a callus they continue straight through. Second: a callus hurts on direct pressure, a wart hurts mainly when squeezed from the sides.
The skin lines tell you whether it is a corn or a wart
This is a check made by looking closely, and it avoids months of the wrong treatment. On the sole the skin has a pattern of parallel lines: if they cross the lesion without interruption, it is pressure thickening; if they curve around it and dark dots appear inside, the more likely hypothesis is a wart, which is viral and requires a different approach. The second clue is the pain: pressing from above hurts a corn, squeezing from the sides hurts a wart. Two minutes of observation, and the therapy changes completely.
How it shows
- Yellowish thickening of the skin at pressure points
- Pain on pressure, especially when walking or in closed shoes
- A hard central core in corns, a diffuse surface in calluses
- Typical sites: sole, toes, heel
- Painful fissures when the thickening is marked
- Constant reappearance at the same spot after removal
How we proceed
- 1Dermatological visit: appearance of the lesion and observation of skin lines
- 2Distinction between pressure hyperkeratosis and plantar wart
- 3Removal of the thickening when painful or fissured
- 4Identification of the mechanical cause, without which it returns
- 5Advice on footwear and load; podiatric referral if an orthotic is needed
Available treatments
- Dermatology visit
- Dermatoscopic diagnosis
- Outpatient removal
- Correction of the mechanical cause
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Frequently asked questions
Are corn plasters all right?+
They are products that dissolve keratin and on simple thickening they can help, but they must be used carefully because they also act on the healthy skin around and can cause ulceration. Two warnings matter more than the rest: do not use them if the lesion might be a wart, because that is not the treatment, and do not use them at all in people with diabetes or circulatory problems in the legs.
Why does it always come back in the same place?+
Because the skin is responding to a pressure that has not changed. As long as that point keeps receiving more load than the others — because of the shoe, the way the foot lands, a toe deformity — the thickening re-forms, and rightly so: it is a protective mechanism. This is why removal is only half the work, and the other half concerns footwear and foot posture.
I have diabetes: does that change anything?+
It changes a great deal, and it is the main reason not to act alone. With diabetes, sensation may be reduced and healing slower: a small injury caused by cutting or using a corn remover can develop into something more serious without producing warning pain. In these cases assessment should be done, and foot care set up through the dedicated pathway.
Related reading
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