Corns and Calluses in The Geriatric Population
Özet
The prevalence of corns and calluses in the geriatric population is significantly exacerbated by age-related physiological cutaneous changes, diminished muscle strength, and foot deformities. Affecting approximately 33% to 68% of individuals over the age of 65, these lesions represent hyperkeratotic dermatoses resulting from the thickening of the stratum corneum due to repetitive mechanical pressure and friction. Corns (helomas), characterized by a central keratinous core, are clinically classified as either hard or soft varieties, whereas calluses present as diffuse, broad-based thickenings with indistinct margins.
Beyond being a cosmetic concern, these lesions carry significant clinical implications; they cause pain, restrict mobility, and impair balance, thereby increasing the risk of falls and associated mortality in the elderly. Furthermore, in diabetic patients with underlying neuropathy, they pose a critical risk for ulceration and potential amputation. Diagnosis is primarily established through physical examination, where these lesions are differentiated from plantar warts by the preservation of skin lines over the surface and tenderness upon direct vertical pressure.
The therapeutic management aims to alleviate pain, identify underlying biomechanical abnormalities, and prevent recurrence. Conservative modalities include scalpel debridement, the application of topical keratolytic agents (e.g., salicylic acid), and the prescription of appropriate footwear and orthoses. Surgical intervention is reserved for cases that are refractory to conservative treatment or involve significant osseous deformities.
Referanslar
Mukhopadhyay AK. Foot that hurts: A brief note on the history of corns and calluses. Indian J Dermatol Venereol Leprol. 2021;87(6):885-9.
Helfand AE, Cooke HL, Walinsky MD, Demp PH. Foot problems associated with older patients. A focused podogeriatric study. J Am Podiatr Med Assoc. 1998;88(5):237-41.
Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol. 2004;159(5):491-8.
Spink MJ, Menz HB, Lord SR. Distribution and correlates of plantar hyperkeratotic lesions in older people. J Foot Ankle Res. 2009;2:8.
Swensson O, Langbein L, McMillan JR, Stevens HP, Leigh IM, McLean WH, et al. Specialized keratin expression pattern in human ridged skin as an adaptation to high physical stress. Br J Dermatol. 1998;139(5):767-75.
Kim SH, Kim S, Choi HI, Choi YJ, Lee YS, Sohn KC, et al. Callus formation is associated with hyperproliferation and incomplete differentiation of keratinocytes, and increased expression of adhesion molecules. British Journal of Dermatology. 2010;163(3):495-501.
Thomas SE, Dykes PJ, Marks R. Plantar hyperkeratosis: a study of callosities and normal plantar skin. J Invest Dermatol. 1985;85(5):394-7.
Hashmi F, Nester C, Wright C, Newton V, Lam S. Characterising the biophysical properties of normal and hyperkeratotic foot skin. J Foot Ankle Res. 2015;8:35.
Woodburn J, Helliwell PS. Relation between heel position and the distribution of forefoot plantar pressures and skin callosities in rheumatoid arthritis. Ann Rheum Dis. 1996;55(11):806-10.
Theodosat A. Skin diseases of the lower extremities in the elderly. Dermatol Clin. 2004;22(1):13-21.
ESKİYURT N. Yaşlılarda Ayak Sorunları ve Tedavisi. Turkiye Klinikleri Physical Medicine Rehabilitation- Special Topics. 2010;3(2):62-8.
Scott G, Menz HB, Newcombe L. Age-related differences in foot structure and function. Gait Posture. 2007;26(1):68-75.
Booth J, McInnes A. The aetiology and management of plantar callus formation. J Wound Care. 1997;6(9):427- 30.
Freeman DB. Corns and calluses resulting from mechanical hyperkeratosis. Am Fam Physician. 2002;65(11):2277-80.
Richards RN. Calluses, corns, and shoes. Semin Dermatol. 1991;10(2):112-4.
Singh D, Bentley G, Trevino SG. Callosities, corns, and calluses. Bmj. 1996;312(7043):1403-6.
Bae JM, Kang H, Kim HO, Park YM. Differential diagnosis of plantar wart from corn, callus and healed wart with the aid of dermoscopy. Br J Dermatol. 2009;160(1):220-2.
Landorf KB, Morrow A, Spink MJ, Nash CL, Novak A, Potter J, et al. Effectiveness of scalpel debridement for painful plantar calluses in older people: a randomized trial. Trials. 2013;14:243.
Pitei DL, Foster A, Edmonds M. The effect of regular callus removal on foot pressures. J Foot Ankle Surg. 1999;38(4):251-5; discussion 306.
Siddle HJ, Redmond AC, Waxman R, Dagg AR, Alcacer-Pitarch B, Wilkins RA, et al. Debridement of painful forefoot plantar callosities in rheumatoid arthritis: the CARROT randomised controlled trial. Clin Rheumatol. 2013;32(5):567-74.
Farndon LJ, Vernon W, Walters SJ, Dixon S, Bradburn M, Concannon M, et al. The effectiveness of salicylic acid plasters compared with ‘usual’ scalpel debridement of corns: a randomised controlled trial. J Foot Ankle Res. 2013;6(1):40.
Akdemir O, Bilkay U, Tiftikcioglu YO, Ozek C, Yan H, Zhang F, et al. New alternative in treatment of callus. J Dermatol. 2011;38(2):146-50.
Stephenson J, Farndon L, Concannon M. Analysis of a trial assessing the long-term effectiveness of salicylic acid plasters compared with scalpel debridement in facilitating corn resolution in patients with multiple corns. J Dermatol. 2016;43(6):662-9.
Zakka Bajjani J, Auzou P, Paniez H, Katsogiannou M, Chapalain V, Pierre C, et al. Pain Relief and Protection of Corns, Calluses and Bunions Using COMPEED(®) Foot Care Hydrocolloid Plasters: A Prospective Non- Interventional Study in Primary Care/Community Pharmacies. Med Devices (Auckl). 2025;18:213-31.
Balevi A, Engin Uysal S, Doga Ustuner P, Ozdemir M. How I Do It: Treatment of Plantar Calluses and Corns With an Erbium-Doped Yttrium Aluminum Garnet 327 Laser. Dermatologic Surgery. 2016;42(11):1304-7.
Anderson J, Burrow J. A small-scale study to determine the clinical effectiveness of electrosurgery in the treatment of chronic helomata (corns). The Foot. 2001;11(4):189-98.
Lucoveis MLS, Gamba M, Silva EQ, Pinto LAS, Sacco ICN. The effects of the use of customized silicone digital orthoses on pre-ulcerative lesions and plantar pressure during walking in people with diabetic neuropathy: A study protocol for a randomized controlled trial. Contemp Clin Trials Commun. 2024;37:101247.
Marti-Martinez LM, Gracia-Sánchez A, Ferrer- Torregrosa J, Lorca-Gutierrez R, Garcia-Campos J, Sánchez-Pérez SP. Description of the surgical technique for condylectomy with minimally invasive surgery to treat interdigital helomas on the lesser toes: a Delphi study. J Foot Ankle Res. 2019;12:13.
Guo J, Qin S, Zhang F, Dong W, Hou Z, Zhang Y. The plantarward oblique Chevron osteotomy: an optional method to treat hallux valgus with painful plantar callosities. Sci Rep. 2019;9(1):17364.
Farndon L, Concannon M, Stephenson J. A survey to investigate the association of pain, foot disability and quality of life with corns. J Foot Ankle Res. 2015;8:70.
