Clavus Clinical Presentation
- Author: Nanette B Silverberg, MD; Chief Editor: William D James, MD more...
A clavus forms because of inappropriate distribution of pressure onto a specific site, usually of the foot. A localized callosity of the soles, which do not resolve, are termed plantar callus, heloma, tyloma, keratoma, or plantar corn. When callosities occur over one or more lateral metatarsals, they are termed intractable plantar keratoses.
Clinically, all variants of clavus lesions look like hyperkeratotic or thick skin; maceration and secondary fungal or bacterial infections are a common overlying feature in heloma molle and diabetes. Plantar helomas tend to have a central keratin plug, which, when pared, reveal a clear, firm, central core. The most common sites for clavus formation are the feet, specifically the dorsolateral aspect of the fifth toe for heloma durum, in the fourth interdigital web of the foot for heloma molle, and under the metatarsal heads for calluses.
- Examination of patients should include assessment of the types of footwear worn, activities performed, gait, and current home therapy or previously prescribed therapy.
- Lesions should be palpated and pared to look for underlying blood vessels (black dots or pinpoint bleeding), which are seen in warts, and to look for underlying ulcerations, as seen in neurovascular ulcerations (especially in patients with diabetes).
- Paring of callosities or corns, as opposed to plantar warts, should reveal normal dermatoglyphics.
- Callosities are generally more painful with direct pressure, whereas warts are more painful with lateral pressure.
- Pedobarographic studies are pressure assessments that may be used to detect an altered distribution of foot pressure. MRI may delineate diabetic foot problems more clearly.
- Biopsy of lesions reveals hyperkeratosis and, occasionally, mucin deposition.
Conditions associated with clavus formation
- Advanced patient age
- Amputation (ie, stump callosities)
- Use of a brace or orthopedic stabilizing product
- Costa acrokeratoelastoidosis
- Doxorubicin toxicity
- Sensory neuropathies, including neuroborreliosis
- Tethered spinal cord syndrome
- Vascular occlusion syndromes
Faulty mechanics: Irregular distribution of pressure and repetitive motion injury (especially in athletes) are believed to be the main inciting causes; however, inappropriately shaped or constrictive footwear in the presence of bony prominences (eg, talar bone prominences ) may exacerbate clavus formation. Furthermore, some disorders may alter the shape or sensation of the soles of the feet. Bony prominences and faulty foot mechanics then allow clavus formation to continue.[25, 26, 27, 28, 29]
- Obsessive-compulsive disorder (pseudo-knuckle pads)
- Ectopic nail
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|Jeweler's callus, cherry pitter's thumb, cameo engraver's corn||Thumb||Digital changes, including callosities related to repetitive use of fine jeweler's instruments, which also may be seen with the use of cherry-pitting tools|
|Weight lifter's callus||Callosities over the palmar metacarpophalangeal joints||Caused by the friction of weight-lifting apparatus (This also may be seen in athletes who participate in crew.)|
|Prayer callus[7, 8]||Callosity on the forehead||From kneeling prayer with the hands on the forehead|
|Cigarette lighter's thumb||Hyperkeratosis of the radial aspect of the thumb||Caused by excessive cigarette lighter flicking|
|Knuckle pads||Hyperkeratosis over the knuckles||Caused by boxing training|
|Russell sign||Callosities of the dorsum of the hand over the metacarpophalangeal and interphalangeal joints||Caused by the friction involved with self-induced emesis in bulimia nervosa|
|Screwdriver operator's clavus||Palmar surface of the hand||Occurs at the site of contact with a screwdriver handle|
|Spine bumps||Hyperkeratosis over the spinal column||Caused by dancing with spinning on one's back|
|Hairdresser's hand||First finger on dominant hand||Callus formation at the site of friction caused by scissors around the first finger on the dominant hand|
|Sucking calluses||Lip, hand, or foot of a newborn||Callus formation at the site of an area of suction on the lip, hand, or foot of a newborn|
|Vamp disease||Feet||Clavus formation due to wearing tight high-heeled shoes|