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Clavus Clinical Presentation

  • Author: Nanette B Silverberg, MD; Chief Editor: William D James, MD  more...
Updated: May 12, 2014


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.[17]
  • Callosities are generally more painful with direct pressure, whereas warts are more painful with lateral pressure.[18]
  • 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

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[24] ) 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]

  • Rheumatoid arthritis[30] : About 17% of patients with rheumatoid arthritis present with intractable foot pain. Chronic arthritis leads to foot deformities and consequent callus formation. Bleeding into callosities in patients with rheumatoid arthritis may be a sign of rheumatoid angiitis.
  • Diabetes mellitus with associated peripheral neuropathy[31] : In patients with diabetes, chronic callosities in the presence of neurovascular deterioration may lead to ulcerations and superinfections.
  • Obsessive-compulsive disorder (pseudo-knuckle pads)
  • Ectopic nail
Contributor Information and Disclosures

Nanette B Silverberg, MD Clinical Professor of Dermatology, Icahn School of Medicine at Mount Sinai; Chief, Pediatric Dermatology, Mt Sinai Health Systems, Mount Sinai St Luke's-Roosevelt Hospital and Mt Sinai Beth Israel Medical Centers

Nanette B Silverberg, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Pediatric Dermatology, Women's Dermatologic Society, European Society for Pediatric Dermatology, Dermatology Foundation, American Association of University Women, Pediatric Dermatology Research Alliance, Vitiligo Support International, American Academy of Pediatrics, American Medical Association, American Medical Womens Association, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.


Smeena Khan, MD Private Practice, Adult and Pediatric Dermatology Associates

Smeena Khan, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

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Screwdriver operator's callus (ie, clavus).
Table. Clavus Formation Named for Specific Etiology or Location
Vernacular Term Location Association
Jeweler's callus, cherry pitter's thumb,[4] cameo engraver's corn[5] ThumbDigital 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[6] Callosities over the palmar metacarpophalangeal jointsCaused 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 foreheadFrom kneeling prayer with the hands on the forehead
Cigarette lighter's thumb[9] Hyperkeratosis of the radial aspect of the thumbCaused by excessive cigarette lighter flicking
Knuckle pads[10] Hyperkeratosis over the knucklesCaused by boxing training
Russell sign[11] Callosities of the dorsum of the hand over the metacarpophalangeal and interphalangeal jointsCaused by the friction involved with self-induced emesis in bulimia nervosa
Screwdriver operator's clavus[12] Palmar surface of the handOccurs at the site of contact with a screwdriver handle
Spine bumpsHyperkeratosis over the spinal columnCaused by dancing with spinning on one's back
Hairdresser's handFirst finger on dominant handCallus formation at the site of friction caused by scissors around the first finger on the dominant hand
Sucking calluses[13] Lip, hand, or foot of a newbornCallus formation at the site of an area of suction on the lip, hand, or foot of a newborn
Vamp disease[14] FeetClavus formation due to wearing tight high-heeled shoes
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