eMedicine Specialties > Dermatology > Environmental

Clavus: Follow-up

Author: Nanette Silverberg, MD, Assistant Clinical Professor, Department of Dermatology, Columbia University School of Medicine; Director of Pediatric Dermatology, Department of Dermatology, St Luke's Roosevelt Hospital Center, Maimonides Medical Center and Beth Israel Medical Center
Contributor Information and Disclosures

Updated: Jun 26, 2009

Follow-up

Further Inpatient Care

  • Further inpatient care is not required unless surgical adjustments are needed.
  • A patient with diabetes who has neuropathic ulcers and overlying clavus formation may require further care.
  • Rheumatoid arthritis patients may benefit more from surgical interventions than callous debridement. Forefoot arthroplasty and first metatarsophalangeal joint implants may improve clavus formation and rheumatoid foot pain long-term.
  • Measurement of the foot for orthoses is beneficial in the case of multiple clavi.

Further Outpatient Care

  • Numerous contributory factors may result in thickened skin on the feet. Factors such as occupation, athletic pursuits, footwear, underlying bony abnormalities, and problems with general health may contribute to clavus formation.
  • Etiologic factors must be carefully assessed before treatment can be given.
  • Symptomatic relief can be achieved by thinning the hyperkeratotic lesions and by using cushions or insoles, which reduce pressure on the affected areas.
  • Surgery can be an adjunctive treatment in those patients with intractable clavus formation and chronic foot pain.
  • Using a combination of modalities and reducing the pressure of footwear ultimately reduces the appearance and discomfort of the clavus.

Inpatient & Outpatient Medications

  • The use of keratolytic agents and retinoids is advised when clavus formation causes discomfort or other problems.

Deterrence/Prevention

  • Clavus formation is a common painful frictional disorder that results in hyperkeratosis.
  • Multiple methods to reduce friction and thus prevent recurrences are described in Medical Care and Further Outpatient Care.

Complications

  • Patients, particularly patients with diabetes, may have ulcerations from chronic pressure. This can lead to infection and cellulitis.
  • Maceration and tinea pedis also may occur.

Prognosis

  • Chronic clavus generally occurs because of the difficulty in removing inciting factors in most situations.

Patient Education

  • Patients must be taught to wear less traumatic footwear, such as shoes with a wide toe space.
  • Using inner soles, lowering the heel (if second metatarsal head lesions are present), and preventing the repetitive injuries that cause occupational clavus formation may be helpful.
  • For excellent patient education resources, visit eMedicine's Foot Care Center. Also, see eMedicine's patient education article Corns and Calluses.

Miscellaneous

Medicolegal Pitfalls

  • The clavus is a disease that is unlikely to be associated with any medicolegal risks or complications.
  • However, in patients with diabetes or poor circulation in the lower extremity, therapy should be advanced slowly to avoid complications that warrant medicolegal intervention.
    • In this setting, avoiding any excess risk of superinfections is prudent.
    • This precaution generally is accomplished by using aseptic procedures and/or prophylactic antibiotics (when procedures involve the dermis) and by avoiding the use of harsh topicals in patients with neuropathy who might be unable to determine if any secondary adverse effects are occurring.
  • MRI of the foot may aid in defining underlying diabetic foot disease.

Special Concerns

  • Patients with diabetes and patients with rheumatoid arthritis are particularly at risk problems because of the association with neuropathic ulcerations and chronic foot deformities.
  • In either situation, special consideration of the underlying disorder is required.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.



More on Clavus

Overview: Clavus
Differential Diagnoses & Workup: Clavus
Treatment & Medication: Clavus
Follow-up: Clavus
Multimedia: Clavus
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Coughlin MJ. Common causes of pain in the forefoot in adults. J Bone Joint Surg Br. Aug 2000;82(6):781-90. [Medline].

  2. Mann RA. Pain in the foot. 1. Evaluation of foot pain and identification of associated problems. Postgrad Med. Jul 1987;82(1):154-7, 160-2. [Medline].

  3. Singh D, Bentley G, Trevino SG. Callosities, corns, and calluses. BMJ. Jun 1 1996;312(7043):1403-6. [Medline].

  4. Viegas SF, Torres FG. Cherry pitter's thumb. Case report and review of the literature. Orthop Rev. Mar 1989;18(3):336-8. [Medline].

  5. Villano PA, Ruocco V, Pisani M. The cameo engraver's corn. Int J Dermatol. Jul-Aug 1990;29(6):424-5. [Medline].

  6. Scott MJ Jr, Scott NI, Scott LM. Dermatologic stigmata in sports: weightlifting. Cutis. Aug 1992;50(2):141-5. [Medline].

  7. Mishriki YY. Skin commotion from repetitive devotion. Prayer callus. Postgrad Med. Mar 1999;105(3):153-4. [Medline].

  8. O'Goshi KI, Aoyama H, Tagami H. Mucin deposition in a prayer nodule on the forehead. Dermatology. 1998;196(3):364. [Medline].

  9. Maharaj D, Naraynsingh V. Cigarette lighter thumb. Am J Med. Apr 15 2001;110(6):506. [Medline].

  10. Kanerva L. Knuckle pads from boxing. Eur J Dermatol. Jul-Aug 1998;8(5):359-61. [Medline].

  11. Daluiski A, Rahbar B, Meals RA. Russell's sign. Subtle hand changes in patients with bulimia nervosa. Clin Orthop Relat Res. Oct 1997;(343):107-9. [Medline].

  12. Koh D, Jeyaratnam J, Aw TC. An occupational mark of screwdriver operators. Contact Dermatitis. Jan 1995;32(1):46. [Medline].

  13. Heyl T, Raubenheimer EJ. Sucking pads (sucking calluses) of the lips in neonates: a manifestation of transient leukoedema. Pediatr Dermatol. Aug 1987;4(2):123-8. [Medline].

  14. Gibbs RC. "Vamp disease". J Dermatol Surg Oncol. Feb 1979;5(2):92-3. [Medline].

  15. Goksugur N, Cakici H. A new computer-associated occupational skin disorder: Mousing callus. J Am Acad Dermatol. Aug 2006;55(2):358-9. [Medline].

  16. 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. Jan 2009;160(1):220-2. [Medline].

  17. Kurvin L, Volkering C. [Diagnosis and treatment of warts, corns, and clavi]. MMW Fortschr Med. Mar 8 2007;149(10):31-3. [Medline].

  18. Murray HJ, Young MJ, Hollis S, Boulton AJ. The association between callus formation, high pressures and neuropathy in diabetic foot ulceration. Diabet Med. Nov 1996;13(11):979-82. [Medline].

  19. Manalo FB, Marks A, Davis HL Jr. Doxorubicin toxicity. Onycholysis, plantar callus formation, and epidermolysis. JAMA. Jul 7 1975;233(1):56-7. [Medline].

  20. Oriba HA, Lo JS, Bergfeld WF. Callused feet, thick nails, and white tongue. Pachyonychia congenita. Arch Dermatol. Jan 1991;127(1):113-4, 116-7. [Medline].

  21. Lemont H, Ravick A. Hemorrhage within plantar callus. A cutaneous sign of rheumatoid angiitis. J Am Podiatry Assoc. Jan 1980;70(1):22-5. [Medline].

  22. Wollina U, Mohr F, Schier F. Unilateral hyperhidrosis, callosities, and nail dystrophy in a boy with tethered spinal cord syndrome. Pediatr Dermatol. Nov-Dec 1998;15(6):486-7. [Medline].

  23. Robbins JM, Ballew KK, Lowery CR, Husni EA. Asymptomatic occlusive arterial disease. A case report. J Am Podiatr Med Assoc. Nov 1985;75(11):616-8. [Medline].

  24. Verbov JL, Monk CJ. Talar callosity--a little-recognized common entity. Clin Exp Dermatol. Mar 1991;16(2):118-20. [Medline].

  25. Oztekin HH, Boya H, Nalcakan M, Ozcan O. Second-toe length and forefoot disorders in ballet and folk dancers. J Am Podiatr Med Assoc. Sep-Oct 2007;97(5):385-8. [Medline].

  26. Baccouche D, Mokni M, Ben Abdelaziz A, Ben Osman-Dhahri A. [Dermatological problems of musicians: a prospective study in musical students]. Ann Dermatol Venereol. May 2007;134(5 Pt 1):445-9. [Medline].

  27. Gambichler T, Uzun A, Boms S, Altmeyer P, Altenmüller E. Skin conditions in instrumental musicians: a self-reported survey. Contact Dermatitis. Apr 2008;58(4):217-22. [Medline].

  28. Verma SB, Wollina U. Callosities of cross legged sitting: "yoga sign"--an under-recognized cultural cutaneous presentation. Int J Dermatol. Nov 2008;47(11):1212-4. [Medline].

  29. Darvall WA. Flash dancing and spine bumps. Med J Aust. Apr 28 1984;140(9):568. [Medline].

  30. Dainichi T, Honma Y, Hashimoto T, Furue M. Clavus detected incidentally by positron emission tomography with computed tomography. J Dermatol. Apr 2008;35(4):242-3. [Medline].

  31. Thomas JR 3rd, Doyle JA. The therapeutic uses of topical vitamin A acid. J Am Acad Dermatol. May 1981;4(5):505-13. [Medline].

  32. Foster A, Edmonds ME, Das AK, Watkins PJ. Corn cures can damage your feet: an important lesson for diabetic patients. Diabet Med. Dec 1989;6(9):818-9. [Medline].

  33. George WM. Linear lymphatic hypopigmentation after intralesional corticosteroid injection: report of two cases. Cutis. Jul 1999;64(1):61-4. [Medline].

  34. McDowell BA. Carbon dioxide laser excision of benign pedal lesions. Clin Podiatr Med Surg. Jul 1992;9(3):617-32. [Medline].

  35. Balkin SW. Injectable silicone and the foot: a 41-year clinical and histologic history. Dermatol Surg. Nov 2005;31(11 Pt 2):1555-9; discussion 1560. [Medline].

  36. Richards RN. Calluses, corns, and shoes. Semin Dermatol. Jun 1991;10(2):112-4. [Medline].

  37. Kitaoka HB, Patzer GL. Chevron osteotomy of lesser metatarsals for intractable plantar callosities. J Bone Joint Surg Br. May 1998;80(3):516-8. [Medline].

  38. Mann RA, DuVries HL. Intractable plantar keratosis. Orthop Clin North Am. Jan 1973;4(1):67-73. [Medline].

[ CLOSE WINDOW ]

Further Reading

Clinical guidelines
Dermatologic manifestations.
New York State Department of Health - State/Local Government Agency [U.S.].  2004. 15 pages.  NGC:003931

Guidelines for the management of actinic keratoses.
British Association of Dermatologists - Medical Specialty Society.  2007 Feb.  9 pages. NGC:005656


Clinical trials

Potential Research Study Participant Registry

Study to Compare Different Light Therapies (Narrowband Ultraviolet B Vs PUVA) for Hand and Foot Skin Diseases.


Related eMedicine topics

Corns (Dermatology)

Arsenical Keratosis

Warts, Nongenital Warts, Plantar

[ CLOSE WINDOW ]

Keywords

callosity, corn, heloma, heloma durum, heloma molle, callous, callus, plantar callus, heloma, tyloma, keratoma, plantar corn, plantar callus, intractable plantar keratoses, jeweler's callus, cherry pitter's thumb, cameo engraver's corn, weight lifter's callus, prayer callus, cigarette lighter thumb, knuckle pads, Russell's sign, Russell sign, screwdriver operator's clavus, spine bumps, hairdresser's hand, sucking callus, Vamp disease, mousing callus

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Nanette Silverberg, MD, Assistant Clinical Professor, Department of Dermatology, Columbia University School of Medicine; Director of Pediatric Dermatology, Department of Dermatology, St Luke's Roosevelt Hospital Center, Maimonides Medical Center and Beth Israel Medical Center
Nanette Silverberg, MD is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, American Association of University Women, American Medical Association, American Medical Women's Association, Dermatology Foundation, International Society of Pediatric Dermatology, Phi Beta Kappa, Sigma Xi, Society for Pediatric Dermatology, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn 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, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.