Clavus Follow-up

  • Author: Nanette Silverberg; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 9, 2010
 

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.
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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.
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Inpatient & Outpatient Medications

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

  • Chronic clavus generally occurs because of the difficulty in removing inciting factors in most situations.
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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.
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Contributor Information and Disclosures
Author

Nanette Silverberg  MD, Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Director of Pediatric Dermatology, Department of Dermatology, St Luke's Roosevelt Hospital Center, Maimonides Medical Center and Beth Israel Medical Center

Nanette Silverberg 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.

Specialty Editor Board

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.

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.

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, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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.

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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
Table 2
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