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.
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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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
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
Follow-up: Clavus