Clavus 

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

Background

A clavus is a thickening of the skin due to intermittent pressure and frictional forces. These forces result in hyperkeratosis, clinically and histologically. The extensive thickening of the skin in a clavus may result in chronic pain, particularly in the forefoot; in certain situations, this thickening may result in ulcer formation. The word clavus has many synonyms and innumerable vernacular terms, some of which are listed in the Table below; these terms describe the related activities that have induced clavus formation.

Synonyms for clavus include callosity, a hyperkeratotic response to trauma; corn, heloma, or a circumscribed hyperkeratotic lesion that may be hard (ie, heloma durum) or soft (ie, heloma molle); and callous, callus, or a diffusely hyperkeratotic lesion. Localized callosities of the soles, which do not resolve, are termed plantar callus, heloma, tyloma, keratoma, or plantar corn.[1] When callosities occur over 1 or more lateral metatarsals, they are termed intractable plantar keratoses.[2]

Clinically, all these lesions look like hyperkeratotic or thickened 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.[3]

Table. Clavus Formation Named for Specific Etiology or Location (Open Table in a new window)

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

A clinical image of a screwdriver operator's clavus is below.

Screwdriver operator's callus (ie, clavus). Screwdriver operator's callus (ie, clavus).
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Pathophysiology

The shape of the hands and feet are important in clavus formation. Specifically, the bony prominences of the metacarpophalangeal and metatarsophalangeal joints often are shaped in such a way as to induce overlying skin friction. As clavus formation ensues, friction against the footwear is likely to perpetuate hyperkeratosis.

Toe deformity, including contractures and claw, hammer, and mallet-shaped toes, may contribute to pathogenesis. Bunionettes, ie, callosities over the lateral fifth metatarsal head, may be associated neuritic symptoms due to compression of the underlying lateral digital nerves. Furthermore, Morton toe, in which the second toe is longer than the first toe, occurs in 25% of the population; this may be one of the most important pathogenic factors in a callus of the common second metatarsal head, ie, an intractable plantar keratosis.

Chronic or repetitive motion may also induce clavus formation, as is seen in computer users and text messengers (ie, "mousing" callus).[15] Callosities can also form from excessive leg crossing.[16]

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Epidemiology

Frequency

United States

Clavus is a common disorder because of the frequency of usage of occlusive footwear and participation in repetitive activities, such as running.

Mortality/Morbidity

Extensive thickening of the skin may result in chronic pain, particularly in the forefoot; in certain situations, ulcer formation may result. Clavus may be a sign of underlying neuropathy due to diabetes or neuroborreliosis, or due to the deformities of rheumatoid arthritis. In the case of neuropathy, a clavus may hide ulceration or denote abnormal neurovasculature of the feet. In the case of rheumatoid arthritis, clavus may enhance the pain of deformed joints.

Race

Persons of any race may be affected by clavus.

Sex

Clavus is more common in women than in men because of their use of occlusive and poorly fitted footwear.

Age

Anyone can have a clavus, but most individuals acquire the risk factors for clavus formation after puberty because of the onset of traumatic footwear use, repetitive motion injuries, and progressive foot deformities.

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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.

References

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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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