Clavus Treatment & Management
- Author: Nanette B Silverberg, MD; Chief Editor: William D James, MD more...
Treatment of a clavus should be aimed at reducing symptoms such as pain and discomfort with walking. Paring of the lesions immediately reduces pain. Once the etiology of the foot pressure irregularity is determined, attempts at pressure redistribution should be made. The use of orthotics and conservative footwear with extra toe space are often beneficial. When all else fails, surgery may be performed.
If abnormal dermatoglyphics or pinpoint bleeding is seen, wart therapy is initiated. If normal dermatoglyphics are noted, salicylic acid compounds and orthotics may be beneficial.
Relief of symptoms may be achieved by thinning and cushioning of the involved lesions.
- Paring of the lesions immediately relieves pain, especially with helomas. Lesions may be maintained in this state if the patient uses short soaks and pumice stone debridement at home. Debridement may be enhanced with the use of keratolytic agents, such as ureas, alpha-hydroxy acid (eg, glycolic, malic, or lactic acid), or beta-hydroxy acid (eg, salicylic acid). Garlic extracts have also been described as being helpful.
- Self-adhesive pads are most effective for reducing thick lesions, whereas lotions, creams, and medicaments in petrolatum are best for maintenance. Most salicylic acid compounds are 10-17%. High concentrations of salicylic acid (eg, 40%) may lead to severe maceration, and in patients with diabetes, it may lead to frank foot ulcerations. Intralesional triamcinolone and topical vitamin A acid compounds also may reduce localized hyperkeratosis. Triamcinolone can lead to localized hypopigmentation.
- A carbon dioxide laser can be used to pare deep lesions.
- A combination product to be applied by physicians consisting of 1% cantharidin, a vesicant, mixed with 30% salicylic acid and 5% podophyllin has been described as effective for most people after just one session. In a study looking at 72 patients, 90.3% with callosities on the feet demonstrated that application of this agent after paring with a 15 blade effected clearance in 79.2%, 12.5%, 6.9%, and 1.4% after 1, 2, 3, and 4 sessions, respectively, with only one recurrence at 1 year follow-up.
- Lamb's wool may be beneficial in interdigital corns. Pads or permanent insoles, which place pressure proximal to the metatarsal head, relieve stress on the region. Insoles may be made of silicone or soft plastics.
- Shoes with extra length are required for toe deformity, and shoes with extra width are required for lateral toe callosities. Shoes should be soft inside without seams that rub or press. Orthotics can be placed in the shoe for patients with abnormalities of the foot, such as cavovarus. Orthotics can be created by using insoles made to correct deformities noted on dynamic pressure molds. Reduction of heel height may be helpful for patients with metacarpal head callosities.
- Vacuum orthoses have been described to aid in lesional clearance for diabetic patients with plantar callosities.
Surgical options for clavus should be used when only conservative measures fail.
- Chronic foot pain despite conservative therapy is the number one indication for surgery.
- Hallux valgus correction may aid in reduction of painful callosities over the long term.
- Surgical corrections for claw, hammer, and mallet toes are simple procedures.
- Shaving of prominent condyles of bony prominences may be beneficial particularly on the fifth digit.
- Arthroplasty of the fifth toe interphalangeal joint also may be performed.
- Metatarsal condylectomy or chevron osteotomy may be performed to relieve metatarsal head pressure.
- Mann and DuVries described the use of a combination of arthroplasty and condylectomy. This combination results in 95% clearance, with only a 13% occurrence of transfer lesions.
- When thinning of the plantar fat pads is contributory to the formations of callosities, injectable silicone can be used on the soles underneath the callosities and corns to reduce pressure related callous formation.
- Description of excision followed by either grafting, use of flaps, or grafting using split-thickness graft with or without a collagen/elastin matrix graft has been described as effective in a single resistant case.
See the list below:
- An orthopedist and a podiatrist can be helpful in adjusting abnormalities of gait or pressure distribution.
- Dermatologists are best consulted to assess for the possibility of other disorders in the differential diagnosis, especially warts and keratoderma.
No special diet is required; however, weight loss relieves some of the foot pressures involved.
Adjustment of the footwear and the use of special insoles aid in the maintenance of full mobility and eliminate the need for activity limitation.
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|Jeweler's callus, cherry pitter's thumb, cameo engraver's corn||Thumb||Digital 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||Callosities over the palmar metacarpophalangeal joints||Caused 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 forehead||From kneeling prayer with the hands on the forehead|
|Cigarette lighter's thumb||Hyperkeratosis of the radial aspect of the thumb||Caused by excessive cigarette lighter flicking|
|Knuckle pads||Hyperkeratosis over the knuckles||Caused by boxing training|
|Russell sign||Callosities of the dorsum of the hand over the metacarpophalangeal and interphalangeal joints||Caused by the friction involved with self-induced emesis in bulimia nervosa|
|Screwdriver operator's clavus||Palmar surface of the hand||Occurs at the site of contact with a screwdriver handle|
|Spine bumps||Hyperkeratosis over the spinal column||Caused by dancing with spinning on one's back|
|Hairdresser's hand||First finger on dominant hand||Callus formation at the site of friction caused by scissors around the first finger on the dominant hand|
|Sucking calluses||Lip, hand, or foot of a newborn||Callus formation at the site of an area of suction on the lip, hand, or foot of a newborn|
|Vamp disease||Feet||Clavus formation due to wearing tight high-heeled shoes|