Clavus Treatment & Management

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

Medical Care

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).[33] Garlic extracts have also been described as being helpful.[34]
  • 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.[35] Intralesional triamcinolone and topical vitamin A acid compounds also may reduce localized hyperkeratosis. Triamcinolone can lead to localized hypopigmentation.[36]
  • A carbon dioxide laser can be used to pare deep lesions.[37]

Reduced friction may be accomplished with the use of silicone-lined sleeves on the toes, padding, and, in select cases, silicone[38] or collagen injections[3] over the bony prominence in question.

  • 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.[39]
  • Vacuum orthoses have been described to aid in lesional clearance for diabetic patients with plantar callosities.[40]
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Surgical Care

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.[41]
  • 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.[42] These procedures generally are performed on multiple joints simultaneously to prevent imbalances, which may be induced by single condylectomy. Induced imbalance causes transfer lesions, ie, clavus formation of a new site on the foot.
  • 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.[43]
  • 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.
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Consultations

  • 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.
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Diet

No special diet is required; however, weight loss relieves some of the foot pressures involved.

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Activity

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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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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