Intractable Plantar Keratosis Clinical Presentation

Updated: Sep 29, 2022
  • Author: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS; Chief Editor: Thomas M DeBerardino, MD, FAAOS, FAOA  more...
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The patient with intractable plantar keratosis (IPK) reports pain in the plantar aspect of the forefoot, which is aggravated by weightbearing. Pain is exacerbated when the individual is barefoot; for instance, Thai monks who walk barefoot have more foot problems (including IPK) than those who work with shoes. [28]  Patients often report a sensation similar to walking on a marble. Most have had this lesion for many years and have tried various home remedies. Sometimes, patients provide a confusing history of a possible foreign-body lesion or of having warts.


Physical Examination

On physical examination, the IPK typically appears in one of two presentations. A focused, discrete IPK is the more common presentation and is seen directly overlying a bony prominence. This lesion is approximately 1 cm, with a hyperkeratotic rim and a painful, white center core. There is rarely any erythema, edema, or suspicion of infection. This lesion occurs as an isolated IPK or as several discrete, isolated IPKs.

The other, less common presentation is a more diffuse buildup of keratotic tissue, called a diffuse IPK or tyloma. This frequently is seen spanning across the plantar aspect of several metatarsal heads and does not have the focused central core. Cysts can arise in IPK or can even cause [5] other related conditions, such as plantar fasciitis. [29]