Clavus/Corn

BACKGROUND

A clavus is a thickening of the skin due to repeated pressure and frictional forces. These forces result in thickened skin. 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.

Synonyms for clavus include callus, a hyperkeratotic response to trauma; corn, heloma, or a circumscribed hyperkeratotic lesion they may be hard (i.e., heloma durum) or soft (i.e., heloma molle). Localized callosities of the soles, which do not resolve, are termed plantar callus, tyloma, keratoma, or plantar corn. When callosities occur over one or more lateral metatarsals, they are termed intractable plantar keratoses.

Clinically, all these lesions look like thickened skin. Plantar callus 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.

A FEW INTERESTING CALLUS/CLAVUS NAMES:

• 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 or cherry-pitting tools.

  the cost of viagra What makes it worse is that it is a legitimate lead. It viagra online in kanada is a member of PDE-5 vasodilators that provide the cure of ED in males. But you heed to take the medicine before the time and should complete the copulation best price for cialis in 4 hours. How does it act on the body? This product browse around this drugstore now cheap viagra is known for strengthening erectile power and it can improve sexual potency in men.

• Weight lifters callus – Callosities over the palmar metacarpophalangeal joints
  • Caused by the friction of weight-lifting apparatus
• Prayer callus – Callosity on the forehead
  • From kneeling prayer with the hands on the forehead
• Cigarette lighters 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 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, or a newborn

WHAT FACTORS PREDISPOSE TO CLAVUS

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 thickening.

Toe deformity, including contractures and claw, hammer, and mallet-shaped toes, may contribute to pathogenesis. Bunionettes, i.e., callosities over the lateral fifth metatarsal head, may be associated with neurotic 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.

Chronic or repetitive motion may also induce clavus formation, as is seen in computer users and text messengers (i.e. ‘mousing’ callus). Callosities can also form from excessive leg crossing.

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.

EFFIECTS OF CLAVUS

Extensive thickening of the skin may result in chronic pain, particularly in the forefoot; in certain situation, 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.

PHYSICAL

Clinically, all variants of clavus lesions look like hyperkeratotic or thick skin.

• Examination of patients should include assessment of the type(s) of footwear worn, activities performed, gait, and current home therapy, or previously prescribed therapy.

CAUSES

Some condition(s) associated with clavus formation:

• Advanced patient age
• Amputation
• Use of a brace
• Walking or posture impact
• Keratoderma palmaris et plantaris
• Obesity
• Sensory neuropathies
• Warts

TREATMENT

Medical care for 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.