Elsevier

The Foot

Volume 13, Issue 1, March 2003, Pages 5-9
The Foot

Epidemiology of plantar forefoot corns and callus, and the influence of dominant side

https://doi.org/10.1016/S0958-2592(02)00112-8Get rights and content

Abstract

Corns and callus are frequent complaints but detailed epidemiological information is lacking. Three surveys were undertaken; one of an employed group and two surveys, 5 years apart, of podiatry patients to identify plantar callus incidence and any change in the population with time. The influence of dominant side on gait and callus formation was studied using the Kistler force plate.

A minimum of 18% of a working population appear to have suffered at some stage with plantar callus, and the mode ages of onset was years with increased frequency in women. Callus formation develops uni- or bilaterally regardless of side of dominance (P>0.05). There was no significant difference between dominant side and duration of foot loading times (P>0.05). The magnitude of vertical loading in left and right dominance showed good correlation between left and right side (r=0.91), also suggesting that dominant side does not influence this gait parameter.

Introduction

When humans move around, the whole of the body’s weight is placed on the feet and each foot in turn will take the entire load during the gait cycle. When there is an increase in duration and magnitude of mechanical stress of plantar skin, it may respond by developing conditions which include blistering, fissures, corns and callus (callosity, mechanically induced hyperkeratosis, callus plaque) [1], [2], [3], particularly when the foot functions abnormally. If a medical disorder is present and the skin is over-stressed then ulcers may form [4], [5], [6]. Pain from corns and calluses may cause development of an antalgic gait and consequent over-stressing of other body segments leading to knee, hip and low back pain. Increased incidence of foot problems [7], and reduced mobility in the elderly due to painful feet is well documented [8], but corns and callus can also develop in the active [9] and middle-aged population [10]. The minor skin complaint of having painful corns and calluses can therefore be seen to have important repercussions in the well-being and mobility of the mid- and old-age population. Popular demand for foot care products is sufficient that a number of pharmaceutical companies supply retail outlets with a suitable range of products, which also intimates these conditions are common and people require treatment for them.

The incidence of callus plaques at different sites of the foot often provides an indicator of the locomotor biomechanical abnormality which is associated with their formation [11], [12]. The hyperkeratotic tissue which develops, in response to the increased duration of loading time [13] and excess mechanical stress, is often hard and non-pliable. These factors may in part be responsible for the pain of which people complain. Corns, classically inverted cones of hyperkeratinised, parakeratotic tissue often cause sharp pain. However, the prevalence of corns and callus in the general population is not well known and there is limited information on the influence of dominant side and its effect on foot loading and the development of callus and corns.

Gait parameters may be influenced by dominant side and thus the site of development of mechanically induced hyperkeratotic lesions may be similarly affected. Changes in gait with increasing age have been reported [14], and control of posture also deteriorates with age, particularly if concurrent tasks are undertaken [15]. Sensory information received by the central nervous system about the changing environment is usually in accord; when in conflict, however, this is always resolved in favour of vision [16]. Right side dominant, sighted people have a tendency to lean towards their right side so invariably in right side dominance, it is the left eye which is dominant for verticality and posture position perception [17]. It is thought that the lean towards the right brings the dominant left eye more in-line with the body’s centre of pressure. This may cause increased loading of one side and asymmetrical acceleration and deceleration demands during gait [18]. Long term asymmetry of this nature may cause chronic minor changes manifesting, for example, in corns and calluses on the feet.

Given limited information about callus or corn incidence, and influence of dominant side, two areas of study were undertaken. The first area consisted of three surveys of plantar corn and callus incidence, and the second was gait analysis relating to callus formation and the influence of dominant side (laterality, preferred side, motor dominance). The first of the surveys involved employees of a large organisation in SE England and aimed to establish the distribution of plantar callus and corns within a sample of the working population. This was followed by two other surveys, five years apart, on the incidence of these lesions among people who were referred to the Division of Podiatry, University of Brighton. These surveys also aimed to identify any change in the population with time, mode age at which treatment was sought and to establish the influence of dominant side on foot loading.

Section snippets

Instrumentation

Kistler force plate (Kistler, Instrumente AG, Winterthal, Switzerland) measurement parameters set at 1 ms sampling intervals for 1 min, Fx=Fy=500 N and Fz=1000 N.

Lesion measurement

The margin between normal skin and callus was clinically assessed (transition between pinkish normal skin and yellowish callus plaque) and the lesion measured across its diameter using a rule. Repeatability of this measurement was demonstrated to be good (P<0.01) both photographically, and using blinded clinical measurements.

Participants

In the first

Results

There was a 27% (n=499) response rate to the questionnaire. Of these respondents, 34.5% (172) had never had plantar forefoot corns or calluses, and all were aged 16–24 years. The 327 respondents who were currently suffering, or had plantar forefoot corns or callus lesions in the past, comprised 18% of the total number of employees (n=1800) in the organisation (and 65.5% of the questionnaire respondents). The ratio for callus formation was one male to four females.

Of the 125 people who agreed to

Discussion

The number of employees surveyed (response rate: 27%) who complained of current or past corns and/or plantar forefoot calluses is quite large when compared with the number of people who suffer with cutaneous conditions such as psoriasis (2%, [20]). Eighteen percent (n=327) of the employees complained of corns and calluses at some stage in their working lives. This figure is confirmed by inference in the number of people who seek treatment either with over the counter remedies (such as salicylic

Conclusion

Corns and calluses may be symptomatic in as many as 18% of a working population with mode age of symptomatic onset towards the end of working life. Women suffered with corns and callus more frequently than men. Dominant side and variation in vertical loading does not appear to be an influential aetiology in the formation of plantar forefoot corns and callus.

Acknowledgements

Acknowledgements to Scholl R&D (now SSL), UK, for part of this work.

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