painful callus or intractable plantar keratosisA special type of callus that forms in response to an area of high pressure, usually under the ball of foot, is called an Intractable Plantar Keratosis or IPK. Unlike regular calluses which may or may not be painful, IPKs are always very painful and can be difficult to treat.

What Are These Painful Calluses or IPKs?

Like all corns, IPKs are a collection of dead skin cells that harden overtime. It can feel like you’re walking on a pebble.

Causes and Risk Factors for Intractable Plantar Kerotosis

Causes and risk factors for IPKs include the following:

  • Faulty foot mechanics. Both high arches and flat feet can lead to this condition causing too much pressure on the ball of the foot. Painful corns or IPKs will develop in different locations based on the person’s foot type. People with high arches tend to develop them under the base of the 1st and 5th toes. Those with flat feet develop them at the base of the 2nd and 3rd toes.
  • Overpronation. Flat feet or low arches often lead to overpronation which places more pressure on the ball of the foot.
  • Certain foot conditions. Presence of hammertoe and big stiff toe (hallux rigidus) are often associated with development of this condition.
  • Tight calf muscles. Tight calf muscles can also cause more pressure on the ball of the foot when walking or running.
  • Older adults. The natural fat pad of the foot gets thinner with age and can put a person at greater risk for painful corns.
  • Wearing high heels. High heel wear can also place more pressure on the ball of the foot.

Treating Painful Calluses or IPKs

Treatment of painful calluses is three-fold: getting rid of the callus, treating faulty foot mechanics, and addressing other foot problems such as hammertoe and big stiff toe or hallux rigidus.

Getting Rid of Painful Calluses

In the past, IPKs or painful calluses have been treated in a similar fashion to regular calluses. The thick layer of skin is removed and that’s followed by use of salicylic acid. Patients are given urea to apply at home and are told to debride the area with a nail file or pumice stone.

Fortunately, now our office uses Swift, a new immune therapy for warts that also shows promise in treating intractable plantar kerotosis.

Treating Faulty Foot Mechanics

After removal of the painful callus, it’s essential to treat your faulty foot mechanics to prevent it from coming back. The following modalities are useful tackling this issue.

  • Padding. Can take pressure off the base of the toe wear the callus develops.
  • Orthotics. Custom orthotics with a metatarsal pad can help rebalance flat feet and a high arched foot. This will help prevent overpronation and take pressure off the ball of the foot.
  • Stretching. Many people with flat feet have tight calf muscles. An aggressive stretching program using an Achilles splint is highly recommended.
  • Proper footwear.
    • Avoid wearing high heels. Buy shoes with heels that are 1 inch or less in height.
    • Wear supportive shoes to prevent pronation.
    • Buy shoes with a wider toe box to help reduce pressure on the ball of the foot.

Addressing Other Foot Problems

As mentioned above if a patient with IPK has a hammertoe or big stiff toe, these conditions will need to be addressed to prevent the painful callus from coming back. Both of these conditions can be treated conservatively but sometimes surgery may be needed.

If you think you have painful calluses, give our office a call at 206-368-7000 or request an appointment online.

Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.