Keratoderma is the medical term used to describe thick calluses on the bottom of the feet and on the palms of the hands. Recently, scientists have shown that there are blisters under the PC callus which cause exquisite pain for patients. As with all PC conditions, patients' experiences with keratoderma and plantar pain vary widely. The techniques that PC patients use to manage their pain also vary. The PC Wiki is a collection of tips and techniques where patients can share what they find works best.
Caring for Callus
Trimming and Filing (Debridement)
Debridement refers to removal of overgrown callus
Callus Removal by Professionals
K16 patient "Have had the hard skin on the soles of my feet shaved down by a doctor to the 'normal' skin, several times now. This is quite beneficial as although the skin grows back the blood vessels which grow within the skin tend to stay away for a year or two, making shaving the skin so much easier and less painful. I am currently enjoying a good couple of months on the pain front as they were last done 3 months ago. After surgery to have the skin shaved I have always woken from the anesthetic literally shouting in pain (feels like feet are in an ever tightening vice!) until large amounts of morphine are then given. However, last time I had it done I made it very very clear to the anesthetist how painful this procedure was and he made sure he gave me morphine before I woke up and I was fine, a small amount of manageable pain. Again this pain goes very quickly, within a few hours and then codeine or paracetamol is sufficient. I have always been able to walk the day after or 2 days after the surgery, with crutches for a few days, and then alone."
K6a patient " Hands and feet are debrided every 2 weeks under a physician's care. Takes a day to recover, but otherwise leads normal active life."
K16 patient "At the moment I can cut my skin quite low as I had an operation to remove all the callous in January. For a while after having this done the skin is not so 'wet' underneath and also not so sensitive and the blood vessels do not start to grow back into the callous for ages if you can keep the skin low. I have had a podiatrist take the skin too low before now and I have then had problems walking (just makes it far too sensitive). I think it needs explaining to them that getting the skin as low as possible is not always the best thing for PCers, it makes the pain worse, not better. I guess because they have been taught to remove as much callous as possible from all patients then they feel this is what is best for everyone. I tell them to stop when I feel it is low enough, sometimes they protest but hey....they are my feet! I find the best thing for me is to trim them once a fortnight, any longer than that and the pain can get worse, or more frequently than that and they can get too sensitive. A podiatrist once told me that it is better to rest your feet for a day after they have been trimmed to give them a chance to 'heal'. I find it really helps to do that if possible, much less pain."
Callus Removal at Home
PC patients use a variety of knives, files, and other tools to trim down their calluses. See the following pages for comments and links to products that other PCers have used.
Some PCers prefer their nails and keratoderma softened before trimming, others prefer only nails softened before trimming and some prefer both not softened. Some PCers prefer to soak 20 minutes to 2 hours before trimming, others prefer to apply creams or ointments and some like to do both. Whether or not to soften the keratoderma before trimming is an individual decision.
Preventing infections: Add 1 capful of bleach (unscented, plain household bleach) into 1 gallon of water then soak. This kills yeast which causes fungus and virus; it is powerful. Use a fresh batch each time as it loses potency if stored. Rinse after using. Apply Vaseline while still wet.
K16 patient "I cut them without soaking them because it allows me to judge better how thick they really are and I don't cut myself. When you soak them, the calluses soften making them easier to cut. The downside of soaking the callus is the color of the callus lightens and makes it difficult to judge how thick they are and I feel you are more likely to cut yourself beneath the surface of the callus, which can be dangerous."
K6a patient "Soak in salt water, nay temperature before trimming."
Cx30 patient "Soak feet in warm water to soften the skin before trimming."
K6a patient "Soak in cold water for pain, but cannot walk after soak, but my feet will feel better the next day."
K6a patient "I file them down without soaking. If soaked before filing they become gooey, and very painful."
K6a patient "If the nail area starts to get red, soak it in warm, salty water or warm solution of Epsom Salts as often as possible. Sometimes prolonged soaking soften nails so hole forms spontaneously - the best outcome. Soaking also relieves symptoms without needing antibiotics or lancing."
Note: Soaking with baking soda has also been suggested as its purpose is to slowly loosen the attachments between the cells in the stratum corneum so that over time they will be shed more easily. It should make this happen by raising the pH.
K6a patient "I tried soaking one foot with baking soda and at first I noticed a little difference, but then didn't seem to be making a difference. When it comes to having to debris my hands and feet, they need to be as soft as possible (for me), which the baking soda wasn't accomplishing as quickly as needed."
Topical care products
PC patients have experimented with a wide variety of topical (surface) treatments for softening and moisturizing callouses. These topical treatments come in the form of creams, gels, ointments, and other products. None of these products completely eliminates callouses, but many have been found to be helpful.
Caring for blisters
A Physician's Comments on Blisters
K6a patient "My daughter has had thick callouses that we have managed to shave down with a callous remover and she does not really complain that it hurts. However, recently, she developed a blister on the bottom of her foot on top of a creased area. She has complained that it hurts but limits her complaining because of her fear of me touching it to do something about it. It's right smack on the bottom of her foot and I see her limping sometimes. In my past experience, early on, when she had other blisters I would pop them with a pin and let them dry out. In this case, she won't let me near it because it hurts and no way she will let me pop it. Any recommendations as to what I should do?"
This email from Dr. Sancy Leachman, MD, PhD was directed to the parent's question above in helping a young child with a painful blister, but it has good information for all ages on blister care.
"Relieving the pressure of the blister (i.e. letting the fluid out) while leaving the roof of the blister intact to help with healing will reduce the pain significantly. You can begin to train children at a fairly early age (4 to 6 years) to do the popping. Remember to always use a clean/sterile needle or clipper. Each child is different and as a parent you will know best whether the child is ready to learn to do this. I think you will find the child trusts their own ability with the needle more than trusting you to make the cut. Sometimes you need to open a little window in the blister in order for the fluid to keep draining - otherwise with just a pin, it closes back up again. The roof of the blister is not innervated - it doesn't have any living nerves in it. The nerves are in the skin below -- that is what is so tender -- so poking a hole in the blister shouldn't hurt too much. A child won't believe you without testing it. The other thing that might help is to soak the blister before pricking or cutting it to soften it - the downside of that is that if it doesn't get drained, it might make it more painful and more swollen. You can always visit a dermatologist or pediatrician who will restrain the child, but frankly, I think that is probably more traumatic and would not be worth the pain relief. The major thing to watch for when a blister is really tender is to assure that there is no element of infection. If a red streak is coming out from it, if fever, chills start, or if the child starts acting irritable, you need to see a doctor quickly because it suggests that the infection has spread into the system and can be quite serious. I hope this is helpful." (May 2009)
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