Calluses (Keratoderma)

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 CALLUSES


Some PCers prefer their nails and keratoderma softened before trimming, whereas 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.

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.

 

PATIENT TIPS & COMMENTS FOR CALLUSES


K16 patient: “I 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, 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 always wake 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 with 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. It takes a day to recover, but otherwise I lead a 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 (because it becomes far too sensitive). I think it needs to be explained 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, and there is much less pain.”

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: “I soak in salt water, nay temperature when my feet ache (usually hot weather).”

Cx30 patient: “I soak my feet in warm water to soften the skin before trimming.”

K6a patient: “I soak my feet 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 I 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 softens nails so holes form spontaneously — this is the best outcome. Soaking also relieves symptoms without needing antibiotics or lancing.”

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.”

K6a patient: “I sleep with my feet sticking out of bed and the air conditioner in my bedroom or a window open in winter. Also, running cold water over the feet is a good calm down cure.”

K6a patient: “It is painful to stand on flat, hard surfaces barefoot. When showering, I use a rubber thing to stand on so I’m not standing on flat tiles. The thing is sort of rolled up and you can balance it under the arches of your feet. At hotels, I roll up a bath mat and stand on it in the shower. I can’t walk on flat surfaces with bare feet, but carpet is okay.”

K6a patient: “I use a shower bench when I shower.”

K16 patient: “As I live in the UK and the weather is quite cool most of the time, I think I get an easier time of it generally. If I go on holiday/vacation to somewhere hotter — in southern Europe — then the pain instantly increases. I can fly from the UK with a very small amount of pain, and by the time I step off the plane at the other end, the pain has increased so much that I almost want to turn around and come back — in fact, usually by the time we have been through customs and baggage claim, I am having trouble walking at all. I usually then spend the whole of the holiday restricted to the hotel and the pool because to walk anywhere is awful. But as I enjoy laying in the sun and swimming then I guess it’s not all bad! One bad thing I do while on holiday is not drink much water during the day. Because of the pain of walking, I don’t want to have to get up and have to walk to the toilets. That is not good in a hot climate! Anyway, this is how badly the heat affects my feet, I have no idea how those of you who live in hotter areas cope with everyday life. We were planning to move abroad, but have decided that my quality of life will be far better in the cooler UK. I hang my feet out of the bed at night — it helps to keep them cool but I also get a bit of pain resting them on the mattress and the weight of the duvet hurts a bit too. It is just more comfortable for me all around. I would rather have cold feet than wear bed socks because they are far too itchy for me. Also, wearing bags on the feet at night (if I have used any special creams) makes them itch badly too.”

K16 patient: “I trim every 2-3 weeks. Try to taper the PC to the skin. Unlace to boot or shoe to air or cool foot off. I use the air hose (air compressor?) to blow into the boot and cool and refresh the foot.”

K6a patient: “I see the podiatrist every 2 weeks (for hands too). I soak in whirlpool with cup of soap softener at 115 degrees for 20 minutes.”

??? patient: “I try my best to keep it from getting really dried out and hard. I pare the callous once a week also. As for pain management, I use cannabis. Nothing else I have ever tried (and I have tried) takes the pain down to a bearable level.”

K6a patient: “When my feet itch really badly, I use Lidocaine Ointment USP 5%. But don’t get it from a store, have your doctor prescribe it for you.”

Details

Category: Pachyonychia Congenita