As a podiatrist, I get this question a lot. Many patients develop foot calluses for a variety of reasons, and the most common is age-related loss of fat padding on the bottom of the foot. With every step, the bones of the metatarsal head hit the ground, and our natural fat padding assists in absorbing those shocks. As we age, the fat pad quality decreases or shifts away from this high-pressure point, causing what feels like literal skin and bones with each step. With less fat padding (fat atrophy), there is less shock absorption and so the body protects itself by growing a thick callus and you may experience pain with every step. Over time, these calluses can damage healthy skin underneath. Worst-case scenario, this becomes an open ulcer and can lead to infection and amputation in the most vulnerable including those with circulation disorders or diabetes. Professional maintenance is key in treating and preventing foot calluses.
Early treatments include proper shoe wear and safe pedicures to keep the skin thickness under control. However, even with medical pedicures, calluses do come back as quickly as every few weeks. So patients often ask, is there anything else that can provide longer pain relief from callus pain?
I am a fan of medical pedicures because this is the easiest to access. Gentle exfoliation of dead skin can decrease the thickness of developing calluses. This can be done with a sugar scrub or emery board designed specifically for the foot. Be aware that sharp blades and mechanical tools should only be used by a medical professional to avoid accidental cuts that can lead to an infection.
Next, I recommend sticky pads that have a cut-out window to off-load the pressure point. I love using U-pads made of felt between ⅛” to ¼” thickness to alleviate pressure points, particularly at the ball of the foot. Eventually, the pads need to be replaced, so having custom-fitted orthotics would be the next consideration. This is very different from inserts purchased from the store. The podiatrist evaluates your feet and your walking pattern to determine the right kind of prescription for your foot pain.
What is also important to know are nontraditional treatments options such as foot fillers that are injected under the callus to decrease pain with walking. There are fat allografts and dermal fillers like hyaluronic acid to increase cushion in the foot. This treatment can last longer than shaving the callus. Touch-ups may be necessary depending on the person’s activity level.
A podiatrist who specializes in minimally invasive options, like myself, is who you should consider learning more about these nontraditional treatment options. Steroid injections should be avoided in these areas since they only cover up the pain rather than addressing the biomechanical issue causing the pain. Steroids can also lead to thinning of the fat pad as well with long-term use. Dermal fillers or fat allograft injections for the foot are not covered by insurance but are an affordable option for longer pain relief short of surgery.
Lastly, long-term benefits are seen with minimally invasive surgery. This is different from traditional surgery in that the incision is only 3mm long and no hardware or hospitalization is required. Patients are able to walk sooner with minimal downtime. Minimally invasive surgery decreases the risks typically associated with traditional surgery such as infection, hardware rejection, and painful scars. As with any surgery, risks and benefits must be weighed before going under the knife so consult with a minimally invasive foot specialist for options.