plantar hyperkeratosis

plantar hyperkeratosis

physiological/pathological, focal/diffuse hypertrophy of plantar stratum corneum; formed in response to repetitive mechanical trauma or dermatopathology, e.g. keratoderma see Table 1
Table 1: Treatment regimes for hyperkeratoses
Treatment regimeComments
Physical removalCareful scalpel debridement of callosity and corn enucleation, to return the skin to normal texture for the site; the prime approach to callous reduction
Topical medicamentsPyrogallol plaster 20-40%, applied for 3 days to neurovascular corns
Wheatgerm and pyrogallol (WP) ointment, applied to deep painful corns, after enucleation, for a maximum of three applications
Salicylic acid 12% in collodion, to assist softening and subsequent scalpel removal of heavy plantar callosity
Dichloroacetic acid, applied after scalpel debridement of heavy callosity, forming a rubbery coagulum, itself debrided away 14-21 days later
Potassium hydroxide 5% solution applied to callosity and left in situ for 7 days to macerate
Urea cream 10% applied liberally each night to hyperkeratosis and seed corns associated with atrophic dry skin, and the feet wrapped in cling film (Seran) until morning
Astringents for hyperhidrosis
Antifungals for athlete's foot
Emollients for anhidrosis
40% Silver nitrate or 60% ferric chloride solution to reduce hypertrophied dermal papillae
Aluminium acetate (Burow's) solution or kaolin powder mixed to a paste in water as a compress to areas of inflammation
Thermal techniquesCryosurgery
Electrosurgery and hyfrecation
Clinical padding See Table 2
OrthosesTemporary (chairside) or permanent simple insoles or casted orthoses
AdviceOn general foot care, suitable shoe styles and hosiery, home treatments for associated conditions (such as fungal infections, hyperhidrosis, anhidrosis, emollients, as appropriate), return period and treatment frequency

Note: The treatment of hyperkeratotic lesions must reflect the patient's overall condition (general health, drug therapy, occupation, activities, age, genetic make-up, skin type), the mechanical deformation of the skin during movement, against resistance, local friction, pressure and shear stresses, and the rate of desquamation from the stratum corneum.

Table 2: Examples of clinical pads
Pad typeExamplesDescription
Digital padsPlantar bar/long propSCF pad formed to infill the plantar aspect of the shanks of lesser toes, in order to prevent/reduce overcontraction of one or more lesser toes
Dorsal barSCF pad formed to infill the dorsal aspects of one or more hammered or retracted lesser toes, to reduce trauma to the skin overlying the prominent interphalangeal joints
Dorsoplantar splintSCF pad made as a combination of the plantar and dorsal bars, to correct digital deformity/reduce trauma to the apices and dorsa of lesser toes
Interdigital wedgeSCF or foam (plain, cavitied or holed) pad formed to match the dimensions of the interdigital space to reduce reformation of an interdigital heloma molle
Dorsal proximal/distal/apical/interdigital crescentA crescent-shaped pad applied proximal/distal to the dorsal/apical/interdigital area of a hyperkeratotic lesion on a digit, to reduce local pressure and friction
Dorsal horseshoeA horseshoe-shaped pad, where the 'arms' of the horseshoe cover the dorsal aspects of toes adjacent to the digit affected by a corn, and the U acts in the same manner as a crescent pad to protect the lesion
Plantar metatarsal padsPlantar coverA pad that covers the plantar skin of the forefoot, from the webbing to a line approximately 1cm distal to the bases of the metatarsals
U'd plantar coverA plantar cover into which a U has been cut to deflect pressure away from a plantar lesion. The U may be infilled with cushioning material
Winged plantar coverA plantar cover into which semicircular cutouts have been made, to deflect pressure from the 1 and/or 5 MTPJs
Plantar metatarsal padA pad applied to the 2/3/4 metatarsals, the distal limit of which applies pressure to the 2/3/4 metatarsal heads so that the 2/3/4 MTPJs are extended and the 2/3/4 toes realigned into a more functional position; the pad will also reduce compression between adjacent metatarsal heads
Plantar barA pad similar to a plantar cover, the distal limit of which had been shaped to accommodate up to 5 U'd areas
Shaft pad/long shaft padA pad applied to an individual metatarsal to allow sagittal-plane realignment
OthersD filler
Valgus pad
A pad that is shaped to infill the plantar aspect of the medial longitudinal arch to reduce excessive pronation or ease the pain of foot strain
Hallux valgus ovalAn oval pad, with or without a central cavity or hole, that is applied to the medial aspect of the 1 MTPJ to reduce local shear stresses in cases of HAV
Heel padA pad shaped to the plantar aspect of the heel, to cushion or reduce pressure to a plantar bursitis or heel spur
Posterior heel padA pad designed to deflect pressure from the posterior lateral area of the heel, in cases with Haglund's deformity
Doughnut pad
Ring pad
Oval pad
A circular pad with a central cavity or hole applied to the plantar aspect of the heel to protect the point of insertion of the plantar fascia
Cobra padA pad that combines a medial heel wedge, a valgus filler and a medial forefoot pad, to reduce excess foot pronation
Dumbbell padA pad that combines the action of a shaft pad to dorsiflex an individual metatarsal head, and an interdigital wedge, to reduce friction and pressure at the depth of the interdigital sulcus
Achilles tendon padA pad applied to the posterior aspect of the heel, to reduce pressure and friction at the insertion of the tendo Achilles

SCF, semicompressed felt; MTPJ, metatarsophalangeal joint; HAV, hallux abductovalgus.

References in periodicals archive ?
Conclusion: Skin tag, plantar hyperkeratosis, fungal infections, striae and acanthosis nigricans were found to be the most common skin diseases in obese patients in our study.
Psoriasis, plantar hyperkeratosis, tinea pedis, and fungal and bacterial infections also have been linked with obesity, Dr.