Question
QUESTION: Dear Dr. Bodart, I'm 63 and walk almost everyday for 45 minutes. I have had several pairs of either walking or running shoes, and they are comfortable and I believe fit fine. But on the outside of both large toes, I develop a callous that gets more and more elevated and starts hurting from pressure. I read that some runners get this, not just walkers, and some have said they go to the Dr. and have them shaved down. I may not be recommended, but I usually cut off a good part of it, trying not to cut too deep, and file it down until it's almost flat and that worked ok. But lately they have come back more quickly (couple weeks) and seem to hurt more when they do, more than they did before.
I really don't think it's due to bad fitting shoes, happens with all of them. What could a podiatrist do, other than either shave them down, only to have them come back again? Would trying to keep them soft with a cream help? Any advice is appreciated, thanks.

ANSWER: Hi, Lee,

Sorry to hear of your difficulty with those painful calluses.  You're right; I cringe when I hear patients talk about cutting their own calluses (or as we call it, doing "bathroom surgery").  It's hard to know how deep is too deep, and I've had several patients come to the office with large gashes in their feet.

Calluses form because of abnormal pressure on a certain area.  It's your body's way of protecting itself, because if you hit an area of skin over and over again, or put too much pressure on it, that closes off blood vessels and that part of skin dies.  The open wound where the skin is gone is called an ulcer.  So in order to prevent this from happening, your body builds up extra skin to try to protect itself.  The problem is that once your body starts doing this, it continues every time you take a step, or do something that creates pressure on the area.  The thickened skin can then lead to pain or at least discomfort, because it ends up getting bigger and putting more pressure on itself.

Yes, a podiatrist can cut off the dead skin so that you feel more comfortable.  But much more than that, the podiatrist can ask questions and examine your feet to figure out why you're getting those calluses in the first place, and then find ways to prevent them from coming back.  My suspicion is that when you walk, something is forcing you to put extra weight on those parts of your toes.  It could be that your big toe joint doesn't flex as much as it's supposed to, or there could be other biomechanical issues.  We are trained to figure out what those issues are, and to find ways to correct them.  You might need a supportive pair of inserts or orthotics to help align your foot and distribute weight more evenly.  Or maybe something else can be done to keep them from returning too quickly.

You can also help your feet by using a pumice stone every day after taking a bath or a shower.  That's when the skin is softest and the calluses are easiest to remove.  Just rub the areas that are getting calluses in order to prevent them from coming back so soon.

I hope this answers your questions.  Thank you for taking the time to write, and feel free to respond if you have any additional questions you would like me to address.

Wishing you health, happiness, and peace,
Dr. Bodart

---------- FOLLOW-UP ----------

QUESTION: Sorry, one question just came to me. I've been using either a nail file or emery board to file down the calluses. Is there an advantage to using a pumice stone?

Answer
Hi, Lee,

Any of those three would work.  A nail file that is made of metal could do a lot more damage if pressed too hard and can cut the skin more easily than a pumice stone or emery board, but using too much pressure with any of them can cause damage.  I'm glad to hear that you're using those tools and not something extremely sharp!  I wasn't sure what you used to work on your feet.  :-)  Thanks again for writing.

Wishing you health, happiness, and peace,
Dr. Bodart