Changes to the integrity, thickness, or appearance of the skin on the bottom of our feet can make it difficult to stay comfortable throughout the day and can lead to many uncomfortable or painful problems, including corns, calluses, cracked heels, and tinea pedis (athlete’s foot).
Experiencing problems with or changes to the skin on our feet can quickly make life much less comfortable. Many patients liken having corns or thick areas of callus to constantly walking over a painful pebble in their shoe. At the same time, cracked heels can easily catch on hosiery, and an athlete’s foot infection can leave our feet and toes feeling itchy and tingly. While it may seem like a minor or superficial issue compared to muscle or tendon injuries, many people will actually adjust their gait to try to avoid the uncomfortable area of pain, leaving them walking more on the outside border of the foot if they’re having pain from a corn beneath the big toe joint, or placing more pressure on the forefoot if their heel cracks are causing pain. We often see this lead to a range of other pains or concerns.
Here at PhysioCentral, our podiatrists understand how disruptive and frustrating even a seemingly small skin problem can be. We take your concerns and symptoms very seriously and work to help you return to walking comfortably, confidently, and without pain.
Podiatry Skin Problems
When treating skin problems that affect the feet, here are some of the top complaints we treat, what they are, and how they’re caused.
Corns
A corn is a small, defined area of thickened skin that appears circular when looking down at the foot, but then extends into the deeper layers of the skin in a cone-shaped manner. Corns are caused by excess focal pressure to an area, and can range from 2mm to 20mm in size. There are three main types of corns:
- Hard corns: medically known as heloma durum, hard corns have a firm, pale yellow core and tend to present on weight-bearing areas of the foot such as at the heels, the ball of the foot, the bottom of the toes, or on the tips of the toes from pressing against the ends of the shoes. While the corn itself is made of ‘dead’ skin that is not painful itself, it is the pressure that is applied to the surrounding delicate tissues that can make this corn so sore and uncomfortable.
- Soft corns: medically known as heloma molle, soft corns are typically present on non-weight-bearing areas of the foot, like between the toes. Like their name suggests, they are much softer than hard corns, and appear more white with an indent often noted in their centre. Their softer nature comes from absorbing moisture into the skin, which may occur from excess sweat in the feet or not drying well between the toes after a shower, especially if the toes are close together and trap’ moisture.
- Neurovascular corns: neurovascular corns more closely resemble hard corns than soft corns, but with a key difference of being notably more painful while featuring nerve fibres and blood vessels within the corn. This gives the corn much greater sensitivity, while also meaning that the corn may bleed when removed, something that does not typically occur with a regular corn. Interestingly, these types of corns have a greater prevalence in smokers.
Callus
A callus is a patch of thickened skin often found on the bottom of the foot, most often beneath the heels, the balls of the feet, or around the toes. Calluses develop as part of a natural process by which your body attempts to protect your healthy skin when exposed to repeated pressure and friction. By thickening over time, the risk of the friction causing a ‘break’ in the skin - and leaving your body vulnerable to infection - is minimised.
Unfortunately, once the callus builds up to a certain thickness, it can become uncomfortable and even painful, placing greater pressure on the tissues, joints and bones beneath it. It can also make fitting shoes less comfortable.
Callus is dead skin with no nerve endings or blood supply, so removing it is typically painless - much like cutting your hair. Unlike hard corns (above), where the thick layer of dead skin is pinpointed to a specific small area and extends into the skin layers, callus remains superficial and can cover a large area - like the entire heel. Developing calluses over the heels is also the first stage in getting cracked heels.
Cracked Heels (Fissures)
Cracked heels tend to form when the skin around the heels builds up with calluses and then dries out, making the skin rigid, inflexible, and vulnerable to cracking when pressure from something as simple as walking is applied.
While many people consider cracks in the heels to be an inconvenience that can get caught on socks and hosiery due to the dry skin ridges, having these cracks can also put your feet at risk. This is because the cracks can extend past the outer dry layer of skin and into the healthy skin beneath, leading to pain, bleeding, and, if not managed, creating a potential source of infection.
Athlete’s Foot
Medically known as tinea pedis, athlete’s foot is a fungal skin infection that occurs on the bottom of the feet and between the toes. It affects the superficial (outer) skin layer and causes itching, blistering, scaling plaques, and cracks in the skin, which can become painful and inflamed.
The name ‘Athlete’s foot’ was coined from an increased prevalence of this condition in athletes. This is because regular use of enclosed shoes that can become hot and sweaty during exercise is the ideal environment for fungus to thrive. Athlete’s foot can affect anyone that comes in contact with the fungus, even if they rarely exercise.
Anhidrosis and Hyperhidrosis
Anhidrosis in podiatry is the clinical name for having dry skin on your feet. Your feet do not contain any oil glands to keep them moisturised and instead rely on the sweat glands to do the job. Hence, if the ability to sweat from the feet is reduced, it can lead to the skin becoming dry and inelastic, and it may be more likely to develop cracks in the heels. Dry skin can be caused by taking very hot baths or showers, repeatedly wearing open-backed shoes, skin damage from burns, nerve damage such as from diabetes, and having other medical conditions.
Hyperhidrosis is the opposite of anhidrosis, describing a situation where the feet sweat excessively. While the cause of hyperhidrosis is not well understood, it is more common in men and young adults. Excessive foot sweating can cause the skin to take on too much moisture and macerate, making it vulnerable to breaking down and picking up foot infections. It can also cause feet to slip and slide in shoes, emit an unpleasant foot odour, and can be emotionally stressful.
Treating Skin Problems At Home
Managing skin problems at home is done by helping maintain the integrity of the skin and relieving pressure away from painful areas where corns or calluses may be present. This can help maximise your comfort on your feet until you can book in with your podiatrist.
- Moisturise your feet daily (avoiding the areas between the toes) unless you have hyperhidrosis. In which case, ensure you wear socks that wick moisture away from the feet
- Dry your feet thoroughly after showering or swimming, including between the toes.
- Avoid firm, unsupportive shoes that increase the pressure on the bottom of your feet. Instead, opt for supportive shoes that have a good fit and do not rub against the feet.
- Soak your feet in warm, soapy water for 20 minutes to help soften the skin
- In case the cause of your skin symptoms is contagious (as in fungal skin infections), avoid direct contact with others, including sharing socks, shoes, bath mats and towels
We strongly discourage using corn pads. This is because corn pads typically contain an acid or other solution that is designed to act on the dead skin of the corn, however, the acid cannot differentiate between the skin of the corn and the healthy skin surrounding the corn. This has led to many people coming in with significant foot pain and skin damage as a result of the corn pad damaging their healthy skin. And to a much more painful level than their original discomfort was causing them. Corns should only be removed (enucleated) by your podiatrist.
Podiatry Treatment For Skin Problems Of The Feet
Your podiatrist appointment starts with a comprehensive assessment to understand how your skin has been affected, what has caused it, and why you’re experiencing the symptoms that you are. Once we know this, we’ll put together an evidence-based management plan that helps you get the best outcome for your feet. This may involve:
- Removing corns: using a small scalpel, we will scoop out (enucleate) corns without damaging the surrounding skin to give you instant relief and greater comfort on your feet.
- Debriding calluses: we use a scalpel initially to reduce the thickness of your calluses, whether present over just a small section of the foot, or cover the entire heel or ball of the foot, for example. As the skin naturally thickens for protection, we will leave behind just the right amount to still offer your feet some protection while relieving your discomfort. We’ll also use a sanding disc to leave you with smooth skin so it feels nice to the touch.
- Reducing cracked heels: using a scalpel, we’ll reduce the cracks in your heels and use a sanding disc to leave the skin nice and smooth. Depending on the thickness of the skin and the cracks, this may remove the cracks entirely, or for deeper fissures, may leave them in a more manageable and comfortable state while reducing the risk of them cracking deeper.
- Anti-fungal care: if we identify that you likely have a fungal skin infection, we will recommend the best anti-fungal products to use, such as creams and sprays
- Footwear advice: we’ll help ensure your footwear is helping keep you comfortable and promoting your skin health, not placing undue pressure on your feet to worsen the problem
- Product advice: there may be other products you can use to best support your skin health, such as a urea-based moisturising cream. We’ll discuss this with you during your appointment and let you know if any products may be able to help.
In some cases, foot concerns like corns and calluses may result from how your feet are loaded in everyday life due to excess pressure over the feet. We have other solutions to help with this, such as using foot orthotics to bring back a more even and better aligned weight and loading distribution over the feet as you walk. For many people, this can go a long way in helping prevent their corns and calluses from returning (and hence the maintenance associated with this) or at least reduce the speed at which they return. This is another factor your podiatrist will consider and discuss with you at your appointment.
You can book your appointment with our podiatry team online here, or you can speak to our reception team by calling +852 2801 4801.