REVIEWS OF DR. SCHULER
Authored by Dr. Burton S. Schuler,
I wrote this article over 3 years ago but it still hold up very well. In fact most of it was written over 32 years ago in my first book The Agony of De-Feet, A Podiatrist guide to Foot Care.
Like Corns, a callus is a protective thickening of the skin created by Mother Nature, that develops as a result of abnormal recurrent friction and pressure. Most calluses are found on the ball of the foot, although they may form elsewhere including the heels.
Its job is to act as defense mechanism, to, insulate and protect the balls of the feet and other areas on the feet against the abnormal bony pressure put upon it.
Footwear is commonly blamed for the formation of calluses, but more often than not, the truth is calluses are most usually caused by a Morton’s Toe which affects how the bones in our forefoot are formed and how they bear our bodies’ weight. When one or more of these bones are misformed, other bones are then forced to bear an excessive amount of weight. Calluses are then formed to help these other bones support this excessive weight on the ball of the feet.
The patient will normal complain of a Burning Pain on the ball of the foot, a condition that has generally spanned anywhere from a few weeks, to a number of years. Or the patient might complaint that they have a “stone bruise type of feeling.” They will claim they think they have a pebble in their shoe. Such a sensation is common and is also commonly caused by a misalignment of the 2nd-5th metatarsal bones; and there may or may not be any sign of callus tissue. PLEASE NOTE!! CALLUSES ARE FREQUENTLY MISTAKEN FOR WARTS.
A week rarely passes when someone does not come into my office with a complaint that quickly tells me that they have misdiagnosed their condition. If a family physician has performed a little surgery on this area, the callous is usually compounded by the formation of scar tissues, and of course the patient is in considerable pain. It is not unusual for someone to tell me: “Doctor, I’ve had these warts on my feet for 30 years.” You can imagine how surprised they are when I tell them that they most probably never had warts and never suffered from warts. It takes a while for me persuade them, but once they had accepted the fact that the warts were indeed calluses, they were most eager to learn what could be done about them.
Like Corns, conservative therapy of callus is done by “trimming” the callus which only gives temporary relief and does nothing to effect the underlying bone problem. You see if you just trim the calluses away you are doing nothing about the real problem, and Mother Nature is adamant about providing her defenses. Remember you can’t fool her !
As always it is my philosophy that “foot surgery should be a last resort”. Because of that we have created a treatment protocol to treat this problem initially without the need of surgery.
We have learned that besides the callus there is almost always an associated Bursitis causing some of the pain, and an associated strain of many of the tiny muscles in the feet, especially on the ball of the feet. By using a great deal of Physical Therapy you can rehabilitate these painful areas. Besides that you must also take the strain off the front of the foot with proper padding and strapping. Finally once the patient is feeling better we fabricate an Orthotic which will rebalance the forefoot to its most ideal position.
In the rare case where these procedures don’t resolve the problem, we have available two minimal traumatic surgeries to help the condition. In order for you to understand the logic behind these surgeries you must sit through your first anatomy lesson. Here we go!
Once the metatarsal bones have fallen out of place, there is a certain amount of contracture or Hammering of the Toes to become tight or bulge. If the toes are pulled back, then chances are that the metatarsal heads are painfully depressed and that there is a burning sensation on the ball of the foot. The action between the toes and metatarsal heads are closely intertwined. You will see that this is so if you take your hand and push hard against the ball of your foot. This pressure, known as retrograde force, will cause your toes to come down, a condition that is more pronounced in cases where people have hammer toes. If the toes can be brought down to a normal position, this in turn will allow the metatarsal heads to pop up, thus taking the pressure off the ball of the foot.
When a person has a large diffused callus with burning (throughout the second and fifth metatarsal heads), we can alleviate his problem by performing a relatively simple but highly effective bit of ambulatory surgery. It involves putting a local anesthetic under the skin on top of the foot and releasing the abnormal pressure on the tight tendons (sometimes we also have to release the pressure at the joint capsule). Once this has been done, the toes will come down, which allows the metatarsal heads to come up, so that the foot may be more properly realigned. At this stage, Mother Nature once again steps in and attempts to reattach these tight tendons over a period of 3 to 6 months. The patient is given simple exercises to do to stretch out the tendons, and after the surgery, leaves the office wearing a bandage inside his shoe. While this is a highly effective procedure, it will not always get rid of the callus tissue that has formed and I never fail to make a point of this, although the patient rarely decides against the procedure on that account. What he will generally say is: “Look, I can live with a little callus tissue. It’s the pain I want to get rid of.”
Moving on to the second procedure, in cases of more severely depressed metatarsal bone, we begin by performing a minute incision into what’s called the neck of the metatarsal bone; with a side-cutting burr, we cut right across the neck of the metatarsal bone, allowing that part of the bone to move up and down; hence getting the pressure off of the ball of the foot. With the aid of a little local anesthetic, it is a quick, relatively painless procedure. Afterwards, we do not put a cast on the foot, do not insert wires or tell the patient that he will have to walk around on crutches. Rather, we encourage them, or even insist that he put his own shoe back on and walk around in it, which is the actual secret in achieving a rapid recovery. With only a minimum amount of discomfort, Mother Nature will take care of the situation in short order (usually six to eight weeks) and during that time, the patient is able to perform the vast majority of their normal activities. Of course, we do not mean to suggest that they should go dancing, skiing, or try to play tennis, golf or bowl, during this recuperative period since the bone is broken, but they are free to work or perform normal chores around the house, and may resume any normal, reasonable activity.
There are many highly successful non-surgical treatments for calluses that give long term relief by treating the abnormal bone pressure. Foot surgery for calluses is rare and should always be used as a last resort, but if needed, it is done using minimal incision techniques, in the comfort and privacy of our Clinic.