Hyperkeratotic Pathology of the Plantar Foot

Surgical management of Diffuse intractable plantar keratoses

2. KERATOTIC DEFORMITIES OF THE LESSER TOES

• considerations

Transfer of load laterally from 1^st ray can occur in disorders of the 1^st ray such as hallux valgus or instability of first metatarsocuneiform joint. This can cause callus formation under 2^nd and 3^rd metatarsal heads where the tarso metatarsal joints are quite rigid. The 4^th and 5^th TMT joints are quite flexible so rarely get callus formation due to transfer from the first ray

Postures of the foot that can precipitate callus formation are

• Equinus deformity of ankle joint, causing increased forefoot loading
• Cavus foot, generally reduced weight bearing area therefore more pressur
• Flatfoot, if it produces a hallux valgus deformity, can cause callus over medial aspect of great toe at the IP joint
• Varus forefoot, with lateral border more plantar flexed than medial border causes callus of lateral side of foot
• Valgus deformity, opposite of above
• Abnormal alignment of MTP joints, eg subluxation or dislocation, causes plantarward force on metatarsal head and callus formation