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Hi,

I recently had an eight year old girl as a patient with relatively severe callus fromation on both feet, in the regions of the 1st IPJ of the Hallux, 1st MPJ, 5th MPJ and around the heels. This is the first time I have ever seen so much callus in such a young person. She has been to other pods before and so far have just removed them every few months. This problem started about 2 years ago. Initially I assumed she must have some seriosly cavoid feet, but that is not the case. Can anyone offer some insight as to why this child would develop so much callus? or any other possible underlying conditions that could be causing this.

Cheers
Byron

 

Hi Byron,

Is there any thickening of the skin on her hands?

Also if you could attach any photos it may assist.

Many thanks,

Mandy.

 

Hi Byron,

I`m thinking along the same lines as Mand` here, is there any familial history of PPK? Did the parent provide type/timing of onset? Was the hyperkeratosis preceded by plantar/palmer erythema?

There are many classifications of PPK so a full medical hx is important here.

Photos would be fab!


Cheers,
Bel

 

Hi, Thanks for the reaponse, I thought of PPK as well, but there's no manifestation on the hands. I have seen 3 other much older patients with PPK and this appear similar at all. The parents said it started at around the age of 6, which is when she would have started going to primary school, and therefore started wearing the crappy school shoes that parents buy for their kids. So i think it may be related to footwear. Initially started on the left foot and then the right a few months later. they can't tell me much more than that. I'll be seeing the child in a few weeks again and will get some pics to post. I just don't this child to have be seeing a pod every 4-6 weeks for the rest of her life just to keep her comfortable.

Byron

 

If you have ruled out the unusual stuff, then lets try the most common reason for calluses on feet, the wrong or poorly fitted shoe.

The parents may have bought shoes too big for the child, too big does not just relate to length but also width, sadly a lot of the narrow fitting shoes are disappearing out of the market place as a broad fitting shoe will fit every foot:hammer:

Then there is the possibility that the child does not lace up/buckle up the shoe firmly enough.

Ask the client to come in dressed in there school shoes, this may help you.
Check the fit, both width and length, then check inside the shoe for the condition of the linings, are they lifting away from the upper or are they torn at all, a sure sign that the shoe is sliding around on the foot adding to the calluses.

Hope it helps

 

I have had a couple of children presenting in a similar fashion ie thick defined areas of callous only on the feet. In one case there was a positive family history also, with dad being similarly affected.
The consensus between myself the paediatrician and GP that it was PPK, and thus they are having regular debridement as well as orthoses to attempt offloading (clinically not very effective WRT callous, but overall pain levels reduced for the patients)