Synopsis
Classify flexible and fixed lesser-toe deformity, treat callus as evidence of pressure rather than a skin diagnosis alone, identify neuropathy and ischaemia, and combine footwear, podiatry, orthoses and surgery without creating ulcer risk.
- Classify the deformity precisely: hammer toe mainly flexes at the proximal interphalangeal joint, mallet toe at the distal joint, and claw toe combines metatarsophalangeal hyperextension with both interphalangeal joints flexed.
- Test flexibility with the ankle and metatarsophalangeal joint positioned to relax tendons; a reducible deformity can respond to footwear, padding, splinting and exercise better than a fixed joint.
- Callus and corns are pressure maps: dorsal corns indicate shoe contact, tip lesions indicate end pressure, interdigital soft corns indicate crowding and plantar callus indicates metatarsal loading.
Key red flags
Dark haemorrhage beneath callus, fluctuance or a skin break can conceal a neuropathic ulcer and requires prompt debridement and depth assessment by a trained foot service.
Investigation priorities
Classify deformity, pressure site, reducibility, metatarsophalangeal stability and footwear conflict.
Identify neuropathy and arterial disease that convert callus into ulcer and treatment risk.
Management branches
A corn, callus or lesser-toe deformity presents without active ulcer, infection or ischaemia.
- Classify hammer, claw, mallet or crossover pattern, test reducibility and examine metatarsophalangeal stability.
- Inspect every pressure surface and footwear and assess monofilament sensation, pulses, refill and arch or hallux contribution.
Key medicines
Urea foot cream for intact dry callused skinApply a urea-containing emollient, commonly 10% to 25%, thinly to intact dry plantar skin once or twice daily according to the product, avoiding toe webs, open ulcers and macerated or infected areas.
Simple analgesia for pressure painUse paracetamol 500–1000 mg orally when required at least 4 hours apart, maximum 4 g in 24 hours, with a lower maximum for low weight, frailty, malnutrition or liver risk.