Diffuse calluses under the second, third, and fifth metatarsal heads. These were caused from wearing high heeled dress shoes.

Deep seated callus (Intractable plantar keratosis) beneath the fifth metatarsal head

This picture illustrates an IPK after reduction of the surface layer of callus. Note the small “core” (nucleation) at the center. Direct pressure on this area is very painful. Further reduction involved enucleation with a small sharp instrument. This is not usually painful.

This illustrates hyperkeratosis (callus) of the heel. These lesions often develop cracks (fissures) which can extend through the skin, making walking very uncomfortable. Aging of the skin, a dry climate, obesity, and abnormal gait can all contribute to this problem.