Many ways to deal with callus pain

I am a 62-year-old woman with a steady daily workout pattern: spinning or cycling three days a week, Pilates and stretching one day a week and running one or two days a week. I have developed a large, uncomfortable callus behind the third toe of each foot. I try to control it with a pumice stone but recently when I ran it was almost like a rock or sock wrinkle in my shoe. New shoes have not helped.

JUDI

Lake Oswego, Ore.

This could be a simple callus, as you suspect, says Dr. Noreen Oswell, chief of podiatric surgery at Cedars-Sinai Medical Center. Over-the-counter remedies include the pumice stone and exfoliating creams, especially ones containing urea. “If you use them every day after your shower, they can moisturize and minimize the callus,” Oswell says. You could also try over-the-counter arch supports to take pressure off the ball of the foot. These don’t feel good on all feet, so test them with easy walking first.

If pain persists, see a podiatrist. You may have an extremely deep callus (a plantar keratoma) or a neuroma. Plantar keratomas require professional debridement as well as an X-ray evaluation of the underlying bones. A bone in the area may be dropped, abnormally long or enlarged, causing extra pressure.

A neuroma occurs when nerves are squeezed between soft tissue and metatarsal bones. “When people say they feel a ‘wrinkle in their sock’ and there’s nothing there, it’s often a neuroma,” Oswell says. Treatment includes orthotics (customized insoles that mold to the foot), steroid injections and, as a last resort, surgery.

Inflammation, arthritis or even a stress fracture could be causing the pain. But regardless of the diagnosis, Oswell thinks that because you are so active, the pain is likely to be mechanically induced. Orthotics could help.

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As a low-mileage runner entering my late 40s, I am experiencing an increasingly higher frequency of calf strains. My goal is to maintain about a 20-mile-per-week regimen, but inevitably a strain will occur during flat, short excursions. I stretch extensively. I follow a balanced diet. Do I need to get specific nutrients as I age?

DENNIS

Santa Clarita

Given the moderate amount of exercise that you’re getting, it’s unlikely that your strains are caused by a nutritional deficit, says Nancy Clark, a Boston-based sports nutritionist in private practice and author of “Nancy Clark’s Sports Nutrition Guidebook.” But there are some dietary culprits to double-check: inadequate protein intake (Clark recommends two palm-sized portions a day), inadequate iron or zinc (found in lean red meat and enriched cereal) or inadequate carbohydrates (if you’re following an Atkins-like diet).

The pain could be caused by a number of things, including overstretching, adds Lynn Millar, a professor of physical therapy at Andrews University in Michigan and fellow of the American College of Sports Medicine. “I would suggest the person limit stretching to after the activity,” she says. “The normal protocol is three, 30-second stretches at a gentle intensity.”

But Millar cautions that the pain could be due to something other than a strain: “A true strain is tearing of the muscle and does not typically occur during a low-intensity run.”

Millar suggests that you see your healthcare provider to rule out a more serious condition, such as peripheral vascular disease, an obstruction of the arteries: “This might cause pain (usually described as a burning pain) or cramping during a run.”

-- Janet Cromley

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