Intractable plantar keratosis (IPK) is a focused, painful lesion that commonly takes the form of a discrete, focused callus, usually about 1 cm, on the plantar (bottom) aspect of the forefoot.An IPK is actuallya collection of dead skin cells that harden over time and may feel like you are walking with a sharp pebble in your shoe. Typically, IPKs occur beneath one or more lateral metatarsal heads or what we call the “ball of the foot”
Patients may often confuse these lesions with a wart or may think there is a problem with the underlying bone because these lesions can be so painful. As the natural fat pad in this area begins to get thinner with age, you may become more susceptible to these kinds of skin calluses.
There is an underlying cause of why they form and it really involves abnormal biomechanics of the foot. It can indeed be a bony prominence or arthritis under that particular area. But anoften-missed etiology is an “equinus” of the ankle which leads to more pressure being put on the front of the foot during the gait cycle. When equinus is present, our foot compensates with pronation, or really overpronation. This hypermobility in the forefoot leads to abnormal forces and pressure points and leads to the formation of an IPK.
We often can treat these problems conservatively in the office. We address the equinus by providing splints for stretching and correcting the equinus. Also, a custom orthotic (shoe insert) can prevent that excessive pronation and provide some cushioning to the specific sites that bother you. In the office we will also shave down the lesion and may prescribe you some cream to put on daily. In most patients these can resolve in 1-2 months.
If you would like some more information or have something similar in your foot, don’t live in pain. Come in and let the doctors at Advanced Podiatry take a look!