Plantar Keratosis

synonyms:

Plantar Keratosis ICD-9

Plantar Keratosis Etiology / Epidemiology / Natural History

• Painful keratotic lesion usually directly plantar to the hallux sesamoids, can be beneath any bony prominence such as the lesser metatarsal heads.
• Can be caused by altered weight-bearing due to a congenital condition, such as a short or unstable first metatarsal or cavus foot, or secondary to trauma or a surgical procedure that elevates the first metatarsal head.

Plantar Keratosis Anatomy

Plantar Keratosis Clinical Evaluation

•  Tender, hard core of avascular keratotic tissue generally located under a site of abnormal pressure such as a metatarsal head or hallux sesamoid.

Plantar Keratosis Xray / Diagnositc Tests

•  A/P, lateral and oblique views of foot. Underlying bony prominence may be evident on xray.

Plantar Keratosis Classification / Treatment

• Discrete lesions: RX=molded metatarsal insert, or a metatarsal pad placed just proximal to lesion to unload bony promience.  Intermittent paring of the lesion may alleviate symptoms. Patients should be instructed on the use of a pumice stone after bathing.
• Discrete Intractable cases: RX=plantar shaving of the sesamoid or affending bony prominence.  Up to 50% of a hallus sesamoid may be resected while leaving sesamoidal complex intact. 
• Diffuse: usually caused by altered weight-bearing due to a congenital condition, such as a short or unstable first metatarsal or cavus foot, or secondary to trauma or a surgical procedure that elevates the first metatarsal head. Initial management is unloading the lesions with soft shoes and metatarsal pads. For intractable cases consider shortening abnormally long metatarsals with an oblique longitudinal osteotomy; plantar-flexion deformities can be corrected with a basal metatarsal dorsal-wedge osteotomy. Also consider a first MTP joint arthrodesis.

Plantar Keratosis Associated Injuries / Differential Diagnosis

• Plantar warts
• Claw toe
• Monoarticular nontraumatic synovitis
• Metatarsophalangeal joint instability
• Frieberg's Infraction
• Cock-up fifth toe

Plantar Keratosis Complications

Plantar Keratosis Follow-up Care

• Hard-soled rocker bottom shoe with metatarsal bar for 4weeks post-op.

Plantar Keratosis Review References

• Coughlin ICL XXXIX 1990:29
• Mizel MS JAAOS 1995;3:166