Different Stages of a Bunion

Written by Bianca Charles on January 22, 2026

Medically reviewed by Sarah Higgins, D. Ch.

A bunion, medically known as hallux abducto valgus, is an angular bony protrusion that forms at the base of the joint that connects your big toe to your foot.

This joint, called the first metatarsophalangeal joint (or MTP joint for short), is a critical junction of bones, tendons, and ligaments that bear much of our weight when we’re on our feet. With bunions, the joint deviates its proper alignment, which causes the big toe to slowly and gradually turns towards the smaller toes.

This foot deformity occurs in about 10-30% of the population, affecting twice as many females as males. Bunions are caused or contributed to by wearing poor-fitting shoes, faulty foot mechanics, muscle imbalances, lax ligaments, inflammatory arthritic conditions, and genetics.

Bunions can be asymptomatic, although some people may experience pain, redness, and swelling at the joint, especially with tight footwear and extended periods of standing or walking. Symptoms may lessen with rest, biomechanical correction, and improved footwear choices.

Unfortunately, a bunion is a progressive deformity and is irreversible without surgical intervention. This means they will slowly get worse over time. However, addressing underlying biomechanical factors may help slow its progression and reduce symptoms.

Stages of Bunions

Bunions are categorized in stages to determine the severity of the deformity.

Without treatment, there is a greater risk a bunion will progress from one stage to the next.

Stage 1

Visually, a bunion at this stage is considered mild. There may be a small “bump” at the side of the 1^st MTP joint and the big toe will be slightly turned towards the second toe, although not touching it.

Stage 2

The big toe further deviates from the MTP joint. At this stage, the first toe may be touching the second toe beside it.

Stage 3

At this stage, the base of the first toe develops a bone spur. This makes the bony protrusion more significant. The first toe also starts to rotate on its axis away from the mid-line of the body.

Stage 4

At stage 4, the first MTP joint has dislocated and the first toe will cross over or under toe. At this stage, the second toe will also present with a hammer toe deformity.

Managing Bunions

Although the only way to reverse a bunion is by surgery, it is only recommended if symptoms are not manageable by conservative measures and if function is severely compromised. Regardless of whether or not surgery is done, non-surgical treatment must be done, otherwise the bunion will reoccur.

Conservative treatments help to slow down the progression of a bunion as well as manage pain. It includes custom foot orthotics, splints, bunions guards, toe separators, and foot exercises.

Talk to your Chiropodist about the stage of your bunions and which conservative treatment options would be best for you!

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About Author: Bianca Charles

With 15 years of dedicated experience in podiatry, Bianca Carter offers a wealth of knowledge and expertise at Feet First Clinic. Throughout her career, Bianca has worked closely with leading chiropodists, continually deepening her understanding of all aspects of foot care.

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February 19, 2026

Which Superfeet Insole Is Right For Me?

Sometimes our shoes need that extra layer of comfort and resiliency to protect us from foot pain. For those already experiencing foot pain, you should take the time to invest in proper foot care right away. You may think Custom Orthotics are the only way to go, which can be true at times. That being said, Superfeet insoles are another option that can help with a wide range of Foot conditions. With this in mind, Feet First Clinic is proud to offer Superfeet insoles, which provide comfort and stability to anyone who needs them. Superfeet offers a wide array of insoles that all provide relief and support. Not only suitable for foot pain, high-quality insoles have also been credited with helping conditions like back pain. They're also favourable for those with flat feet or a high arch. Some are more tailored for different needs and activities, some for different shoes. The Superfeet insole you choose will ultimately depend on your needs and the shoes you wear them with (which is why you should always try them with the shoes you want to wear them with before purchasing). Superfeet Insoles: Classic Features Superfeet insoles are made with high-quality materials and features that support foot health, including: High-density foam: One of the best materials for insoles, it offers a firm foundation, comfort and sufficient shock absorption. Heel cup: This can help stabilize the foot for those who need it. It also helps properly align the foot. Odour control: Some Superfeet insoles feature an odour-control coating that helps prevent bacteria growth and keeps the insoles smelling fresh. Contoured shape: All Superfeet insoles come with a shape that accommodates various foot types. How to Choose Over-the-Counter Insoles When shopping for over-the-counter insoles, it's important to consider the following: Arch Height: High, medium, or low/flat Primary Use: Running, walking, work boots, slim footwear, or all-day casual use Cushion vs. Support: Do you want plush softness, firm structure, or a balance? Shoe Fit: Roomy vs. snug-fitting shoes Available Superfeet Options We'll discuss the following Superfeet insoles with the hope that you can find the right one for you: All-Purpose Support High Arch (formerly Green) All-Purpose Support Medium Arch (formerly Blue) All-Purpose Support Low Arch (formerly Black) All-Purpose Women's High Impact Support (formerly Berry) All-Purpose High Impact Support (formerly Orange) All-Purpose Memory Foam Support (formerly Copper) Carbon Run Cushion High Arch Work Cushion Work Slim-Fit Cushion Best Insoles for High Arches All-Purpose Support High Arch (Green) Choosing insoles with high arches can seem like a lost cause, but Superfeet Green is great for this foot type. In fact, Superfeet Green is Superfeet’s flagship product, and its most popular. One of the reasons why is its high arch support, which differentiates it from the Blue and Orange insoles. This high arch support helps alleviate foot, ankle, back, and knee pain by properly distributing pressure along the foot. Superfeet Green also provides the most support and stability among all Superfeet’s insoles. It's beneficial for a variety of other foot conditions too, such as plantar fasciitis and even flat feet (albeit with a break-in period). If you have high arches, but need extra cushioning and flexibility, you may also want to consider the Run Cushion High Arch or Work Cushion: Run Cushion High Arch This insole has all the supportive features of the Green, but with extra cushioning and flexibility. It's a great option for people who love the support of Green, but not the firmness. It's also great for sports and high-impact activities. Work Cushion This insole is designed especially for safety shoes and safety boots, but they go great with all footwear. They're designed for people who are on their feet all day and feature extra cushioning and shock absorption in the weight bearing parts of the foot (under the ball of the foot and the heel). It also has extra support around the heel, which makes it great for people who overpronate and need extra stability in their shoes. All Purpose Memory Foam Support (formerly Copper) Cushioning is one of the most important features to look for in an insole if you have high arches. That's because less of your foot contacts the ground, which concentrates more shock and force onto a smaller area. This means your feet can't properly absorb shock when you move. Cushioning provides that shock absorption for you. While the arch profile on the Copper insole is lower than the others listed above, it has abundant memory foam cushioning to soften each step you take. Thin Insoles - Dress/Slim Fitting Shoes Black The Superfeet Black insole is thinner, which makes it very adaptable. It fits snugly inside a wide range of footwear types, provides shock absorption and has an odour-control coating. Carbon The Superfeet Carbon insole is designed specifically for those interested in optimal performance enhancement. While still being lightweight, the Superfeet Carbon insole stands out with its "carbon fibre-reinforced stabilizer cap with a durable, ultralight foam layer." Superfeet notes that the Carbon insole is especially suitable for running shoes and cleats. The trademark Superfeet features, such as foam cushioning, the resilient shape and the heel cup, are also present. It's super-thin profile also makes it perfect for dress shoes and shoes that don't have removable insoles. Best Insoles for Flat Feet All Purpose Support Medium Arch (formerly Blue) Some of the best insoles for flat feet are Superfeet’s Blue inserts. The deep heel cups stabilizes the flat foot and prevents it from rolling inward, also known as overpronation. Individuals with this foot type often experience plantar fasciitis over time, and wearing Superfeet Blue can be preventative and, according to Mayo Clinic, reduce symptoms like foot pain. Superfeet Blue also hasa medium arch shape. This allows you to get the arch support you need, without being too aggressive and putting too much pressure along the arch. It’s also important to note that despite their thin appearance, Superfeet Blues are firm and highly durable. The thinness lets you use them in various footwear, making them one of the most popular over-the-counter insoles and a great option if the insoles with higher arch support (i.e.: Green, Run Cushion High Arch) don't fit into your shoes. All Purpose Women's High Impact Support (formerly Berry) If you like the arch and support of blue, but want a little extra cushioning, Berry could be a great option. The Berry is designed to accommodate the female foot, which characteristically has a slimmer heel. The arch length is also catered to support women. If you're a busy woman who spends long hours on her feet, whether it be for work or physical activity, this may be the insole for you. Superfeet Berry also comes with foam cushioning, allowing all of your footwear to feel exceptionally comfortable and preventing foot pain. The odour-control coating also fights bacteria from causing unpleasant foot odour. Lastly, like any good insole, the Superfeet Berry provides excellent shock absorption while running, with extra padding underneath the metatarsal (forefoot) area. Insoles for Normal Arches / High-Impact Activities: Superfeet Orange Superfeet Orange is a good choice for people with a normal to slightly pronounced arch. However, whether its brisk walking or playing sports, Superfeet Orange is great for physically active individuals. The heel cup perfectly cradles the foot during exercise, providing maximum control and optimal positioning of the soft tissue beneath the heel. Superfeet Orange also stands out with its extra high-impact foam on the forefoot, where the ball of the foot generally withstands the most pressure. It’s important to note that many Superfeet varieties complement a normal arch. Furthermore, flatter and more pronounced arches may also be able to mix and match different insole types. These are simply some of our best sellers. To learn about the various types of Superfeet insoles, click here.

January 8, 2026

Top Tips for Winter Hiking

Hiking is a great form of exercise and a fun way to get outdoors during the colder months of the year. However, if you’re planning on going for a hike, you need to know how to keep your feet warm and safe. Not only will this keep you comfortable during your journey, but it will also minimize the chances of you getting frostbite or another cold-related issue. That is why we are highlighting our top winter hiking tips, with a focus on proper footwear and keeping your feet protected in icy and snowy conditions. Continue reading to learn more about how you can protect your feet while hiking in the winter. Wear Boots That Fit Properly Before going on a hike, you need to assess the quality of your footwear. Preferably, you have a pair of warm boots that you can wear. By wearing boots, you’ll be able to walk in deep snowdrifts without worrying about getting your feet wet. Look for boots that are waterproof and insulated. If your boots are not insulated, be sure to wear them with a wool sock (more on that below). However, it doesn't matter how warm your boots are if they don't fit. Tight-fitting boots will restrict circulation, which will make your feet feel cold no matter what you do. That's why boots should fit properly: When purchasing boots, try them on in-store with a warm, thick sock. When in doubt, it's better to go too big than too small. Wear The Right Pair Of Socks Everybody knows that you should never go on a winter hiking trip without a warm pair of socks. Look for thermal socks with thermoregulating materials like merino wool. Materials will not only keep your feet warm; they're also breathable, meaning you won't need to worry about foot sweat (moisture buildup from foot sweat will make your feet cold). Whatever you do, do not double-layer socks; the increased thickness can make your shoes too tight, which will restrict circulation and make your feet colder. If you have poor circulation or suffer from conditions like Peripheral neuropathy (nerve damage caused by diabetes), you may want to wear a pair of compression stockings. Compression stockings are high-quality garments that are made to stimulate the blood flow in your feet and lower body. These garments can help prevent pain in several ways. Some benefits include: Boosting circulation to your lower extremities to help keep them warm Decreased swelling in your ankles and knees Minimizing aching and overall discomfort Reducing leg and foot fatigue If you don’t currently suffer from any of the issues mentioned above, you can still benefit from wearing compression stockings! They can help prevent issues like: Blood clots Varicose veins Complications due to venous disorders Keep Your Feet Dry Keeping your feet dry is just as important as keeping them warm during winter hikes. Moisture from snow, slush, or sweat can quickly lower foot temperature and increase the risk of blisters, irritation, and cold related injuries. Choose waterproof or water resistant boots whenever possible, and consider wearing moisture wicking socks to help pull sweat away from the skin. Packing an extra pair of socks in your backpack is also a smart idea, as changing into a dry pair during or after your hike can significantly improve comfort and help protect your feet from the cold. Wear Shoes with Good Tread Winter can make for slippery conditions. Whether it's slush, snow or ice, it's easy to lose your footing on winter trails. That's why it's important to look for shoes with a good tread and traction. The outsole should be rubber or a high-abrasion rubber compound. Tread depth and tread pattern is also very important. Ideally, the tread depth should be at least 5 mm, and the pattern should have many small shapes. A waterproof hiking shoe or hiking boot usually will do the trick!

December 11, 2025

FootCare 101: What Is A Chiropodist?

Our feet are pretty amazing structures. With over 52 bones, over 250,000 glands and nerves, they're certainly a complex parts of our bodies, and so they deserve a dedicated specialist to keep them in peak condition. How exactly do these specialists work? And why might you need to see one? Read on and find out. What's A Chiropodist? A Chiropodist (pronounced "kerr-op-o-dist") works to support the prevention and management of acute and chronic conditions that affect our feet and lower limbs. Think: skin conditions like warts and calluses, nail conditions like ingrowns or fungus, and musculoskeletal conditions like Plantar Fasciitis and Gout. These are just a few examples of the foot conditions a chiropodist can treat. Click to learn more about other Common Foot Conditions. Is a Chiropodist Different than a Podiatrist? It depends on where you live. ChatGPT said: In Ontario, both chiropodists and podiatrists are regulated foot care professionals, but their training and scope of practice differ slightly. Chiropodists are the most commonly licensed foot specialists in the province and provide comprehensive care including assessments, routine and advanced treatments, custom orthotics, minor procedures, and certain injections. Podiatrists are less common and were grandfathered into practice prior to 1993, when Ontario transitioned to licensing only chiropodists. A podiatrist can perform bone surgeries like bunion or hammertoe corrections, whereas a chiropodist cannot (they can still do other surgeries). Regardless of the title, both professionals are highly qualified to help you manage foot pain and keep you moving comfortably. What Do Chiropodists Check For? When a chiropodist sits down to assesses your feet, they'll be able to spot and treat minor problems right away, like hard skin, Warts, and Ingrown Toenails. For people with diabetes, the chiropodist will check the sensation and circulation in the feet, as well as examine the feet for any potential irregularities or cause for concern. If you have foot pain, a chiropodist can do a biomechanical assessment and gait analysis. They'll check your alignment when you walk, and will then be able to recommend or prescribe solutions including, but not limited to, Orthotics or Insoles, to get the feet working in peak condition. Either way, you'll leave your first visit knowing your feet are being properly cared for. As you can see, foot health isn't just about feet! When feet are in good condition, the whole body can be properly supported. When they're not, you'll likely notice problems elsewhere. Foot health is every bit as much about your legs, hips, and spine as it is about the way your toes look in sandals. Chiropodists are trained to see the bigger picture of your physical health and the role your feet play in it. Even if you don't have foot pain, we urge you to visit a chiropodist. Your feet, after all, are your body's foundation, and having them assessed could save you aches and pains later on. Foot problems affect well over half the population. Don't be one of those people who finds themselves at risk of long-term consequences.

July 10, 2025

What’s the Difference Between an Ankle Foot Orthotic and a Regular Orthotic?

What is an Ankle Foot Orthotic (AFO)? An ankle foot orthotic (AFO) is a medical-grade brace that supports the foot and ankle. It often extends partway up the calf. Unlike regular foot orthotics—which fit inside shoes to support the arch and heel. AFOs offer external stabilization of both the foot and ankle joints. AFOs are commonly made of lightweight plastic or carbon fiber and may be custom-made or prefabricated. They assist walking, correct alignment, reduce pain, and help prevent further injury. Who Needs an AFO? Image from https://braceworks.ca/ and the Washington Post AFO's received mainstream attention a few years ago when NFL quarterback Alex Smith returned to the football field after a catastrophic leg injury. The key to his return: an ankle foot orthotic. Due to a post-surgical infection, the nerve that helps flex the right foot was severed. This meant he couldn't lift his foot. So he got an AFO to help and made a brief comeback (with the help of an extensive rehab team). So who exactly needs an AFO? Since AFOs are heftier than regular orthotics, they're typically recommended for patients with more complex conditions than those addressed by traditional foot orthotics. You might benefit from an AFO brace if you have: Foot drop (difficulty lifting the front of the foot) Cerebral palsy or neuromuscular disorders Stroke-related gait issues Multiple sclerosis (MS) Post-surgical ankle instability Tendon or ligament injuries Severe arthritis affecting ankle mechanics Ankle foot orthotics are most commonly indicated for neuromuscular disorders and foot drop. AFOs v Regular Orthotics: What's the Difference? FeatureRegular OrthoticsAnkle Foot Orthotics (AFOs)ScopeFoot support onlyFoot and ankle supportPlacementInside the shoe (underneath the foot)Worn underneath and around the foot, and around the ankleConditions TreatedArch pain, plantar fasciitis, overpronation, high arches, other biomechanical irregularitiesNeurological and structural gait disorders, severe instabilityCustomizationOften custom-fit or prefabOften custom-molded to leg shapeMobility SupportModerateHigh—can aid in walking and balance While regular orthotics focus on redistributing pressure and correcting foot mechanics inside the shoe, AFOs provide external control for more complex biomechanical or neurological issues. Think of it as the difference between cushioning a sore spot and physically guiding your limb’s motion. How Are AFOs Made and Fitted? https://www.youtube.com/watch?v=nA_QklH7AWY AFOs are usually prescribed by a foot specialist or chiropodist after a full assessment. The process may include: Biomechanical Assessment Gait analysis Casting or 3D scanning Custom fabrication Fitting and adjustments Some patients may only need short-term use post-injury or surgery, while others may rely on AFOs for long-term mobility support. Final Thoughts If you’ve been told you need more than just arch support or if your walking pattern has changed due to injury or illness, an ankle foot orthotic could be a game-changer. At our clinic, we assess your full biomechanics and work with you to find the right support—whether that’s a custom orthotic, AFO, or a combination of both.

March 13, 2025

Do Flat Feet Cause Bunions?

Flat feet are a condition in and of themselves. However, flat feet also have an impact on future foot health and can lead to other more painful foot conditions. But can flat feet really cause bunions? While it seems unlikely that a toe deformity can be linked to a flat arch, you'd be surprised how interconnected our lower extremities are, especially the feet! Today’s article will explore how flat feet cause bunions, what you can do to prevent them, and how a foot specialist like a Chiropodist or Podiatrist can provide treatment. What are Flat Feet? Flat feet, or pes planus, cause the entire sole or most of it to contact the ground when standing and walking. For some people, this condition can extend into adulthood from childhood (children have flat feet before the arch forms) when the arch fails to form.When you have normal arches, they provide an elastic, springy connection between the forefoot and the hindfoot, allowing forces incurred during weight-bearing to be distributed properly. When these arches don’t exist, this mechanism is disrupted, leading to pain and other complications. What are Bunions? https://www.youtube.com/shorts/sXF8lWHad0g Bunions, or hallux valgus, are bony protrusions that form on the inside edge of the first metatarsophalangeal (MTP) joint at the base of the big toe. They develop when pressure causes the big toe to deviate toward the second toe, resulting in a misalignment of the joint. Emerging research indicates that hypermobility in the midfoot (specifically the mid-tarsal joint between the navicular and the base of the first metatarsal) may be a key underlying factor in the development of bunions, and this hypermobility is often genetic. Common Bunion Causes and Risk Factors: Ill-Fitting Footwear: Wearing the wrong shoes for years is a major risk factor for most foot conditions, especially bunions. Wearing tight, narrow, or high-heeled shoes can exacerbate pressure on the big toe joint, contributing to bunion formation. Your toes need space to splay and rest comfortably! Gender and Age: Women, particularly those over 60, are more prone to developing bunions, generally due to decades spent making poor footwear choices, or possibly due to hormonal influences that affect the ligaments in the foot. Inflammatory Conditions: Diseases like rheumatoid arthritis can cause joint inflammation, which increases stress on the big toe and the risk of bunions. Foot Injuries: Trauma to the foot can alter its mechanics, leading to bunion development. https://www.youtube.com/shorts/KZiVzLyBUMo Flat Feet and Bunions: The Connection If you’re not proactive, the shape of your foot arch can have a big impact on our foot health over time. You may know that flat feet can lead to plantar fasciitis, and you may also know that high arches can lead to back pain, but our arch shape can affect us in countless ways. Let’s talk about the science behind why a flat foot can lead to a painful bunion. It all boils down to flat feet causing an abnormal gait (walking pattern), and the damage caused by walking with that abnormal pattern for a long period of time.The structural anomaly of flat feet and barely having an arch, or no arch at all, can significantly impact foot mechanics—particularly during walking. In a typical gait cycle, the foot pronates (rolls inward) to absorb shock and then supinates (rolls outward) to create a rigid lever for propulsion. Individuals with flat feet often experience overpronation, where the foot remains excessively rolled inward during the push-off phase. The altered biomechanics increases pressure on the first MTP joint, leading to instability and misalignment. Over time, this persistent stress can cause the big toe to deviate toward the second toe, resulting in a bunion. Moreover, flat feet can lead to muscle imbalances that exacerbate bunion formation. Weakness in the intrinsic foot muscles (a group of tiny muscles inside the foot) and the tibialis posterior muscle (a muscle in your lower leg) compromises arch support, worsening overpronation. This chain reaction places additional strain on the big toe joint, accelerating bunion development. Therefore, the combination of altered foot mechanics and muscle imbalances associated with flat feet plays a significant role in the development and progression of bunions. https://www.youtube.com/shorts/pdyv58z1D2Y Preventing Bunions With Flat Feet First and foremost, it’s all about the shoes! Selecting footwear that fits properly with a wide toe box and adequate arch support is crucial. A spacious toe box prevents crowding of the toes, reducing pressure on the big toe joint and minimizing the risk of bunion formation. Adequate arch support helps maintain proper foot alignment, distributing weight evenly and alleviating stress on MTP joint. Avoiding high heels and narrow shoes is essential, as they can exacerbate foot misalignment and increase the likelihood of developing bunions. Incorporating custom orthotics can provide even more arch support if you have flat feet. These orthotics help correct overpronation—which we know now is a common issue—by stabilizing the foot's movement during the gait cycle and keeping it in neutral alignment. By improving foot alignment, orthotics reduce undue pressure on the big toe joint, reducing your risk of bunion development. Lastly, Engaging in specific exercises can strengthen the muscles supporting the foot arch, enhancing stability and function. These exercises should aim to: Strengthen Foot Muscles: Targeting the intrinsic and extrinsic muscles of the foot to provide better support for the arch and improve overall foot stability. Improve Flexibility: Enhancing the range of motion in the toes, feet, and ankles to prevent stiffness and reduce strain on the MTP joint. Enhance Balance and Coordination: Developing proprioception to ensure proper foot placement and gait mechanics, thereby reducing the risk of misalignment. Regular practice of these exercises can improve foot biomechanics, reduce overpronation, and subsequently lower the risk of bunions. See below for an example of a great flat foot exercise. https://www.youtube.com/shorts/whJ3TZAOn00 Foot Clinic Bunion Care If you already struggle with bunions and foot pain, don’t worry; there are plenty of options available to you. Bunions cannot be reversed after they form, but they can be managed with guided care from a podiatrist or chiropodist. The goal is to avoid invasive surgical intervention while still preventing bunions from impacting your daily life as much as possible. Most of these bunion treatment options are available at our downtown Toronto foot clinic: Footwear Modification. Wearing shoes with a wide toe box and avoiding high heels can help reduce pressure on the bunion. Orthopedic shoes designed to accommodate bunions provide additional support and comfort. Anti-inflammatory Medication. Over-the-counter NSAIDs, such as ibuprofen, can help reduce inflammation and alleviate pain associated with bunions. Bunion Splints and Aligners. Devices like bunion splints and toe spacers can help realign the big toe and reduce discomfort. They can provide symptomatic relief, and you can try a more rigid device if your bunion is severe. Therapeutic Taping. Applying tape to the foot can help maintain proper alignment and reduce strain on the bunion, providing temporary relief from pain and inflammation. Shoe Stretching. Professional shoe stretching can create additional space in the shoe, reducing pressure on the bunion without altering the overall size of the footwear. Supportive Insoles or Custom Orthotics. Custom orthotics can provide support to the arches and correct faulty biomechanics. This can potentially slow the progression of bunions by reducing pressure on the first MTP joint. Bunion Exercises. Strengthening foot muscles through specific exercises can improve joint stability and decrease bunion-related pain. Try these 5 simple exercises for bunions. Shockwave Therapy: This non-invasive treatment can address tight muscles and soft tissue injuries associated with bunions. This can potentially reduce pain and improve function. Implementing these non-surgical interventions can significantly alleviate discomfort and slow the progression of bunions, enhancing overall foot health and quality of life. https://www.youtube.com/shorts/8g43ZWreZ1g

March 6, 2025

Palmoplantar Keratoderma: What is it?

Figuratively speaking, it’s a good thing to have “thick skin,” right? But if you have palmoplantar keratoderma, it’s a different story. This condition, sometimes shortened to PPK, refers to a group of foot skin disorders characterized by thick, rough, and yellowed skin on the hand palms and feet soles. These conditions can be either inherited or acquired. In today’s article, we’ll explore the symptoms, causes, and, most importantly, the treatment options available. This type of skin thickening may warrant a trip to a foot clinic and the expertise of a foot care professional, such as a Chiropodist or Podiatrist. However, successful treatment may depend on the underlying cause of the skin thickening. What is Palmoplantar Keratoderma? This condition combines two scientific terms: palmoplantar, which specifically refers to the skin on the soles of the feet and the palms of the hands, and keratoderma, a term for epidermis (skin) thickening. In less common cases, transgradient keratoderma can affect the top of the hands and feet. The feet are usually more severely affected than the hands. Palmoplantar keratoderma (PPK) causes thickened skin on the palms and soles due to an overproduction of keratin, the protein that forms the outer layer of the skin. Normally, keratin helps protect the skin from friction, pressure, and environmental damage. However, in PPK, something disrupts the balance of keratin production and shedding, leading to excessive buildup. This happens because of genetic mutations or external factors that affect how skin cells grow and mature. Inherited forms of PPK often involve mutations in genes that control keratin formation or the connections between skin cells. These mutations make the skin cells more resistant to breaking down, so they pile up instead of naturally shedding. Since the palms and soles experience the most pressure and friction in daily life, they are especially prone to this excessive keratin buildup. Over time, the thickened skin can cause pain or become hard and cracked, depending on the severity of the condition. Some types can also cause blisters to form. Types of Palmoplantar Keratoderma and Associated Symptoms https://www.youtube.com/shorts/-iNFLGednYY Genetic (hereditary) keratoderma is usually divided into three main categories: diffuse, affecting the entire hand palm and foot sole; focal, where thickening is limited to pressure points; and punctate, which appears as small, hard lesions. Some genetic PPKs - particularly diffuse - are syndromic, meaning they are associated with other health conditions and additional symptoms, ranging from hearing loss to nail abnormalities to internal organ damage. Acquired PPK, on the other hand, is always syndromic and develops later in life due to external factors such as infections, inflammatory diseases, or underlying systemic conditions like internal malignancies. Acquired forms may be easier to treat since you and your healthcare team can address the underlying cause. Acquired PPK is also more common than genetic, since there are more causes and risk factors associated with it. Most types of PPK cause varying degrees of thick skin, potential foot odor (as a result of sweat combined with thick skin) and yellow/discoloured skin. Genetic PPK Types and Symptoms Diffuse PPK This form presents with even thickened skin on the palms and soles, often with a red border at the edges. Symptoms typically appear in early childhood and may include excessive sweating (hyperhidrosis). The thickening is usually confined to the palms and soles, without extending to the tops of the hands or feet. Focal PPK This type is characterized by linear (striate) thickened areas on the palms and soles, often following the lines of skin tension. It is typically caused by mutations in genes encoding desmosomal proteins, which are crucial for cell adhesion. A specific type of focal PPK called Pachyonychia Congenita is a rare genetic disorder that can also cause thick toenails. Punctate PPK This form is characterized by multiple small, hard, corn-like lesions scattered on the palms and soles. It is associated with mutations in genes that play a role in skin cell function. Acquired PPK Types and Symptoms PPK from Infections (syphilis, etc) Rough, scaly and yellow thickening on the palms and soles. May come with a rash or other symptoms affecting the whole body. Clears up when the infection is treated. PPK from Inflammatory Skin Conditions (psoriasis, eczema) Thickened, inflamed skin with redness and scaling. Can extend beyond just the palms and soles. Often improves with medicated creams or treatments that calm the immune system. PPK Linked to Other Health Conditions (cancer, hormone disorders) Yellow thickening of the palms and soles that appears suddenly in adulthood. Can sometimes signal an underlying health issue, like cancer. Needs further medical evaluation to check for possible internal diseases. What is the Difference Between Palmoplantar Keratoderma and Calluses? PPK is not the only cause of skin thickening on the feet and hands. In fact, it is more rare than another common culprit: calluses. But how do you know which condition you have? Calluses are localized areas of thickened skin that develop as a protective response to repeated friction or pressure. Commonly found on individuals who are physically active or spend long hours wearing ill-fitting shoes, they are much less severe than PPK. PPK tends to be thicker and more noticeable, alarming and unsightly than calluses, often covering a larger, symmetrical area on the palms and soles. It can appear hard and more yellow, or red and flaky. In some PPK cases, you may observe a red band at the edges of the thickened skin. Calluses can have a more mild appearance (but not always; they can sometimes be thick and painful!), with some people not even realizing they have them. Does that mean that PPK is the same as having excessive calluses? Not exactly. Calluses are only caused by friction and pressure----whereas PPK always has a driving force behind it, whether it's a genetic mutation or the result of an illness. https://www.youtube.com/shorts/yBACD8bUim0 Palmoplantar Keratoderma Treatment: Can a Chiropodist or Podiatrist Help? While there is no outright cure for certain forms of PPK, Chiropodists and Podiatrists can help manage symptoms, reduce discomfort, and improve mobility. This typically involves regular debridement (carefully removing excess skin), possibly prescribing medicinal products, and offering footwear advice to minimize friction and pressure. The latter may also include prescribing custom orthotics to properly distribute pressure on the bottom of the feet, especially if the thickened skin is impacting daily life. Scheduling an initial assessment is a good start! Naturally, since PPK can be linked to an underlying condition, more comprehensive care may be needed. A Chiropodist or Podiatrist might become a part of a broader team of healthcare professionals that can help you, including a dermatologist, your family doctor or other specialists trained to tackle the root cause. You may need advanced treatments such as topical retinoids, corticosteroids, or even laser therapy in some cases. https://www.youtube.com/shorts/sBIdll7qylQ

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