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Pain Under Your Foot: Could it be Intractable Plantar Keratosis?

If a common callous turns into a far more painful problem, then you might be suffering from a condition know as Intractable Plantar Keratosis (IPK).

Learn everything you need to know about Intractable Plantar Keratosis (IPK).

Learn everything you need to know about Intractable Plantar Keratosis (IPK).

Intractable Plantar Keratosis is a deep callus that causes extreme amounts of pain and discomfort. The condition is known as intractable because this painful callus will not simply go away by itself. It is described as plantar because of its location on the bottom of your foot. A keratoma, meanwhile, is the medical term for a hard, thickened portion of skin.

This unique condition is most often caused by what is known as a “dropped metatarsal,” which happens when the metatarsal head drops to a lower level than the surrounding metatarsals and protrudes from the bottom of the foot. Once this drop occurs, more pressure is applied to the protruding area and causes a thick, centralized callus to form.

“Nine times out of 10, an IPK will correlate with a metatarsal head,” said Dr. Ian S. Goldbaum of Delray Beach Podiatry. “It’s a combination of a lack of a fat pad, a dropped metatarsal and having a lesion. It happens over time.”

As Dr. Goldbaum alluded to, an IPK doesn’t just appear overnight. If you have one metatarsal bone that is longer or lower than the others, it will be hitting the ground first, causing it to sustain more force than it is used to handling. This, in turn, will eventually lead to the development of an IPK that is centralized around the area receiving the unwanted pressure.

This sensation of having an IPK is sometimes compared to walking on a stone that you simply cannot kick out of your shoe. In most cases, a dropped metatarsal is caused by a congenital abnormality, a result of a metatarsal fracture, or a structural change that may have occurred over time.

Although they can sometimes be mistaken for an ordinary callus due to their similar appearance and location, an Intractable Plantar Keratoma is far more painful and harder to ignore due to its location deep under the ball of the foot.

“The problem is that people continue to think that it’s a callus formation,” said Dr. Goldbaum. “It’s actually an encapsulated lesion. A lot of times, it’s a plugged sweat gland that’s encapsulated within. If you de-nucleate them out, then the pain goes away for the patient.”

Treatment for Intractable Plantar Keratosis

Although you can treat an Intractable Plantar Keratoma conservatively with consistent trimming and padding, these procedures will only serve alleviate your pain for a short period of time. In short, conservative treatments for an IPK are like putting a bandaid over a wound that requires stitches — it just won’t work!

If a dropped metatarsal is causing the problem — which, in most cases, it likely will be — then it will simply continue to rebuild and restrengthen the IPK. If you simply refuse or are unable to undergo surgery, however, a custom orthotic device is recommended in order to redistribute body weight from the problematic metatarsal bone to the other parts of the foot.

Once again, this won’t fix the problem, but it can make living with it much easier.

“In order to fix the root of the problem, you have to dorsiflex the metatarsal, bringing it up and taking the pressure of the area,” said Dr. Goldbaum. “The utilization of an orthotic, however, is a really good way to take care of some of the problem without surgery. In fact, even if you choose to undergo surgery, you will also need to be fitted for an orthotic after the fact to compensate for the lack of a fat pad.”

By utilizing a dynamic walking scan analysis, Dr. Goldbaum is able to create a holistic picture of the forces acting on your feet and throughout your body as well as pressure distribution and foot motion as you move in order to identify exactly why an IPK is forming. With this information, he is able to create a custom orthotic device that will properly offload the pressure that is causing the IPK, effectively providing a substantial amount of pain relief for his patients.

“You want something with shock absorption properties,” said Dr. Goldbaum. “From heel strike all the way through gait, we’re able to offload the areas of pain. We do that with a fabricated orthotic, making an actual plaster cast of your foot to get the perfect fit.”

If you are suffering from Intractable Plantar Keratosis and are interested in having a custom orthoic crafted to fit your needs, please see our contact information below.

Follow Dr. Goldbaum on Twitter @Delray_Podiatry

The content on this website is for informational purposes only. Do not rely or act upon information from without seeking professional medical advice. If you live in South Florida and would like a consultation with Dr. Ian Goldbaum, a podiatric physician and surgeon with over 30 years of experience, please see our contact information below:


16244 S. Military Trail #290, Delray Beach, FL 33484



2900 N. Military Trail #210, Boca Raton, FL 33431 (SOUTH BLDG)



8198 Jog Road #100, Boynton Beach, FL 33472




General Podiatry

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