Generality
Tiloma is a circumscribed thickening of the skin ( hyperkeratosis ) that typically develops in the feet, in an area subject to repeated mechanical insults, such as friction or compressions .
This hyperkeratotic lesion is well defined, rounded and concentrated in a specific point. Unlike a callus, the tiloma is deeper, as it extends over most of the underlying dermis, and, for this reason, it is often painful .
In general, the tiloma appears as a reaction to continuous and repeated rubbing or due to excessive pressure on the affected area, usually after wearing tight and inadequate footwear . The tiloma can be favored by inflammatory or arthritic phenomena on bones and foot joints (as in the case, for example, of the hammer toe). These injuries can also derive from a defect in posture or from any alteration of the usual gait (eg changes in body weight, a habit of wearing high-heeled shoes, sports activities on rough terrain, etc.).
The diagnosis of tiloma is based on the clinical aspect of hyperkeratotic, thickened and hard tissue. The treatment consists of manual abrasion, associated or not with the use of keratolytics (eg salicylic acid in colloidal solution or 40% urea pack). Rarely, surgery is required to eliminate the tiloma or any tissue involved in the injury.
Wearing soft and comfortable shoes that do not alter the biomechanics of the foot can help prevent the onset and recurrence of this hyperkeratosis.
What's this
Tiloma: what is it?
The tiloma is an area of thickened and circumscribed skin that typically develops in areas subject to repeated compression or rubbing. In most cases, this hyperkeratotic lesion develops between the toes, on the top of the fingers and on the sole of the foot .
The tiloma extends deep with respect to the stratum corneum of the epidermis; for this reason, despite having dimensions comparable to those of a lentil, this thickening can cause pain.
Differences between calluses and tilomas
Unlike calluses, tilomas are cutaneous hyperkeratosis:
- Well delimited : the tilomas are roundish cutaneous thickenings concentrated in a specific point, therefore they involve small surfaces;
- Deeper: a tiloma extends over most of the underlying dermis;
- Painful : often, tiloma pressure evokes an annoying sensation; if it extends deep, this lesion can cause spontaneous pain when it compresses the connective tissue of the dermis and atrophies the elastic tissue. Sometimes, even entrapment of dermal nerve and / or vascular terminations in hyperkeratosis can occur.
Callus, on the other hand, is more superficial, affects large areas of the skin and is usually not painful.
Tiloma: terminology and synonyms
- " Tiloma " is the medical term used to indicate cutaneous hyperkeratosis typically found in the feet.
- In common parlance, the tiloma is known as " partridge eye ".
Causes and Risk Factors
Tiloma: what are the causes?
The tiloma is a reactive alteration, ie it represents a response to the perpetuation of local insults. In fact, like the bladders or calluses, this lesion develops following mechanical trauma, such as excessive pressure, continuous rubbing or repeated friction.
In most cases, a tiloma can arise as a reaction to the excessive constriction of poor quality shoes, narrow, uncomfortable or inadequate for the activities performed. Even shoes with high heels and those that are too loose can cause this hyperkeratosis.
The tiloma can also derive from a defect in posture or from an incorrect way of walking .
To learn more: Cutaneous hyperkeratosis - What is it? Why is it manifested? »Tiloma: predisposing and / or aggravating factors
The onset of a tiloma often indicates that something has changed in walking.
In this sense, the disturbance can be favored by:
- Changes in body weight (excessive or excessive weight loss);
- Inflammatory or arthritic phenomena affecting the bones and joints of the feet, such as the hallux valgus or the hammer toe .
The major predisposition to develop a tiloma derives from:
- Heeled shoes : this type of footwear induces a mutual rubbing of the toes, especially if they are very high and narrow at the tip.
- Non-lace-up shoes : the habit of walking with non-laced shoe laces allows the feet to slip inside the shoes. In this case, rubbing can occur at one or more points.
- Incorrect support of the foot : the presence of conditions capable of deforming or making the foot bones prominent, such as a hammer toe and hallux valgus, make the use of some shoes problematic. The repeated friction of the parts involved against the inner walls of the footwear worn predispose to the onset of the tiloma.
Tiloma: who is most affected?
The tiloma usually occurs in people who work standing up and practice intense sporting activities, especially if carried out on rough terrain (eg running, walking, trekking, etc.).
Symptoms and Complications
Tiloma: which sites are most affected?
In most cases, hard tilomas appear at the level of the feet, at the plantar surface, at the interphalangeal joints of the fingers or at the bony prominences (eg calcaneus, metatarsal heads, etc.). The soft tilomas, on the other hand, are located in the interdigital spaces.
What symptoms does a Tiloma involve?
The tiloma develops as an area of thickened skin of hard consistency, mainly on the bony prominence between the fourth and fifth toe; this hyperkeratosis can also appear on the plantar surface. In some cases, the tiloma appears as a lesion of soft consistency.
In addition to noticing a noticeable thickening of the skin, those suffering from tiloma manifest:
- Foot pain, in the area of the skin involved;
- Difficulty walking properly ;
- Problems wearing the shoes that caused the disease;
- Sense of discomfort, increased sensitivity to the feet or tenderness after many hours spent standing.
Tiloma: why does it cause pain?
The tiloma causes intense pain as it compresses the dermis and the deepest part of the lesion (the so-called horny taproot ) can stimulate the nerve fibers present below, causing neuralgia .
The sensation perceived by the patient with a tiloma is comparable to that of having a pebble in the shoe or a drawing pin stuck in the skin of the foot. The pain is felt more in the case in which the formation is present between the fourth and the fifth finger.
The pain is typically accentuated in the evening or after a walk and can be evoked by exerting pressure with a finger on the tiloma. This hyperkeratosis causes difficulty in walking properly and staying upright for long periods. Sometimes, a bag or a pocket filled with liquid is formed at the tiloma.
Possible complications of Tiloma
Tiloma does not usually involve complications in people who are in good health. However, this injury could give rise to problems in those who suffer from peripheral vascular insufficiency, particularly if they have diabetes . These patients should regularly undergo intensive podiatrist care. In the diabetic, in fact, the tiloma can give rise to deep ulcers and infections, with acute pain and pus production.
Diagnosis
When the tiloma is particularly painful and / or occurs recurrently, it is advisable to consult your doctor.
Tiloma: which exams are needed?
The diagnosis of the tiloma is based on the clinical aspect, so a simple objective examination of the affected area is envisaged. During the visit, the doctor can collect anamnestic information to determine what causes the disorder. The knowledge of the factors responsible for the tiloma makes it possible, in fact, to establish the most appropriate therapeutic procedure for treating hyperkeratosis and to prevent it from recurring again.
Differential diagnosis: tiloma or wart?
In some cases, the distinction of a tiloma from a plantar wart is not so immediate: the differential diagnosis requires a thorough dermatological examination to confirm or exclude either condition.
Normally, this assessment requires that the doctor remove the part of the stratum corneum that thickens the lesion:
- Once polished, the tiloma appears translucent and with a clearly delimited nucleus, of a yellowish-brown color, which interrupts the normal architecture of the papillary dermis;
- The wart also appears as a well-defined lesion, but signs of capillary thrombosis are evident, in the form of central blackish points and soft and macerated tissue.
Treatment and Remedies
As anticipated, the best approach to treating tiloma involves eliminating the cause that caused its appearance and preventing further lesion formation. In this sense, the most useful measures consist of changes in the biomechanics of the foot, such as, for example, changing the type of footwear or solving the orthopedic problem at the base (hammer toes, hallux valgus or stiff, flat foot or hollow) . Generally, with adequate treatment, the tiloma is correlated with a positive prognosis .
Drugs and other therapeutic interventions
With regard to the removal of the tiloma, in general, the use of manual abrasion, associated or not with the use of topical keratolytics (usually, salicylic acid in colloidal solution at 17% or wrap of salicylic acid or urea at 40 %). The latter are useful for their softening effect against the stratum corneum of the epidermis which constitutes the tiloma. Their application is painless, but is contraindicated in the presence of diabetes, peripheral neuropathy, particularly fragile skin or with wounds.
If an infection occurs, the tiloma requires antibiotic therapy and the elimination of the area of skin that shows signs of the inflammatory process. If the problem does not resolve itself, it is necessary to resort to surgical removal .
Natural remedies and behaviors
To avoid thickening in the areas of greater foot friction and to prevent the formation of a tiloma, it is possible to resort to natural remedies and behaviors, such as:
- Avoid wearing shoes that have caused the disturbance or, in any case, tight shoes;
- Use creams that have urea as a vector in low percentages;
- Make footbaths with hot water and baking soda or coarse salt;
- Apply a slice of lemon on the area for a few minutes.
Furthermore, to avoid further compressions, it is possible to use products that redistribute excessive pressure and limit rubbing, such as silicone orthoses, protective and separating rubber discs or soft insoles.
If there is no improvement after a couple of weeks, it will probably be necessary to remove the tiloma with a surgical approach.
Tiloma: some advice
In general, it is important to take care of foot hygiene on a daily basis : using pumice stone immediately after bathing to eliminate hyperkeratotic tissue and wearing comfortable and appropriate shoes are the main steps to take to prevent the formation of a tiloma.
To learn more: Pumice Stone - What it is, What It Is For and How It Is Used »
