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Bill:

Now that you have sent us the diagram, please explain it to us. I have converted your illustration to a jpg image so it is easier for you to discuss.

Attached Images

Bill's Callous Model.jpg (120.5 KB, 32 views)

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Hi,

I have spent a bit more time creating a diagram and writing a description of how certain areas directly underlying the callus do not transmit the pressure directly although of coutrse other area translit greater pressure to compensate.

I am attaching the new and better (I hope) diagram and another attachment with the words that go with it.

here goes.

Attached Files

	Striae 1.pdf (118.6 KB, 4 views)
	Striae.pdf (177.0 KB, 3 views)

Bill,

Is there any evidence that your diagrams represent reality? I'm not up on the latest histology of callus and non callused skin.

Eric

Hi Eric,

My evidence is based on years of removing callus with a scalpel and noting how frequently the striations, under the callus, appeared further apart, thicker and deeper and how stratum corneum, to a greater of lesser degree, filled the valleys between the striae.

Possibly my evidence is at the level of expert witness. However I am sure there are plenty of expert witnesses out their who will be able to confirm or refute my evidence.

I am sure someone will be able to direct us to electron micrographs of normal and callused plantar skin?

Bill

The attachments aren't quite what I want. One is of thick skin and the other is of thin skin.

The thick skin is either from the palmar or plantar surface and shows the rete pegs and the stratum corneum following the same contour.

Now I am looking for one of callused thick skin to see if the rete pegs are more exaggerated.

Bill

Attached Images

	skin thick.jpg (123.7 KB, 22 views)
	skin thin.jpg (68.9 KB, 22 views)

Found a supportive reference.

Lorimer D, French G, O'Donnel M, Burrow JG, Neale's Disorders of the Foot, 6th Ed. 2004, page 490, Fig.14.16. Churchill Livingstone.

I suspect Kate Springett may have looked at comparative histology of callused and normal skin as part of her PhD studies- check her chapter in Assessment of the Lower Limb -Merrimen and Tollafield

__________________
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"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Hi Simon,

Thanks for the suggestion.

I don't have access to any podiatry books but I did find a contact e-mail address for Kate online and have e-mailed her asking if she has any photos that demonstrate changes in the rete pegs in callused skin.

Best wishes,

Bill

Bill:

I wish I could say that I was impressed with your ideas, but I can't. I believe that the microscopic geometry of the rete pegs are insignificant mechanical factors when compared to the thickness and elastic modulus of calloused skin in producing the abnormal tissue stresses that create the pain from plantar callouses.

However, please have a go at proving me wrong...I'm all ears.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Hi Kevin,

I think that you may well be partly right but I don't think the two ideas are incompatible ie the geometry of the rete pegs may be 'slight' in comparison to the thickness of callused skin in producing the abnormal tissue stresses that create the pain from plantar callus without being 'insignificant'.

Using the table analogy. For me the 'table' produced when the callus is thick doesn't have to be a perfect table it only has to be slightly better than the uncallused 'table' to be significant. 'Better' meaning able to protect, in a relative sense, a more vulnerable area, a little more effectively for a little longer.

At this stage I think my idea is qualitatively sound but quantitatively it needs some support, ie yes theoretically it seems reasonable that a more protective arch is formed but the extent to which it shelters anything is likely to be very small possibly insignificant?

I am going to spend it little more time thinking about the factors contributing to 'significance' in this case.

Bill