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Differential Diagnosis & Pitfalls

• A clavus, or corn, is a painful hyperkeratotic lesion with a central core that lacks pinpoint thrombosed capillaries and retains normal skin dermatoglyphics. Clavi occur in sites of pressure and repeated friction.
• Foreign body reaction, which may have a history of trauma or inoculation.
• Acquired digital fibrokeratoma tends to have a smoother and more pedunculated appearance with a collarette of normal skin.
• If the patient has recently traveled to a tropical area, consider tungiasis (infestation with a burrowing flea into the sole of the foot). Look for a firm, white papule with a central black dot.

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