Common foot complaints

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Corns

Disorder
Corns

Definition
Most corns are effectively a type of callus, and may be associated with areas of callused skin. They are commonly found on the ball and heel of the foot, and overlying the small joints and apices of the lesser toes. They may also be found between toes.

Corns are indicative of abnormal forces being applied to a specific area of skin. These forces are usually intermittent. As with calluses, it needs to be borne in mind that a corn in itself is not a distinct condition, but a complication. A corn will only present due to an abnormality of structure or function, or due to excessive external forces. It is the cause that first needs to be addressed.

There are different types of corns. They differ in regard to their size and location. The most common type of corn is a hard corn. As their name suggests they are hard to the touch and may feel like a small stone in your shoe while walking. They appear as hard round masses of yellow callus and are generally uncomfortable / painful on direct compression.

Another common type of corn appears between the toes, this is a soft corn. Soft corns do not have a hard central mass to their structure, like that of the hard corn. They tend to have a thin central area surrounded by white macerated skin. Soft corns are usually very sore when opposing toes move against each other.

Incidence / Age
Corns present on the feet of all age groups, but are a rare finding in children. There is an increased prevalence of corns with increasing age.

Treatment
All corns require treatment. It is always best to seek advice from a State Registered Podiatrist / Chiropodist as soon as you identify a lesion on the skin you suspect as being a corn. The earlier a corn is treated properly the greater the likelihood of full remission.

Self treatment
Self treatment should only involve footwear modification or selection and dressings. It is inadvisable to ever try to remove or reduce a corn by oneself. Never try to cut a corn out as the likelihood of infection is high. Corns that are poorly removed may become more fibrous and difficult to resolve when treated appropriately.

Shoes: As a first line of treatment look closely at your footwear. Identify the area of the shoe that would be in contact with the area of skin presenting a corn. Always choose a shoe that has a restraint such as laces or a strap holding the foot from moving forward. The toe box of the shoe should not touch the tops of the toes. Avoid high heels and look for shoes that have a spongy / shock absorbing quality to the sole.

Corn Plasters and Dressings: Dressings can be used to deflect pressure away from a corn. A classic corn pad will be a circular or oval shape with a central aperture for positioning over the corn. This type of dressing will deflect pressure from the corn but will do little to reduce the size of the lesion. Some corn plasters or pads have a cover to be placed over the corn that contains an acid. This acid is used to reduce the corn. These types of dressings should always be avoided. The extent to which the acid will reduce the skin is variable between individual skin types. In some people one acid may be virtually ineffective whereas in another person the same acid could cause ulceration of the skin. Dressings containing acids are always contraindicated for any person that is diabetic, has a poor circulation, thinned skin or heals slowly for whatever reason. For these individuals acids must not be used other than by the prescription of a health care professional.

Clinical and biomechanical treatments
If you believe that you may have a corn, it is advisable to seek a consultation with a State Registered Podiatrist / Chiropodist. The Podiatrist will make a full assessment and advise you as to treatment lines available. These treatment lines often include a combination of those listed below.

Enucleation: Enucleation is an operative technique that is used to reduce a corn so that it is no longer painful. This procedure is carried out using a sterile disposable scalpel. The procedure is quite painless and the positive effect from enucleation can be felt immediately.

Enucleation is not however a cure. It is usually used as part of a treatment line to alleviate symptoms. The corn will return if the cause has not been fully addressed. It is commonly believed that corns have roots, and that if the root is not removed the corn will re-grow. This is not the case. A corn is a stress reaction by the skin and the corn will return because the stressor has not been addressed. It should be noted that some structural abnormalities that result in the formation of a corn cannot be addressed conservatively, and for this reason some people may require regular enucleation of corns to alleviate symptoms and prevent associated complications.

Acids: Podiatrists will sometimes use acids in the treatment of corns. These acids are chosen and applied carefully, to achieve a particular therapeutic effect.

Electro surgery: Some podiatrists employ electro surgical equipment in the treatment of corns. A high frequency current is used to destroy the corn and some surrounding tissue. For certain types of corns this treatment may be more effective that enucleation. The procedure is carried out under a local anaesthetic. Dressings / Padding / Digital Devices: Podiatrists often use different types of devises to redistribute stress away from a corn or area prone to the development of such a lesion. These devices may be made from a large variety of materials and differ significantly in design, depending upon their application.

Biomechanics: Corns are as stated previously a stress reaction. The cause of this stress, when not purely footwear related, is either structural and / or functional. Once the stressor has been identified the Podiatrist may manufacture an insole / orthotic to accommodate or compensate for the abnormality. Such orthotics are usually easily accommodated in foot wear and are generally found to be comfortable. Orthotics may not always cure the presenting corn but will help reduce discomfort or pain experienced, and increase the duration between visits to the Podiatrist.

Surgical
For some people surgery may be employed in the treatment of painful corns. Surgery will usually address a structural or functional deformity, which contributes to the formation of a corn, often with excision of the corn as part of the procedure. Surgery is carried out as a curative procedure.

Outcome / Prognosis
Corns always require consultation with a State Registered Podiatrist / Chiropodist. If treated early they can often be fully resolved. There are a variety of treatments available for corns that can cure or alleviate presenting symptoms. Corns should not be a cause of concern if professional advice is sought.

Recommended links

http://www.feetforlife.org

 

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Corns - Common Foot Complaints - Birmingham Foot Clinic