As mentioned in a previous Blog, I’d like to present case-studies on interesting cases that I/we see here at Silver Podiatry. As I’m (Elan) the filter and usually author of them, they’ll usually be the wins because, well, I think we’re pretty awesome. But sometimes, things don’t go to plan.
Recently, a patient expressed dissatisfaction, feeling that their treatment for a troublesome corn was ineffective. Despite our efforts, including deep enucleation (using a scalpel blade to get the core out), chemical cautery and organising imaging to determine if a bone spur was an internal cause, the patient became frustrated. I'd like to take this opportunity to clarify the situation and provide further insight into the complexities of treating corns.
In this particular case, the corn was located on the side of the big toe at the first joint (not the bunion joint). There was an obvious circular core with an underlying whiteish solid base at the bottom of the corn. Experience would suggest that this mass would be scar tissue as a long-term corn can cause damage to the deeper layer of skin causing scarring. I’ll jump ahead and state that it is not a wart (which is a skin viral infection)
How does a corn grow?
Typically, when skin is under pressure or twisting forces (which happens at this joint a lot!), the outer layer thickens to protect the skin; this is callus. BUT the pressure against it pushes it into the middle layer of skin; now it is a corn. This can become a self-perpetuating problem – as the callus and corn grows it creates more pressure which fuels its growth, and so it gets deeper. If it starts impacting the third layer of skin, the deeper part, it can cause scar tissue. Scar tissue, being thicker and less flexible than normal skin, can create excess pressure on underlying skin layers, leading to the development of a corn.
Treatment of a corn is debridement and enucleation – shave the top off (the callus) then remove the core (dig the corn out). Sometimes this can be a single treatment as the skin settles, but if the cause behind it continues, the corn will return. So we also address the cause behind the corn.
Some corn causes and treatments:
The movement of the foot, biomechanics, can cause the corn if the foot rolls in and on to the side of joint – direct pressure or the skin gets pinched. So we can stop that movement with padding in the shoe or even consider an orthotic/innersole. If the shoe sole has compressed, the foot may sit lower in the shoe and get rubbed from the material or seams (don’t forget the seam in socks). Tight or the shape of the shoe toebox can cause direct pressure; we may be able to stretch the shoe, but they may need to be replaced.
A silicone sleeve with a donut-hole cut-out to protect and reduce direct pressure on the corn can be fashioned, either pre-fabricated or custom-made by us. While filler injections are not currently within our scope, we can enquire about their availability.
It's important to note that surgical excision of scar tissue often results in more scar tissue formation and is therefore not recommended as a first-line treatment. However, if it becomes necessary, we can assist in the healing process post-surgery to minimise the area affected, although this would require avoiding pressure on the area during the healing period.
We’ve discussed the external causes, but sometimes a corn can be an internal issue. X-Rays were organised to see if a bony spur was rubbing on the inside of the skin, which was not the case here. This was important to do as the results here would change the treatment for a corn.
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