Corns

The following signs and symptoms may indicate corns:

• Flesh-colored, dry, hard, rough papules with a whitish center (called the core), usually located over a bony prominence.
• A raised, hardened bump in which the center may be a dense knot of skin.
• Can cause pain when walking.
• A thick, rough area of skin.
• Tenderness or pain under the skin.
• Flaky, dry, or waxy skin.

Corns can be of the following types:

• Hard corns: Usually small and occur on the bony areas of the feet and hands.
• Soft corns: Whitish in color, with a rubbery texture, and may appear as an open sore that can be painful. They typically occur between the toes and in moist, sweaty areas of skin.

A callus is a section of skin that thickens due to friction, pressure, or irritation. It often occurs on the feet but can also develop on the hands, elbows, or knees. However, corns and calluses are not the same.

Calluses are usually asymptomatic, but if friction is extreme, they may thicken and cause irritation and mild burning discomfort.

A callus is less circumscribed than a corn, is usually larger, does not have a central core, and may or may not be painful.

The bones of the feet have many projections. Excessive pressure is applied to the skin overlying these bony projections either by poorly fitted shoes or by certain foot deformities, such as hammer toes.

The body attempts to protect this irritated skin by accumulating the outermost layer of the epidermis. However, this accumulation creates a prominence that further increases the pressure on bony projections, leading to a vicious cycle and ultimately resulting in the formation of corns and calluses.

Here are some intrinsic and extrinsic risk factors that can lead to the development of corns and calluses:

Extrinsic (outside) factors

• Poorly fitted or open footwear
• Irregularities in the shoes, such as a poorly positioned seam or stitching
• High heels
• Wearing shoes without socks
• Physical activities that lead to excessive pressure and friction, including running, jogging, and climbing
• Professions that cause repeated friction or pressure on skin, e.g., athletes or construction workers

Intrinsic (from within) factors

• Bony prominences
• Malunion fracture
• Faulty foot mechanics
• Cavovarus foot (a foot with an arch higher than normal, and that turns in at the heel)
• Toe deformity (claw, hammer, mallet)
• Short first metatarsal (the shortest of the metatarsal bones located at the base of the big toe)
• Hallux rigidus (stiff big toe)
• Transfer lesion from osteotomy or removal of adjacent metatarsal head
• Overweight

In most cases, doctors can diagnose corns and calluses through visual examination. However, other diagnostic methods include:

Medical history and physical examination

The doctor will inspect the feet for certain signs and symptoms of corns, focusing on the following:

• Patient's footwear and information about any previous treatments, such as osteotomies or orthoses.
• Patient's gait and alignment of feet for faulty mechanics.
• Location and characteristics of keratotic lesions.
• Problems with the structure of foot bones.
• Bone alignment.

Imaging tests

The doctor may perform the following imaging tests to determine the cause of corn formation:

• Dermoscopy: A noninvasive technique primarily used to examine skin lesions and areas affected by hyperkeratosis.
• Radiographs: X-rays of weight-bearing feet may help reveal any bony prominences contributing to corn formation.

Other tests

Additional tests used by healthcare professionals to investigate the underlying cause of corns and calluses include:

• Blood tests: Tests such as fasting glucose levels and rheumatoid factors are conducted to identify the etiology of foot deformities in some patients.
• Pedobarographic studies: Pressure studies (pedobarographs) of the feet can highlight areas of excessive pressure associated with corns.

Following are some tips to prevent corns and calluses:

• Wear properly fitted shoes. The shoes should neither be forcibly broken into nor should they be too loose. Instead, they should be comfortable to wear right out of the box.
• Allow a space of 1/2 inch between the end of the shoe and the longest toe. For athletic shoes, allow up to 1 inch.
• Check the width of the shoes. Adequate room should be allowed across the ball of the foot. The first metatarsophalangeal joint should be in the widest part of the shoe.
• The heel should fit snugly.
• Check the fit over the instep. A shoe with laces allows for adjustment of this area.
• Avoid activities that apply repeated friction or pressure to the skin.
• Wear gloves and properly fitted socks with no irritating stitching.

Corns and calluses can become a hindrance in daily life activities and may require treatment for a better quality of life. The principles of treatment should be:

• To provide symptomatic relief
• To determine mechanical etiology
• To formulate a conservative plan by advising on footwear and prescribing orthoses
• To consider surgery if conservative measures fail

The following treatment protocols may be considered for the management of corns:

• Manual removal: Use a nail file, emery board, or pumice stone immediately after bathing to manually remove hyperkeratotic tissue.
• Topical keratolytic agents: These agents facilitate lesion paring by softening the corns. They usually contain salicylic acid 12.6-40% as a pad or solution. Urea 20-50%, silver nitrate, and hydrocolloid dressings can also be used for this condition. More recently, hydrocolloid dressings with a hydrating effect on the skin have been evaluated as potential treatments for keratotic lesions. However, keratolytic agents must be used with caution, as overapplication can cause chemical burns. Neuropathic and immunocompromised patients should avoid these agents.
• Gentle paring, debridement, or enucleation: Pain associated with a callosity can be relieved to a certain extent by sharp debridement to reduce the amount of hyperkeratotic tissue. This procedure involves cutting off the lesion with a sharp scalpel blade and removing the central keratin plug, with the use of local anesthetic if necessary. It reduces the pressure on underlying dermal nerves, thus alleviating the pain. Recurrence can be prevented by gently trimming the lesion after soaking it in warm water for 20 minutes using a pumice stone.
• Laser therapy: The 2,940 nm erbium-doped yttrium aluminum garnet laser has been used to treat corns with minimal thermal tissue damage. The carbon dioxide laser has also been reported to be efficient. However, if the trigger factors are maintained, it might lead to recurrence of lesions in some patients.
• Cushioning and foot biomechanics/Orthoses: Cushioning and altering foot biomechanics can help prevent corns and treat existing ones. Orthotic devices are often prescribed to redistribute mechanical forces in the foot and allow a lesion to heal. Various types of orthoses, including doughnut-shaped corn pads, heloma shields, and silicone toe splints, relieve pressure from the tender central core in corns. Additionally, silicone sleeves release mineral oil, thereby softening the lesion. Interdigital wedges made of plastazote or orthodigital splints made of silicone promote healing of an interdigital soft corn.
• Surgery: Various surgical options are available for patients in whom conservative measures have not worked. In rare cases, surgery to correct an underlying problem of bone structure may be needed to treat a corn or callus that keeps returning and is not relieved by padding, shoe inserts, and periodic shaving.

Note: Diabetic patients with corns and calluses need to be cautious, as attempting any treatment of corns on their own may lead to excessive trimming and ultimately abrasion of the skin. Treatment should strictly be done by a specialist only.

Before treating corn, first evaluate the cause of friction. In many cases, they will go away on their own when the pressure or friction causing them stops. If protecting the corns from further irritation does not solve your problem, a podiatrist or GP may recommend the following home-care tips to get rid of them:

• Soak the affected area in warm water: You can soak the corn or callus in warm water for about 15-20 minutes or until the skin becomes soft.
• File or pumice the surface: You can file the corn and callus using a pumice stone. First, soak the pumice stone in warm water for some time, then use it in circular or sideways motions gently to file the corn or callus.
• Do not take off much skin: Be careful not to file the skin excessively, as this may lead to bleeding and infection.
• Keep the toenails trimmed: Long toenails can push against your shoe, causing a corn to form over time. Keep your toenails trimmed to remove this pressure.
• Use padding: Surround the corn with donut-shaped adhesive pads to prevent contact with the shoes. For calluses, cushion the affected area with moleskin to relieve pressure or further irritation. You can also create a "donut" with moleskin, lamb's wool, felt, or foam. Many pharmacies sell over-the-counter products to cushion corns and calluses.
• Wear properly fitted shoes: Tight shoes are the main cause of corns and calluses. It is advised to wear low-heeled shoes and choose shoes that are not too loose or tight. This reduces the irritation that caused the problem in the first place.
• Moisturize the skin regularly: Use a moisturizing lotion or cream with salicylic acid, ammonium lactate, or urea. These ingredients gradually soften the hard corns and calluses.

Though corns appear to be a minor health problem, they can take a severe shape if not treated in due time. Complications might include:

• Pain
• Tinea pedis (a fungal skin infection that usually begins between the toes)
• Ulceration and infection
• Septic arthritis
• Osteomyelitis

Post-surgical complications include:

• Digital swelling
• Numbness
• Infection
• Floppy or flail toe
• Deformity recurrence
• Joint and toe stiffness

The conventional method of treating corns involves surgery. However, this is not a permanent solution, as corns have a tendency to recur.

Alternative treatments such as homeopathy may be considered.

To read more, click here.

Usually, corns and calluses aren’t a serious problem, but these minor nuisances can interfere with everyday work. Therefore, it is important to manage them in a timely manner.

Consider the following general strategies and tips to manage corns and calluses:

• Calluses on hands can usually be prevented by wearing gloves while engaging in certain activities, such as gardening or lifting weights.
• Calluses on feet can usually be prevented by wearing shoes and socks that fit well.
• Corns on feet can be prevented by wearing shoes that have a wider toe box.
• Wear gloves while using tools, such as a garden spade or rake.
• Wear appropriate padding if you expose other parts of your body to friction. For example, if you are on your knees laying carpet, wear knee pads.
• A podiatrist may be able to help you make changes that can manage and prevent their occurrence.

In addition, foot problems are common in people with diabetes. You can prevent diabetes-related foot problems by taking care of your feet every day. Managing your blood glucose levels, also known as blood sugar, can also help keep your feet healthy.

Over time, diabetes may cause nerve damage, also called diabetic neuropathy, which can result in tingling, pain, and numbness in your feet. When you lose feeling in your feet, you may not notice a pebble inside your sock or a blister on your foot, which can lead to cuts and sores. These cuts and sores can also become infected. Hence, special care is paramount for diabetic patients. Here are a few things that you can do every day to keep your feet healthy:

• Check your feet every day.
• Wash your feet every day.
• Smooth corns and calluses gently.
• Trim your toenails straight across.
• Wear shoes and socks at all times.
• Protect your feet from hot and cold.
• Get a foot check at every health care visit.