ALL ABOUT CORNS

A corn is a hard area on the foot, usually on the top part of the toes where the shoe presses in. These can often be debilitating to athletes, when any pain can be detrimental to performance. This corn got its name from the Latin word Cornu, which means horn. Actually, these used to get so large that they would stick out like a horn and in rare cases, they do now. These areas are causes by the pressure on the toe or foot on certain areas that damages and may eventually kill the skin. This pressure causes the skin to die through the dermal (inner) layer of skin and almost to the bone itself. In some cases, it does erode through the full thickness of the skin and causes a rather deep sore. This especially occurs in diabetics and others who have poor circulation or diminished sensation from any cause.

Before we go any further, I would like for you to try a little experiment. Take a drinking glass that is clear, clean and smooth. put your fingers inside the glass and press on the inside of the glass until you see the fingertips become pale. The paleness is related to a diminished blood supply getting to the area. This is why corns develop, because of too much pressure in a small area; therefore, the skin can die and build up as hard layers in that case.

Soft corns occasionally will occur. The same process is taking place. They just don't get enough circulation in that area because the two toes are pressed together. The soft corn usually occurs between the fourth and fifth toes. This is nothing more than excessive pressure in this area. If there is some way you can relieve the pressure of the two toes pressing against each other, the corn goes away. The best way is to put some gauze or a silicone sleeve between the toes so there is actually a space left between the toes where the corn is located. Of course, this requires that your shoe width and depth permits this to be inserted without undue pressure on other parts of the foot! Sometimes, the bony prominence of the inside of the toes has to be removed. This has to be done surgically and frequently and it can recur in another area if shoes that are too tight are worn. Surgery is not a 100% guarantee that you will never have a corn in that area again.

One procedure that has given rather good results in the last few years is taking the skin from between the toes out and then sewing the toes together partially. This sounds kind of gruesome, but actually it turns out to be one of the better ways to get rid of the corns in a more permanent way. This is called a syndactylization of the toes. Some people are born with this type of structure between the toes, a sort of web between the toes. The toes cannot be separated fully but they do well. Syndactylization of the toes is a very acceptable procedure, but is usually done as a last resort. In resistant cases of soft corns between the toes, this probably should be considered strongly. Remember, you can get rid of soft corns the easy way by keeping the toes from pressing against each other. Hard corns can be gotten rid of by increasing the height of the shoe housing for the forefoot so the toes do not press on the shoe.

It is amazing what human beings will go through, especially the fairer sex when it comes to wearing shoes. They try to squeeze their feet into a shoe that is about half the size they should normally be wearing. This doesn't give them the proper amount of room. The proper amount of room can be determined by placing the foot on a piece of paper and tracing around it while you are standing. To see if your present shoes are large enough, set your shoe down on that shadow and if you can see any of the line after you get your shoes over this, then your shoes are too small! Of course, if you intend to wear orthoses in your shoes, always make sure your shoes are large enough to accommodate them. Usually non-prescription corn remedies are worthless and may cause problems. If all else fails, and the corns persist and present significant problems, the offending bony prominences may be surgically removed. This is almost always successful, but it may take several weeks to fully recover.

REFERENCES

1.Bonavilla, E.J., Histopathology of the Heloma Durum: Some Significant Features and Their Implications. J.Sm. Podiatry Assoc., 58:423, 1968.

2.Galland, W.I., An Operative Treatment for Corns. J.A.M.A., 100:880, 1933.

3.Giannestras, N.J., Shortening of the Metatarsal Shaft for the Correction of Plantar Keratosis. Clin. Orthop., 4:225, 1954.

4.McElvenny, R.T., Corns: Their Etiology and Treatment. Am. J. Surg., 50:761, 1940.

5.Mann, R.A., and DuVries, H.I., Intractable Plantar Keratosis. Orthop. Clin. North Am., 41:67, 1973.

6.Rutledge, B.A., and Green A.I., Surgical Treatment of Plantar Corns, U.S. Armed Services Med. J. 8:219, 1957.

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