Corns or calluses on toes are thickened skin deposits occurring in specific areas in response to pressure and shear force. In most cases, the pressure is caused by ill-fitting shoes, hammertoes, or arthritis. Corns may have black areas, pain, infections, and limit walking. If a corn has black spots in them, they are technically ulcers, because the black spots are blood deposits from breakdown in the dermis or deeper tissues. These areas may or may not be painful. In people with diabetes and some other disorders, the nerves may not function properly, people may not feel pain at all or until the corn has started to cause severe build up, an open wound or an infection. There are several different types of corns, they will be broken down into groups based on treatment and location.
Distal Hard Corns
Distal hard corns form on the tips of toes because of shear force and pressure. The shear force and pressure are caused by a contracture of the toe or hammertoe. When walking and shifting pressure from the rear of the foot to the front of the foot, the tips of the toes are forced into the ground. Therefore, distal hard corns are caused by disagreement between hammertoes and the ground, in most cases shoes have little to no bearing on distal hard corns – unless they are too small.
Conservative Treatment of Distal Hard Corns
There are only a few conservative treatments effective for distal hard corns. The most effective conservative treatment is called a crest pad. Crest pads can be made from different materials, bought in a store or made by a podiatrist. They function by elevating the tip of the toe by filling the dead space created by the hammertoe. The store bought ones often work, but may need some adjustments with time. We do not recommend corn “medicine”. These are compounds with a high concentration of salicylic acid, salacylic acid is designed to eat skin away, if the medicine gets on healthy skin, it can cause sounds.
Surgical Treatment of Distal Hard Corns
Surgical treatment is the only way to cure these deformities permanently. The corn is a symptom of the hammertoe and the hammertoe is a symptom of an unstable foot. Because the hammertoe is a structural deformity caused by bone, ligament, and/or tendons they need to be altered to regain the proper alignment of the toe. This can be done different ways and depends on your podiatrist’s preferences. Typically, the healing time is about 3-4 weeks with hammertoe surgery, assuming there are no complications.
Dorsal Hard Corns
Dorsal hard corns are most commonly found on the 2nd toe and 5th toe, however they can occur on any toe. They occur on top of the toe at the 1st toe joint known as the proximal interphalangeal joint (PIPJ). This type of corn is caused by pressure and shear force of a shoe at the joint, therefore this corn is strictly a problem between the hammertoe and the shoe.
Shoes that do not have enough height in the toe box will cause pressure across this area resulting in a corn. In some cases the hammer toe is so severe; no shoe will accommodate the deformity.
Conservative Treatment for Dorsal Hard Corns
Dorsal hard corns are caused by hammertoes not fitting in shoes properly. Conservative treatment can be effective in less severe cases. Conservative treatment options include sensible shoes, open toed shoes, stretching shoes, visco gel sleeves, custom molded digital appliance, and routine trimming of corns. Visco gel sleeves have been used with some success placed over the toes to absorb the sheer force and cushion the toe. Custom molded devices can be used with great success, these are constructed by podiatrist to reduce the pressure from shoe. Open toed sandals without straps across the toes will alleviate the pressure and the corn will go away. In some of my patients with severe deformities an X is cut in the shoe where the pressure is located. This quickly brings relief.
Surgical Treatment for Dorsal Hard Corns
Surgical treatment is much the same as it is for distal hard corns.
Interdigital Soft Corns
Interdigital soft corns occur between the toes and can occur in any of the interspaces. Usually one corn will form between the toes, however there can be a corn on the adjacent toe (communicating corn) as well. Interdigital corns can be very painful and come on quickly. Most are easy to trim by a skilled podiatrist. Interdigital soft corn are caused by bone spurs, arthritis, or enlarged toe joints creating excessive pressure between the toes.
Conservative Treatment for Interdigital Soft Corns
Conservative treatment is straight forward for interdigital soft corns. Putting something soft between the toes will help to alleviate the pressure preventing the corn from forming. There are several different types of toe separators and spreaders made from foam, felt, rubber, and Visco gel that work very well. The key is to cushion the pressure and reduce the shear force, these products work very well. Check out MyFootSupply.com Silicone Toe Separator Sampler
Surgical Treatment for Interdigital Soft Corns
Surgical treatment is the same as it is for the hammertoes in most cases. In years past Minimal incision surgery was performed by shaving off some of the bone responsible for the pressure. This surgery lost favor for various reasons.
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