Corn

Overview of Corn

It is thicker than a callosity and causes more concern to the patient. This occurs at the site of friction and often spontaneously disappears when the causing factor is removed.

Often corns are multiple and bilateral. Corn can be commonly hard in the sole or rarely soft corn do can occur between 4th and 5th toes due to friction of bases of adjacent proximal phalanges.[2]

Location: It is common in soles, tips of toes.

Epidemiology

The prevalence of foot problems in an Indian population was studied.

• Reference: The prevalence of foot problems in an Indian population – DiabetesontheNet (https://diabetesonthenet.com/wp-content/uploads/ pdf/dotn6877e4c72098e1df1399b43ccc7058c5.pdf)

The study does not explicitly mention the year of publication, but it references other studies published between 2004 and 2013.

This study looked at the prevalence of foot problems, including corns and calluses, in an Indian population.

Causes 

Generally, Corns are caused by friction and pressure from repeated actions. Some sources of this friction and pressure i.e.:

Wearing ill-fitting shoes and socks-

• Tight shoes and high heels can squeeze areas of the feet.
• If your shoes are loose, your foot may repeatedly slide and rub against the shoe.
• Your foot may also rub against a seam or stitch inside the shoe. Socks that don’t fit right can also be a problem.

Skipping socks-

• Wearing shoes and sandals without socks can cause friction on your feet.

Playing instruments or using hand tools-

• Corn on the hands may result from the repeated pressure of activities such as playing instruments and using hand tools or even a pen.

Inheriting a tendency to develop corns-

• The type of corn that forms on non-weight-bearing areas, such as the soles and palms (i.e. keratosis punctata), might be caused by genetics.

Classification 

Two Types of corn:

Firstly, Hard corn:

• It is localized area of thickening over a bony projections like heads of metatarsals.
• Histologically it differs from callosity by having severe keratoses with a central core of degenerated cells and cholesterol.
• It presses over the adjacent nerves causing pain. It can get infected causing severe pain and tenderness with inability to walk.

Secondly, Soft corn:

• Soft Corn It usually occurs between 4th and 5thtoes due to friction of bases of adjacent proximal phalanges.[3]

Risk Factors of Corn

• Pressure and friction: Repeated rubbing and pressure on the skin, often from ill-fitting shoes or abnormal foot mechanics.
• Bony prominences: Areas of the foot with prominent bones are more susceptible to pressure and friction.
• Foot deformities: Conditions like hammertoes, bunions, or flat feet can alter foot mechanics and increase the risk of corns.
• Occupation and activities: Occupations or activities that involve prolonged standing or repetitive movements can contribute to corn development.
• Age: Older individuals may have thinner skin, making them more prone to corns.
• Reduced sensation: Conditions that reduce sensation in the feet, such as diabetes or peripheral neuropathy, can increase the risk of corns because the person may not feel the pressure or friction that leads to their formation. [8]

Pathogenesis of Corn

• Hyperkeratosis: Repeated pressure and friction on the skin stimulate excessive production of keratin, a protein that forms the outer layer of the skin. This leads to thickening of the stratum corneum (the outermost layer of the epidermis).
• Cone-shaped formation: The thickened keratinocytes form a cone-shaped mass with the apex pointing inwards towards the dermis.
• Pressure on underlying tissues: The apex of the corn can press on underlying nerves and soft tissues, causing pain and discomfort.
• Inflammation: The pressure and friction can also lead to inflammation of the surrounding skin. [9]

Pathophysiology

• The repeated friction and pressure of the skin overlying the bony prominences leads to a hyperkeratotic thickness.
• Corn consists of severe keratoses with central degenerated dead cells and cholesterol.[3]
• This latter is a protective body reaction that produces an excess of horny epithelial layer to prevent skin ulceration.
• This explains the preferential location of corns next to the condyles of the metatarsals and phalanges as well as the occurrence of corns in patients with a foot deformity.[5]

Clinical Features of Corn

Circumscribed hyperkeratotic lesion: A well-defined area of thickened skin with a hard, rough surface.

Cone-shaped core: A central core of hard keratin that points inward towards the dermis.

Pain and tenderness: Pressure on the core can cause pain, especially when walking or wearing shoes.

Location: Commonly found on the dorsum (top) of toes, especially the fifth toe, and on the plantar (bottom) surface of the foot, particularly over the metatarsal heads.

Types:

• Hard corns (Heloma durumum): Smaller, denser, and more painful than soft corns. Often found on the tops of toes or on the soles of the feet.
• Soft corns (Heloma molle): Whitish, rubbery, and macerated due to moisture. Typically found between the toes, especially the fourth and fifth. [10]

Sign & Symptoms of Corn

• A thick, rough area of skin
• A hardened, raised bump
• Tenderness or pain under the skin
• Flaky, dry or waxy skin [3]

Clinical Examination of Corn

Inspection:

• Location: Note the precise location of the corn, whether it is on a bony prominence, between toes, or elsewhere.
• Appearance: Observe the size, shape, and color of the corn. Hard corns are typically yellowish and have a well-defined, round or oval shape. Soft corns are whitish and may appear macerated.

Palpation:

• Texture: Assess the texture of the corn. Hard corns are firm and have a hard central core. Soft corns are softer and more pliable.
• Tenderness: Determine if the corn is tender to palpation, especially on direct pressure over the central core.

Assessment of surrounding skin:

• Erythema: Look for redness or inflammation around the corn, which may indicate irritation or infection.
• Callus: Check for the presence of surrounding callus formation, which is common with corns.

Foot examination:

• Deformities: Assess for any underlying foot deformities, such as hammertoes, bunions, or flat feet, which can predispose to corn development.
• Gait analysis: Observe the patient’s gait to identify any abnormal foot mechanics that may contribute to pressure and friction.

Neurological examination:

• Sensation: Assess for any sensory deficits in the feet, especially in patients with diabetes or peripheral neuropathy, as this can increase the risk of corns and complications. [8]

Diagnosis of Corn

• Your health care provider will likely diagnose corns by examining your feet.
• This exam helps rule out other causes of thickened skin, such as warts and cysts.
• Your health care provider might confirm the diagnosis by paring away a bit of hardened skin if it bleeds or reveals black points (dried blood), it’s a wart, not a corn.[4]

Differential Diagnosis of Corn

• Plantar wart
• Poroma
• Warty dyskeratoma
• Calcinosis cutis
• Gout and pseudo gout
• Hypertrophic lichen planus
• Interdigital neuroma
• Lichen simplex Chronicus
• Palmoplantar keratoderma
• Keratosis punctata of palmar creases
• Porokeratosis plantaris discrete
• Porokeratosis palmoplantar et disseminate [5]

Complication of Corn

• Ulceration
• Tenia pedis
• Septic arthritis
• Osteomyelitis [5]

Investigations for Corn

Paring: Paring (shaving) of the lesion can help to confirm the diagnosis and differentiate corns from warts. Warts often have small black dots (thrombosed capillaries) or pinpoint bleeding when pared, while corns do not.

Radiography: X-rays may be useful in identifying underlying bony abnormalities, such as osteophytes (bone spurs) or exostoses, which can contribute to the development of corns.

Biopsy: Biopsy is rarely required for the diagnosis of corns but may be considered in atypical cases or if there is suspicion of another underlying condition, such as a squamous cell carcinoma.

Microbiological culture: If there are signs of infection, such as erythema, warmth, or purulent discharge, a swab can be taken for microbiological culture and sensitivity testing to identify the causative organism and guide antibiotic therapy.

Other investigations: Depending on the clinical context, other investigations may be necessary to rule out underlying conditions that can predispose to corn development, such as diabetes mellitus (fasting blood glucose, HbA1c) or peripheral neuropathy (nerve conduction studies). [8]

Treatment of Corn

It involves avoiding the repetitive actions that caused them to form. Wearing shoes that fit and using protective pads can help.

If a corn persists or becomes painful despite your self-care efforts, medical treatments can provide relief:

Trimming away excess skin:

• Your health care provider can pare down thickened skin or trim a large corn with a scalpel.
• This can be done during an office visit.
• Don’t try this yourself because it could lead to an infection.

Medicated patches:

• Your health care provider may also apply a patch containing 40% salicylic acid.
• Such patches are sold without a prescription.
• Your health care provider will let you know how often you need to replace this patch.
• Try thinning the thickened skin with a pumice stone, nail file or emery board before applying a new patch.
• If you need to treat a larger area, try non-prescription salicylic acid in gel (e.g. Compound W, Keralyt) or liquid (e.g. Compound W, Duo film) form.

Shoe inserts:

• If you have an underlying foot deformity, your health care provider may prescribe custom-made padded shoe inserts (in other words, orthotics) to prevent recurring corns or calluses.

Surgery:

• Your health care provider may suggest surgery to correct the alignment of a bone causing friction. In brief, This type of surgery can be done without an overnight hospital stay.[4]

Prevention of Corn

• Wear shoes that give your toes plenty of room- If you can’t wiggle your toes, your shoes are too tight. Have a shoe shop stretch your shoes at any point that rubs or pinches. Shop for shoes when your feet are most swollen, usually at the end of the day. If you use orthotics and inserts, be sure to have them on while fitting your shoes at the store.
• Use protective coverings- Wear felt pads, nonmedicated corn pads or bandages over areas that rub against your footwear. You can also try to separators or some lamb’s wool between your toes.
• Wear padded gloves when using hand tools- try padding your tool handles with cloth tape or covers.[4]

Homeopathic Treatment of Corn

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Corn:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy. potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Antim Crudum:

• Presence of large, horny corns on feet which may or may not be inflamed.
• Antimonium Crudum is also one of the best medicines for corns where the corns are very tender.
• Pain is felt in the corns while walking.
• This homeopathy medicine can help when the feet are covered with too many corns which make walking difficult.
• Also, it is the best medicine to treat corns that are too pointed and hard to touch.
• Further, it also helps those patients who are higher in weight which may cause pressure due to which these corns may erupt.

Silicea:

• Silicea is another of the top-grade medicines for corns.
• Excellent results in patients with soft corns with the use of Silicea, which is natural and therefore, safe.
• Soft corns mainly appear between the toes.
• Silicea is one of the most effective.
• The characteristic symptoms – corns between the toes may be sore and painful.
• Patients may also feel burning or tearing pain in these corns.
• Silicea also works wonders in cases of corns between toes that tend to suppurate (discharge pus).
• Excessive sweat with an offensive odours may be present on the foot where the corn is located.

Hepar Sulph:

• Hepar Sulph is one of the best choices of medicines for corns that tend to suppurate (have pus formation).
• I have seen many corn cases with pus formation heal magnificently well with the use of Hepar Sulph.
• The kind of corns for which Hepar Sulph would be the most suitable prescription are corns infected with pus formation and pricking pains.
• Burning, stinging pains may also be experienced in cases where Hepar Sulph would be one of the ideal medicines for corns.
• Such corns may also be highly sensitive to touch.

Sulphur:

• When there is a burning pain that the patient experiences in the soles and the corns, then this condition can be treated with the help of Sulphur which also ensures that the hard coating of corn quickly yields from the very first dose or application.
• This also helps those patients who find their feet sweating excessively due to the development of these corns.

Nitric Acid:

• Nitric Acid is best medicines for corns that are very painful.
• The guiding feature for prescribing Nitric Acid as the most suitable among medicines for corns is the presence of corns with either splinter-like or sticking pains.
• In cases where the most prominent symptoms are thick, indurated (in other words, hardened) corns on the feet with pressing, tearing, aching and drawing pains.

Lycopodium:

• When walking around with the corn causes a dull pain and persistent ache, then the patient can use this medicine.
• This medicine also helps in treating symptoms like pain in the heels when the patient steps on something hard.
• Lycopodium is also one of the best medicines for corns which are inflamed and result in sore, stinging, burning pains.[6]

Thuja:

• Thuja is specifically, deep acting medicine.
• Moreover, Thuja is indicated in very fleshy persons with dark complexion, black hair and unhealthy skin.
• Thuja personality have tendency for overgrowth of tissues also hyperkeratosis.
• Additionally, People with recurrent tendency of corns responds well to Thuja.
• Besides this, Aggravation from damp weather.
• Lastly, Perspiration is oily and sweet smelling or sometimes offensive.[6]

Diet & Regimen of Corn

Regimen and diet for Corns 

Diet for Corn Prevention and Foot Health:

While no specific diet directly eliminates corns, focusing on overall foot health and skin integrity can help prevent them:

• Vitamin C: Adequate vitamin C intake supports collagen production, which is essential for healthy skin. Include citrus fruits, berries, and leafy greens in your diet.
   
• Zinc: Zinc plays a role in wound healing and skin health. Good sources include beans, nuts, and whole grains.
   
• Hydration: Staying well-hydrated helps maintain skin elasticity and overall health.
   

Regimen for Corns:

• Offload the Pressure: Reduce pressure on the affected area by wearing comfortable, well-fitting shoes. Avoid high heels and shoes with pointed toes.
• Cushioning and Padding: Use padding or corn cushions to protect the corn from further friction and pressure.
   
• Soaking and Exfoliation: Soak your feet in warm water to soften the corn. Gently exfoliate with a pumice stone to reduce thickness.
   
• Moisturize: Keep the skin around the corn moisturized to prevent dryness and cracking. 
   
• Avoid Self-Treatment: Do not attempt to cut or shave the corn yourself, as this can lead to infection.
• Professional Care: Consult a podiatrist for professional corn removal or treatment options like medicated pads or orthotics.

The Do’s & Don’ts 

Do’s:

1. Wear comfortable, well-fitting shoes: Choose shoes that have ample space for your toes and do not rub or pinch any areas of your feet.
2. Use padding or orthotics: If you have bony prominences or foot deformities, use padding or orthotics (custom-made shoe inserts) to reduce pressure and friction.
3. Soak your feet in warm water: Soaking your feet in warm water for 10-15 minutes can help soften corns and make them easier to remove.
4. Use a pumice stone or foot file: Gently rub a pumice stone or foot file over the corn to reduce its thickness. Be careful not to rub too hard, as this can irritate the skin.
5. Apply moisturizing cream: Keep the skin around the corn moisturized to prevent dryness and cracking.
6. See a podiatrist (foot specialist): If the corn is painful, recurrent, or does not improve with home care, consult a podiatrist. They can safely remove the corn and offer advice on preventing future corns.

Don’ts:

1. Don’t try to cut or shave the corn yourself: This can lead to infection and other complications. Always leave corn removal to a healthcare professional.
2. Don’t use over-the-counter corn removers: These products often contain harsh chemicals that can irritate or damage the skin.
3. Don’t ignore the corn: If a corn is painful or interfering with your daily activities, seek treatment from a podiatrist.
4. Don’t continue wearing ill-fitting shoes: If your shoes are causing the corn, stop wearing them and choose more comfortable footwear.

Important Note: If you have diabetes or poor circulation, it is crucial to consult a healthcare professional for any foot problems, including corns. These conditions can increase the risk of complications, such as infections and ulcers. [8]

References use for Article Corn

1. SRB’s Manual of Surgery, 3rd Edition
2. Clinical Surgery S. Das.pdf
3. SRB’s Clinical Methods in Surgery
4. https://www.mayoclinic.org/diseases-conditions/corns-and-calluses/diagnosis-treatment/drc-20355951
5. cbi.nlm.nih.gov/books/NBK470374/#:~:text=The%20differential%20diagnosis%20of%20a,Warty%20dyskeratoma
6. https://www.drhomeo.com/corns/ homeopathic-medicines-for-corns/
7. The prevalence of foot problems in an Indian population (https://diabetesonthenet.com/wp-content/uploads/ pdf/dotn6877e4c72098e1df1399b43ccc7058c5.pdf)
8. Rook’s Textbook of Dermatology, 9th Edition (2020), edited by Christopher Griffiths et al., and published by Wiley-Blackwell
9. Andrews’ Diseases of the Skin: Clinical Dermatology, 13th Edition (2020) written by William D. James, Timothy Berger, and Dirk Elston, and published by Elsevier
10. Fitzpatrick’s Dermatology in General Medicine, 9th Edition (2019), edited by Klaus Wolff, Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy S. Paller, and David J. Leffell, and published by McGraw Hill Medical