Corns

Summary

A corn is a prominent, painful thickening of skin, usually associated with the web spaces between the small toes. Corns are often related to increased skin pressure caused by bony prominences that irritate the skin, causing thickened skin to develop. Non-operative treatment is usually successful and is oriented towards off-loading the callused area with various pads and spacers. Surgery is rarely indicated, but when it is, the goals include addressing the underlying reason why the corn has developed – usually removing a prominent bone spur and possibly straightening the affected joint of the involved toe.

Clinical Presentation

Patients with corns describe a painful lump on one of their smaller toes. This can be quite uncomfortable, as it often rubs right up against the adjacent toe or is painful when walking.

Physical Examination

Clinical examination will identify a callused area on the side of the involved toe. The area is often painful to touch. In advanced cases, there may be a breakdown in the thickened skin, leading to discharge and potentially an open wound. There is often a prominent bone underlying this thickened skin region. This bony prominence is usually the reason the corn has formed. Corns are typically associated with the joints in the small toe.

Imaging Study

Occasionally it is helpful to perform an x-ray of the affected foot. This can allow identification of an associated bony prominence and allows checking the status of the nearby joints of the toes and foot.

Treatment

Non-Operative Treatment

Treatment is usually non-operative and is oriented towards protecting the painful area of thickened skin. Non-operative treatment typically includes:

A padded corn sleeve: This is a protective sleeve that slides over the toe, covering the corn. Essentially it provides padding to disperse the force from the surrounding toes over a wider area, thereby reducing the load on the corn.
Toe spacers: Small toe spacers can be placed between the involved toes to help reduce pressure on the corn. This can improve symptoms significantly. These can be made from a variety of materials, including gel, foam, and lamb’s wool.
Corn donut (doughnut): Padded donut-shaped device that surrounds the corn, distributing pressure to a wider area while off-loading the painful central area.
Regular trimming of calluses: If the corn is associated with a large callus, this can be trimmed or shaved back resulting in an immediate improvement in symptoms. For many corns, it is often best to have this done by a trained healthcare professional. Unfortunately, trimming the callus does not address the underlying reason why the corn has formed. Therefore, the corn usually reoccurs in a matter of weeks requiring repeated trimming.

Surgical Treatment

Occasionally, surgery is required to address a painful corn that has failed an attempt at non-operative management. The surgery is oriented towards addressing any bony prominence associated with the development of the corn, either on the involved toe or adjacent toe. At the time of surgery, it may also be necessary to straighten out one of the associated small joints (interphalangeal joints) of the involved toe. This can be quite successful in addressing the corn, but it is also associated with the problems inherent in operating on the toes, specifically that there is now going to be excessive swelling in this area and that there is the very real potential for a complication such as: infection, wound healing problems, nerve injury, vascular injury, and associated joint stiffness.

Edited on June 9, 2020

mf/ 7.10.18