Are "Corns" Curable?

Hi Mark,

Would you buy a second hand car from me? I hope the hand's OK.

As I remember it you were working on the car with your tie on and the engine running, the tie got caught in the fan belt, you put your hand in to pull it out and the fan hit your hand and you pulled out a plumb?

Hope life's treating you well.

Bill

 

Bob,

I had to come back on your reply again.

I think you have demonstrated the simple complexity of the subject and you have demonstrated that it's even more complex than I was suggesting.

Unless you have been very unfortunate in your practice the intellectual profile of your patients is likely to be pretty similar to that of any other practitioner anywhere in the world it or at least in America. Therefore, if your patients, my patients and Kevin's patients find it just about impossible to grasp the relationship between pressure, corns and pain I would suggest that their resistance to understanding is just one aspect of the psychological complexity of all patients if not all human beings. Ourselves excluded of course, unless you feel that by excluding ourselves I am suggesting that we are something other than human?

While I was ranting on in my initial post I totally ignored the fact that on the other side of the foot is a human being or at least a patient. With just a foot in front of you, so to speak, your chances of curing a corn are slim but add the confounding factor, ie the rest of the humanbeing and the idea of cure is rapidly replaced by the need to survive.

As Mrs. Boufler used to say, 'Oh, I wouldn't start from here'.

Bill Donaldson

 

Its nice to see patients are the same the world over.

I was mulling on this.

Can we cure corns? Only very rarely.

Can patients cure their OWN corns with our help? Yes.

This is one of those where the clinician / client contract is particularly important. It is important to remember that it is not our job to cure patients corns, or anything else. It has to be a team effort.

We can tell patients how to cure their own corns. Whether or not they choose to take that advice is up to them, but it is well to be very clear about that. The word "empowering" is probably going to come up any time now.

Dorsal, and often plantar corns are often curable, or at the least treatable. However it is well to remember that they are coming back during the time the patient is out of your office. You can tell them what to do to prevent / slow them down in that time but you can't make them do it. And that is THEIR choice in much the same way as over eating or smoking. Nothing wrong with that that. Personal responsibility is a fine thing. So long as they are clear.

I think of it thus the corn is there because of the shoes. Its up to you whether to change your shoes and get rid of the corn or keep both. I personnally don't mind either way because its not my foot which hurts.

Regards
Robert

 

yawn :0) is anyone really interested

 

Having just discovered 'podiatry arena' I was trying to describe it's attraction to someone. I described 'podiatry arena' as being like the wild west and lo and behold here we were sitting in the saloon having a quite drink and a chat about a subject that occupies 90% of the time of 90% of podiatrists when the salon doors burst open and in staggers a pugilistic pom making his point with his fists.

Quick, invite him over to our table, put a drink in his hand and get him talking. I sure he has something useful to say if we keep his hands occupied.

Bill Donaldson

 

Hello Bill

How are you? Me and Al are going to Vienna soon so will be thinking and talking about you over Christmas.

I told you London was just a big Tranent and now look at you in France, in a pub and looking for a fight. What's changed?

Take care and love and kisses from downunder.

toeslayer
The podiatrist previous known as Syd

 

ROFLMAO!!!!

 

netizens

Just reading through the thread again and have to say what an interesting topic it has turned out to be.

I recall previously posting a piece on my "cork screw theory" of skin biomechnics and the reactions recorded. Nil.

Just in case it may add another dimension to the current discussion I wil restate it.

Three dimensional movement of the kinetic foot meets with reactive forces (Newtons 3rd Laws). Unable to act in the original direction the reactive forces resolve to a corkscrew effect pin pointing a local area of skin and anchoring it against the bone beneath. This is done intermittently corresponding to the stance phase of gait (ground reaction). When the nuclear envelope of the keratin cells are eventually damaged they trigger a 'biochemical feedback' which controls the future epithelial grown specific to that area. The cork screw effect explains the physical presentation of the corn ie conical shape of the clavus (corn); and the biochemical factor (enzyme?) why corns are not curable.

The only way forward is to dissect the hyperkeratosis on a regular basis due to the cyclic nature of the cell reproduction (28 days). By physically reducing the bulk then temporary pain relief is achieved. This was discovered in antiquity and the Greeks developed the scalpel for the occassion.

What say you?
toeslayer

 

Dear Robert,

I am mightily encouraged by you acronymic accolade and will continue to do everything in my power to live up to it.

Dear Toesplayer,

Don't be encouraged by the lack of response. From my point of view this debate on corns has, in the immortal words of Karen Carpenter, 'only just begun'.

Using the medium of print often makes it very difficult to understand someon elses ideas. I need to ask questions to increase my chances of understanding.

I will only ask one at a time and will bang away at it until I think I understand or until you, I or anyone else who wants to contribute decides that they neeed to get out more. Be wary of my questions because I am sure thay will not always be totally clean, ie I will be trying to push you towards conclusions that suit my world view but I suppose that, characteristic isn't peculiar to me.

When you speak of a 'local area of skin' what do you mean by 'skin'?

Best wishes to you both,

Bill

 

Bill
Just spoken to Ali and he and Alan were at the Teachers Confeence in Manchester at the week-end. Our ears should have been burning.

>When you speak of a 'local area of skin' what do you mean by 'skin'?

Following the descriptive defintion of Swanson or whoever, a corn was thought "to be an abnormal response to intermittent pressure and friction (presumably the epidermis) over a bony prominence ie a subluxated joint or prominent pertruberance." And in accord with Bulloch and Jarret et al., the hypergranuation occurs after the nuclear envelope of the keratin cells are damaged.

Under these circumstance "the skin" would be stratum corneum, initially. Chronic damage caused by prolonged corkscrewing (skin pathomechanics) may result in pathology at the epidermal dermal junction (bursitc corn); and eventually the dermis as in a fibrous corn. This would I propose be a process which effectively anchors the overlying keratin layers to the bone beneath caused by shear and not represent a form of healing by second intention. This is often mistakenly implied by reference to the white appearance of the fibrous lesion. I think what is observed is maceration caused by water trapped in the broken side salt linkages of keratin (similar to the chemical effect of keratolytics) and not microscopic white fibrous tissue. (impossible to see with the naked eye). Even my one eye.

If you follow my drift.

toeslayer
Here we could write a paper for the FIP conference.

 

Dear Top layer,

'.....a local area of skin and anchoring it against the bone beneath'

I now understand why contributors to the forums so rarely attempt to seek clarification of anything others write. Every attempt just seems to muddy the waters even more and it rapidly becomes a 'sare fecht'!

I wonder why the author ignored the tissues between the skin and the bone? For me this phrase suggests that the skin, ie epidermis and dermis is directly against the bone. It ignores the existance of the hypodermis (even though it may, in some situations be very thin, in others it is very thick) and the possible presence of underlying tendon and/or ligament or enthesis. As these structures are present between the skin and the bone and make up part of the 'local and immediate' shock absorption system I consider that they, at least, should be included in any description of possible causative mechanisms.

Is it possible that the author is suggesting that by the time a corn occurs the intervening tissues between the epidermis and the bone have effectively been destroyed and that the skin is therefore directly against the bone?

Would you feel OK about restating 'local area of skin' as 'skin and underlying subcutaneous tissue including hypodermis and possibly, tendon and ligament'?

Once we get the above sorted out my next question will be aimed at clarifiying 'anchoring', followed by attempting to define 'abnormal' unless your response to the above throws up more confusion in my mind.

I can see this is going to take a long time and I am asking myself what the value of it is?
I suppose it keeps us off the streets? Secondly it is banging ideas about that are equally applicable to all 'pathologies' involving the application of force to tissues with varying tissue vitality?

Best wishes,

Bill

PS When AlandAl get together(socially that is) do they become 2Al or Al to the power 2?