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Are "Corns" Curable?

Discussion in 'General Issues and Discussion Forum' started by Mark Russell, Feb 23, 2006.

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    Are Corns "Curable"?

    Interesting discussion on thatfootsite. Any comments?

    Last edited: Feb 23, 2006
  2. DrPod

    DrPod Active Member

    Thats got to be the dumbest question of the year.... any first year student knows the answer.
  3. John Spina

    John Spina Active Member

    Corns are biomechanical.What could be happening here is a plantarflexed MT or a long metatarsal.
    You raise a good question regarding the use of keratolytics.I find that a once a day application of Aldara cream can help in some cases.
    As for your other point:Well,yes you can "cure" a corn with surgery,but in my experience,a transfer lesion post op is rather common.You are altering the biomechanics of the foot by,say,a shortening osteotomy of a metatarsal.If this corn is a dorsal corn,an arthroplasty can help to relieve pressure points,but,again,you are changing the shape of the foot to fit into a shoe.Without the proper shoe modifications,these corns will recur.
  4. admin

    admin Administrator Staff Member

  5. Cameron

    Cameron Well-Known Member


    At the risk of being argumentative (me? ), I think you pose a very interesting question, Mark. Indeed I would have to say the most fundamental question to all skin care specialists. I have chaired several debates on related topics and by far this is the one which get the greatest division and strongest argument.

    There is much research on epitheliasation and although it is neoplasms which take the majority of attention there is sufficient evidence to support epithelial rates are directed by biochemistry. Triggered initially through damage to the keratin nuclear envelope (causation still unknown, all be it intermittent pressure and friction are commonly cited), enzyme type control in the blood (genetic predisposition ) results and determines local epithelial growth rates. The physical presentation (of a corn) is conical but rarely is the indentation directly over the constant resistance (i.e. as defined by the geometric centre of the bone head) more often than not it sits to the side. This cannot be by chance.

    If we take a trophic ulceration pattern as a comparison. The interruption to the skin is direct and perforates straight down into the bone. This is more likely to be caused by remitting pressure whereas corns are intermittent. If we takes the effects of three dimensional movement over the corny nucleus (dreadful term), and apply Newton's Laws and the principles of moments you soon derived a corkscrew effect which takes the skin surface and twists it laterally against the bone beneath. The position of the corkscrew reaction is determined by the magnitude of reactive forces occurring around the lesion which explains why corns differ from individuals.

    The base of the nucleus describes the point of greatest resistance. Traditionally corns were though to have roots or grow from the base and hence the silly term nucleus. In effect you have a compromised skin surface which is corkscrewed against a resistance during stance phase. Biochemistry does the rest and controls the rate of epithelisation and this is why there are no cures for corns.

    Hydrating the skin will improve desquamation and anecdotal stories abound of people on prolonged bed rest where the corn just falls off. However put them back on their feet again and bingo the lesion return in time . Local application of hydrating creams are incredibly effective but for only a short period. Within hours of application the water content of the keratin cell increased dramatically. However within a short number of days the skin cell refuses to maintain increased water levels artificially introduced by bland or barrier creams. Hydrophilic and lypophilic preparations are limited through their penetrative properties. Ambiphilic which passes through water and fat are more likely to act as an effective vechile but are rarely used in podiatry.

    This is why there is nothing in a bottle or tube yet which will rid the populous of corns. Changing creams may temporarily extend the hydration but inevitable in a short period of time hydrating creams are nil and void. Routine massage may have beneficial effects on the peripheral circulation, which is as good a reason as any to apply cream Chemical creams such as those which contain keratoplastics like salicylic acid and or lactic acid , or urea interact with the acid mantle or the long chains of the side salt linkages of the keratin molecule suffice to change the pliability of hard keratin but these creams have side effects such as uticaria and therefore have limited use in sensitive skins. The creams are more likely to be used in chthonic hyperkeratosis.

    Electro surgery was a hopeful development a few years back. Basically it introduced an epidermal/ epidermal-dermal blister under the corn formation. Pressure cannot travel through fluids and the temporary relief was remarkable. Once the blister burst then the skin above would appear to fall off leaving a granulated new skin. When combined with foot orthoses initial results were encouraging but long term reports indicated a return of the original lesion. The return to the staus quo was more than likely due to the permanent pattern change in epithelialisation foot orthotic control being a complete red herring.

    Silicone implants (exactly the same principle of introducing viscoelastics, sub dermally) were heralded as a successful care plan until they discovered the silicone products were unstable and crystallised. The techniques are still used today with more stable compounds. A radical procedure when compared to external silicone plugging. The lesion is enucleated and the removed keratin replaced by homogenous viscoelastic silicone material. Filled like a crack in the plaster wall the physical properties of the visco-elastic (a solid which contains both fluid and gas) acts as waterbed reducing peek points of pressure, As the skin reproduces itself in the normal 28 cycle, the plug is physically push out. Serial management of corn treated with silicone plugs physically present a conical lesion which opens up like a rose in full bloom. Hypertrophy of the keratin layer remains the same but the physical indentation of the nucleus reduces in depth. To illustrate this take a hankerhief or paper tissue and lay it flat over the hand with the thumb and forefinger set in a 0 shape. Use you index finger on the other hand to simulate a clockwise turning effect into the centre of the 0 until there is an indentation (the nucleus). Now gently tease out the overlying edges of the tissue and observe the base of the indentation rise to the horizontal. This is the physical effect of serial care using silicone plugs

    Plugging over 36 weeks (usually at 6 weekly intervals ) will reduce the size (depth of the corn). Painful lesion become much less of a concern and complicated skin protrusion such as vascular or neurovascular involvement can easily be treated with protein precipitants to encourage reabsorption. Often after three or four treatment the lesion is quantitatively smaller but the client reports a return of acute symptoms. Maintaining the regime unabated results in eradication of this pain . Skin care can be used in conjunction with biomechanical care however it is unlikely maintaining middle range motion has any effect on established corny lesions (which are determined by biochemistry controlled by enzymes in the blood stream)

    Relating to another post on Arena concerning old podiatry text. Books of the fist half of the twentieth century contained oodles of information on corn management whereas text appearing in the later half of the century have avoided the topic despite the volume of hard data research available in this most interesting subject so pertinent to foot physicians

    What say you?

    Hey, what do I know
  6. You were half-way through this answer last July when you got completely distracted by a lithesome waitress with 4" canary-yellow toeless mules. Thanks for finishing it now! Going back to the point about tissue specific enzymes which stimulate keratinisation, is there/has there been any research looking at ways of influencing their behaviour?

    I get the bit about the pathological changes in the skin and can see how the mechanics you describe result in changes to the physical appearance, but it's the biochemical changes that I find interesting. Would it be possible to develop a geneticly modified antagonist that can be administered to reverse the process, for example? Or an enzyme specific cream that can block the messenger mechanism and prevent an increase in the rate of keratinisation?

    Be no use to guitarists though.

    Kind regards
    Last edited: Feb 24, 2006
  7. Cameron

    Cameron Well-Known Member


    >Going back to the point about tissue specific enzymes which stimulate keratinisation, is there/has there been any research looking at ways of influencing their behaviour?

    The yin and ten Chaoliine throery has been around for decades now
    Jarrett did a lot of work in the 60s and early 70s and published a much on what they thought controled epithelial rates. He was interested in neoplasms and I briefly spoke to him in 1980 at a conference and he said he was unaware of corn pathology but thought his work on epithelialisation would apply. There has been an explosion of research since them and if Kate Springette is a subscriber she would be more able to give chapter and verse.
    Karen Roberts researched the effects of ambiphilic preparations used to take active agents such as fungacides into deeper layers of the dermis. Karen was an Edinburgh student who went on to read a doctorate in pharmacology. Bill "Tubby " Kerr did prilimentary work on water uptake in keratin cell as did Stephen Jackson in Australia. Although the studies were small and used different methodologies, the results were remarkably similar. Frank McCourt from Manchester also published his work on keratinisation about a decade or so ago.

    I suppose it is my turn to pick up the tab next time we meet.

  8. Cameron

    Cameron Well-Known Member


    >I get the bit about the pathological changes in the skin and can see how the mechanics you describe result in changes to the physical appearance, but it's the biochemical changes that I find interesting. Would it be possible to develop a geneticly modified antagonist that can be administered to reverse the process, for example? Or an enzyme specific cream that can block the messenger mechanism and prevent an increase in the rate of keratinisation?

    To achieve that objective would I suggest be like solving the enigma of the Holy Grail and make us richer than Bill Gates. Of course in the search for skin cancer cures individual antagonists have been tagged but obviously it is not an easy process and nothing yet seems to have emerged with any practical purpose for corn cures.

    Moons ago I was interested in seeking a solution and got as far as discovering ambiphilic preparations. I did have a trial run with one subject ( n = 1). The young lady was the lead singer of a well known Scottish pop group that had peaked but were living in reasonable luxury on the outskirts of Glasgow. She had mild callous and I advised her to use Ungenum Merk. Both she and me were delighted with the result. I moved to Sussex and became a heath service manager for podiatry services. There I introduced Ungenum Merk as the vehicle for salicylic acid (for warts), unfortuantley I was unable to organise clinical trials.

    Chirpy chirpy cheep, cheep

  9. dmdon

    dmdon Active Member

    With all due respect Dr Toe, the only 'dumb' question is the one that is not asked!


    David D
    Last edited by a moderator: Feb 24, 2006
  10. DaVinci

    DaVinci Well-Known Member

    I am not sure what DrPod meant, but I initially reacted very negativly to the word "corn" in the title of the thread and thought "Oh my god". This is a professional and not a lay forum - how embarrasing. Then, in a flash, the "inverted commas" were added around "corn" in the title, which makes it a bit more palatable.
  11. I had meant to use the inverted commas around cuarable and indeed changed them on the post header as you will have noted. Could you explain why you felt embarrassed and why the term corn is so unpalatable?

    Mark Russell
  12. admin

    admin Administrator Staff Member

    Mark - I will respond as I had a couple of others PM me about it as well. They basically suggested changing the thread title (which I didn't). I think what it is, is that "corns" is layperson terminology, we are "professionals" and should be using professional terminology, which I assume is DaVinci's and DrPod's issues (...I think, but stand to be corrected).
  13. Craig - how interesting. I guess where I come from plain speaking is very much the norm. Apologies if my terminology caused offence. Perhaps Dr Pod and DaVinci will be kind enough to elaborate on their views so that I may learn from the error of my ways.

    Mark Russell
  14. admin

    admin Administrator Staff Member

    I would not worry about. The quality of content in the thread here and at ThatFootSite speaks for itself.

    I do "pull my hair out" when students speak to me about "corns", "thins the blood" etc, when we try to drill into them apropriate terminology for a healh professional to use.
  15. Mhmm. I did think about the terminology before I started the post and came to the conclusion that “corn” was most appropriate. Why the embarrassment? Sure I could have used “heloma durum” or “lesion” but I thought that almost verged on being snobbishly elitist. Not my style. And as it has been pointed out this is a public forum and as such is a valuable resource for many seeking information about common foot disorders. It is simply a fact of life that the vast majority of the general public will know these problems as “corns”. So why confuse the issue? I suppose we have to accept that global online forums will be subject to regional variation – in a way that’s what makes them interesting – but I have to say I found the comments by the aforementioned contributors curiously condescending. But of course I may be mistaken.
  16. admin

    admin Administrator Staff Member

    You are right. I have changed the title of a number of threads to better reflect that global outlook -- (eg how many outside the UK know what the "NHS" is?). I got berated on another forum (non-podiatry) that I moderate at because I could not spell - I simply used the word "optimise" .... guess which country the person who launched into me (and made a fool of themselves) was from as they insisted it be spelt "optimize"? How come everyone from outside that country knows about these differences in spelling and those from that country do not?
  17. Well they do say that parochialism is a localised, sorry - localized issue. Maybe we’d all do well to bear that in mind.
  18. Cameron

    Cameron Well-Known Member


    What's in a name?

    I think we could be on thin ice when it comes to calling a corn, a heloma durum, as precise scientific terminology. Intracable keratoma is also a bit iffy but more acceptable since it does give a blanket term to localised hyperkeratosis with a range of dermal protrusions and localised hydration varients.

    The term corn comes from the latin term, clavis (meaning nail as in hammer and nail). Nothing lay about that , nor is the term anything to be embarrassed about. Treatment of corns was developed by the Ancient Greeks and Aristotle, himself, is thought to have crafted the first skin knives (precursor of the surgical scalpel) specifically to scrape the hard skin. He certainly recognised the need for regular minute disectioning and upheld this as the only treatment available for corns and callous . Not wrong there either. Corn cuttering was a well established trade by the time of the Great Fire of London. Later corn operators became more popular term until Lowe introduced Chiropodist in the eighteenth century. Chiropodists and podiatrists are one of the same and all look to caring for foot morbidity, irrespective of the scope of practice.

    What say you?

  19. From recent photographs, I can see this has been an intractible problem ;)
  20. One Foot In The Grave

    One Foot In The Grave Active Member

    PMSL :D
  21. Craig, Syd et al.

    There is another aspect of this discussion I would like to explore, namely the use of simple insoles in the treatment of pathological corns and callous. For many patients - especially the elderly - the use of functional orthoses is not as effective (indeed sometimes contra-indicated) as simple cushioning insoles using materials like poron or cleron. However, when calculating the most appropriate prescription, many clinicians abandon evidence based protocols in favour of practical considerations - i.e. making the insole fit the shoe rather than suit the patient.

    Frequently I see patients who have simple foot problems - for example, atrophy of the plantar adipose tissue resulting in forefoot callous and corns in patients whose weight is inxs of 200lbs - being fitted with 3mm thick insoles into shoes with solid composite or leather soles. The primary consideration being something which fits into the existing footwear rather than addressing all the pathophysiological factors - weight, tissue loss, skin changes, mechanical problems & etc.

    Given the previous comments regarding histological changes that take place in the skin, what considerations do colleagues make when calculating prescriptions?

    Mark Russell
  22. Cameron

    Cameron Well-Known Member

    Mark et al

    > Given the previous comments regarding histological changes that take
    place in the skin, what considerations do colleagues give when
    calculating prescriptions?

    I am of the opinion the shoe is the ultimate orthoses and provided it fits the foot comfortably, is appropriately for the activities and contains the required support for weightbearing and non weightbearing events then you can ask for little else foir the vast majority of the populus. Although conditions apply

    As you know I taught "Appliances aka foot orthotics and prosthetics" for longer than the Train Robbers were incarcerated but was never happy with traditional insoles manufacture, To the uninitiated the fabricated metatarsal pads stuck to leatherboard and delighted when thermoplastic materials became available. I shall refrain from wining on but would refer anyone interested to the review of insoling "what I wrote" and had published in 1988 (The Chiropodist - UK). There I wax eloquent on the benefits of elastic memory and isobaric and isotactic effect in the serial management of prominences on the sole of the foot. Well worth the read (but of course I would say that).

    When I was a manager of a diabetic unit a thousand years ago I used 6mm plastazote templates fitted cold to the shoe then left to dianomically form through wear. The devices were replaced at each treatment and I kept the originals for comparison. Good compliance from the client was surpassed only by the record of the foot contour which was then, early 80s adequate palliation for ulceration. For fun I used different colours of plastazote to help me register the stage of care.

    What I was pleased to see go were the perenial tradional insoles lovingly crafted over years, but stained with contaminated exudate.

    Management of chronic leasion (ie fibrous corns) I used silicone plugs and plastazote insoles in tandum and wrote up these experiences in the Chiropodist throughout the eighties.

    The more cases I became involved with the more I found silione props could be used to reduce peak pressures on plantar lesions. Often this was sufficient and a plastazote insole was not necessary. In the nineties companies began to produce viscoeslastic inlays which were intellegent materials and took off the peg insoles to a new level.

    In summary my findings were thermoplastic inlays were servicable, economical and as good therapeutically as bespoke traditional insloes. Patients would respond to comfort and more likely to comply when lesions showed improvement. Many podiatrists were offended at the thought bespoke accommodative insoles were outmoded.

  23. Peter

    Peter Well-Known Member

    Mark wrote "There is another aspect of this discussion I would like to explore, namely the use of simple insoles in the treatment of pathological corns and callous."

    Is it a callus or a callous?

    The Concise Medical Dictionary 3rd edition, says its a callus.

    Hope I haven't set any fires :p
  24. How varied is this - within two paragraphs!?

    Last edited: Feb 28, 2006
  25. Cameron

    Cameron Well-Known Member


    The origins of both words derive from the Latin word 'callum' meaning, hard skin, and are the masculine form. Middle English, from the Old French word 'cailleux', meaning hard skin. They first appeared, as a variant, in the English language in and around the 16th century, just as corn cutters were becoming popular in Europe and Britain. Practitioners flourished after the Quack Act (UK), when non-medical persons were legally able to treat open sores with almost anything and everything that made the patient better. Scathingly medical practitioners referred to these alternative persons as 'quacks' and hence the Quack Act. The popularity of non-medical skin healers was brought about directly by the plague epidemics of that time, Syphilis (large pox) and small pox were rife, as was Hansen's Disease. Lack of understanding among physics meant many doctors refused to treat patients suffering form venereal diseases and hence this sector of the population sought alternative medicine and occult remedies. Many claims corresponded to disease remission as the disease process ran its course to secondary and tertiary stages. Among this ground swell the corn cutter emerged. To them callus (singular noun) described and area of thickened skin or area of bony tissue formed during the healing of a fractured bone. The plural version was calluses.

    As a verb, to callus means to produce or cause thickening of the tissues. Inflected forms of the intransitive verb would be callused, callusing, and calluses. Callous meantime is not a noun but an adjective meaning unfeeling and insensitive. When used to describe callus it means skin that has hardened and thickened. The term callous can also be used as a verb to describe the pathological processes involved in producing callus (es). The intransitive, inflective version of the verb being calloused, callousing, and callouses. All meaning to make or become callus. So as a footnote to this piece allow me to demonstrate correct usage. Do not confuse the adjective callous, as in

    "Years of dealing with self centered, self opinionated, patients with self inflicted injuries has left me callous, with the thought of the callus(es) and corns on the soles of their feet."

    Also, do not confuse the verb callous, which means “to make or become callous,” with the verb callus “to form or develop hard skin.”

  26. Cameron

    Cameron Well-Known Member

    Hi Davidh

    There is quite a lot known about the biochemical control of epithelial rates and epithelial growth factors. The research is based in the area of neoplasms and there heas never been done, to the best of my knowledge, studies on on simple hyperkeratosis in humans. I am not conversant with dyskeratosis and parakeratosis however but I would suspect skin conditons like psoarisis have volumes of research. Wound epithelielisation would also contain reference to epithelial growth factors.


    As far as I understand Bullough's Chaoline theory is still held as plausable. Much of the early research was done on rat's tails and more recently hairless mice.

  27. Syd,
    What did Bullough demonstrate in relation to EGF?

  28. Cameron

    Cameron Well-Known Member


    Bulloch predates EGF albeithe wason the right lines.

    The chaoline theory relates to an inverse rule where depending on the quantity of "chaoline" ( an emzyme?) in the blood will determine the epithelial growth. High concentration low epithelial growth and vice versa. The chaoline was tissue specific.

  29. At the risk of appearing monumentally dim (or even dumb), where can I reference Bullough’s research - and if “chaoline” has been demonstrated to be tissue specific and act in the manner you suggest, has there been any in vivo study to determine whether it can be introduced artificially into the tissues to influence cell proliferation?

    Fretting away in complete ignorance.

  30. Cameron

    Cameron Well-Known Member

    Cannot have you fretting Mark

    I think this is a reference to Jarret's book Biochemistry and Physiology of the Skin Vol 2. New York and Oxford: Oxford University Press, 1983: 1255-95.

    You should get a reference to Bullough's work there.

    Jarret makes reference to an epithelial growth factor but had not isolated it by the time he published the book. They were working with interferon at the time (on cancer) and all he would say when we had a chat the EGF was likely to act in a similar manner.

    Much water has passed under the bridge since then and thereis now much more know about epithelialisation. Try this site as an introduction.


  31. Many thanks. On reflection, if this was first year theory, it must have passed me by - not difficult as most of my time was spent intoxicated in Sandy Bell's rather than inspired at Fanny Adam's! Will get reading and play catch-up over the weekend. Apologies to all the other members who must be bored senseless by now!

    Last edited: Mar 1, 2006
  32. Charlesworth

    Charlesworth Member

    Epidermal chaolones

    Dear Cameron and Mark,

    I and my compeers at College were very briefly taught this theory in our first year of training at the Northern College of Chiropody in the early 1980s (I'm giving my age away here!!) by the late Tony McCluskey, who sadly passed away in the early 1990s. Anybody here who trained at Salford remember him?

    They were referred to as 'epidermal chalones', and the name emanated from the research of W. S. Bullough. The only paper which I have is the following:

    Bullough, W. S. (1972) The control of epidermal thickness. British Journal of Dermatology. 87(3): 187-199.

    However, if you do a PubMed search, many more references will come up; indeed, some earlier than 1972 - going back to the early-to-middle 1960s.

    Best wishes,

  33. Charlesworth

    Charlesworth Member

    Incorrect spelling in last title

    To all,

    My apologies, in the title of the last posting, I committed an editorial sin by giving out an incorrect spelling :eek:

    The correct spelling is: chalones

    Too much codeine phosphate and coffee I think.

    Best wishes,

  34. admin

    admin Administrator Staff Member

    There is an edit button to the bottom right of a message that you post that gives you 24hrs to make changes to the message.
  35. Eric

    Many thanks for the info - much appreciated. From a PubMed search there are several interesting papers.
    From the above it is apparent that chalones can be injected and that application of other substances can influence their effect. Anyone aware of any study or research specific to podiatric conditions?

    Mark Russell
  36. wdd

    wdd Well-Known Member

    I wonder if it is possible to resurrect this highly interesting topic and one which is central to the practice of podiatry (though if you used the total content of the forums as an indicator of podiatric activity you would imagine that corns and calluses are extremely rare)?

    I would like to start with the use of the words corn, callus, callous, clavus, heloma to describe the lesion.

    My concern about these words is that they all refer simply to the epidermal manifestation, ie the lump of hard skin. The effect this seems have is to focus attention almost exclusively on the changes in the stratum corneum.

    To me the idea that one day corns will be cured simply by a local application of something affecting the rate of cell division and or the cell adhesion within the epidermis underlying a corn or callus is to me evidence of the hypnotic effect of the words corn, etc.

    For me callus and corn are tissue responses to highly specific forms of tissue damage against a background of varied tissue vitality (don’t necessarily reduce the tissue vitality but alter the characteristics of the applied force, result blister. Reduce the tissue vitality a little, alter the characteristics of the applied force and therefore the nature of the tissue damage, result ulceration. Reduce the tissue vitality even more and apply any type of force, result gangrene. Reduce the tissue vitality even more, apply no force to the tissues, result gangrene).

    Tissue damage occurs when the characteristics of the forces applied are beyond the level of tissue tolerance. The tissue tolerance is dependant upon the level of tissue vitality, ie healthy tissues are more difficult to damage than unhealthy tissues and the magnitude and other characteristics of the applied force.

    The body has many shock absorption mechanisms designed to prevent the forces exceeding the upper level of tissue tolerance. In fact the body is a shock absorber. Change any aspect of the body away from the optimum and you will reduce the shock absorption ability.

    If you made a list of the changes that can take place in the human body you would still be working on it this time next year. I will give one or two examples well away from the foot. Weight gain, wear and tear of intervertebral cartilaginous discs, arthritis of the hip, varicose veins, chronic hepatitis, etc. Each of these alters either the shock absorption mechanism of the body or the tissue vitality. How many oh these can the podiatrist influence directly?

    Now you start to get some idea of why it is difficult to cure corns. In as much as management of any condition is identifying and removing the etiological factors and then attempting to return the tissues to normal. How many of the etiological factors for corn and callus can we identify? How many can we eliminate? What can we do to return the local damaged tissues to normal? By local damaged tissues I mean the underlying epidermis, dermis, hypodermis, periosteum, bone, joint.

    Even focusing on the local underlying tissue. Can damaged soft tissue ever return totally to normal? I doubt it. I would imagine the capacity to return to normal is influenced by the duration of the damage and the reduction in tissue vitality. Fat cells in the hypodermis can not regenerate. The body heals by scarring, ie laying down fibrous tissue. The ‘healed’ tissue always has to a greater or lesser extent a reduced capacity as a shock absorber.

    Of course even though the list of causative factors is as long as your arm is it likely that some factors are more important than others, ie the etiological factors can be weighted. If these factors can be identified and eliminated the percentage cure rate is likely to increase significantly.

    What do you think they are?

    Bill Donaldson
  37. Hmmm. All clever stuff! Is it that complex?

    I'd say better than half the corns I see are on dorsal IPJs.

    I shall now recount the standard conversation I used to have at least a dozen times a week with patients.

    Patient-"I have a corn"
    Me-"its caused by your shoes"
    P-"I don't buy cheap shoes!"
    Me"No. Its caused by your shoes"
    P- "isn't it in the skin"
    M - "yes. Caused by pressure"
    P "Whats the pressure from?"
    M "Your shoes"
    P "but these shoes are comfortable"
    M "notwithstanding, that corn is caused by shoes"
    P "What else could it be?"
    M. " Nothing, its your shoes"
    P "Can you get rid of it?"
    M "are you going to change your shoes?"
    p. "I Don't think it is the shoes"
    M "Is there anything else pressing the top of your foot?"
    P "no"
    M "Then its your shoes"
    P "But they're comfy!"
    M "apart from the corn"
    P "yes but the SHOES are comfy"
    M "except that they cause the corn"
    P "the shoes cause the corn"
    M "yes"
    P "what else could it be?"
    M "nothing, its the shoes."

    Etc etc to fade. Or a pair of gunshots.

    How often do you see dorsal corns vanish after digital surgery or when a patient becomes house / bed bound? How often do you see massive callus fade to nothing when a patient ends up in wheelchair?

    I'm but a simple podiatrist all alone in this crazy world so I like simple answers. Pressure / trauma causes corns. If you want to get rid of the corns, get rid of the trauma / pressure. So to the OP, yes.

    Simple Bob
  38. wdd

    wdd Well-Known Member


    Many thanks for the reply. I loved it. As soon as I started reading it I started laughing, very therapeutic. Thanks.

    I would imagine every podiatrist has been through that same conversation as you say, a dozen times a week with patients. I used to think that there was something wrong with me that I wasn't able to explain it in a way that patients could understand but you have highlighted the banging your head against a brick wall aspect of it magnificantly.

    However I still think it's that complex. On the apices and dorsal aspects of digits you might be able to reduce even eliminate the pressure and bring about a cure although a fitting system that only fits the longest toe is unlikely to make eliminating the pressure from other toes too easy. If the same fitting principle applied to all of the toes and not just the longest toe I would say we could just about eliminate all apical and digital corns.

    For corns on any other aspect of the foot changing the characteristics of the forces applied to the underlying living tissues sufficiently to bring about resolution of the lesion doesn't seem at all easy.

    Thanks again

    Bill Donaldson
  39. Bill

    Thanks for the informed and comprehensive opinion. You wouldn't be the Bill Donaldson from Edinburgh and former afficianado of Edinburgh Foot Clinic perchance?

  40. Robert:

    This is classic!!:good:

    I have been meaning to write one of my "Forum" features in Podiatry Today magazine on this exact same subject using a very similar story since I have had the same conversation so many times that it boggles my mind.

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