Interdigital soft corns

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Can anyone give me the benefit of their experience by explaining what their choice of caustic on an interdigital soft corn would be? It is on the right 4th lateral pipj so the surrounding area may be difficult to mask properly. The patient believes Silver nitrate will do the trick as this is what a previous chiropodist treated her with, giving her 12 solid months of relief. She suffers from underactive thyroid, but all circulatory checks appear normal and she is otherwise healthy.

 

Hi pacman,

Personally I would not apply caustics in an I/D area. I would advise astringents to reduce maceration though as I have found this may help.

I usually begin pre treatment by making an I/D sillicone then when you remove the H/molle the problematic I/D area rests in the cavity.

I appreciate this won't be effective for every patient but it's certainly part of my initial treatment (+ the usual advice RE: footwear etc.)

For patients with a chronic problem I/D I have in the past referred on to the Podiatry surgery team locally who may consider performing a syndactlyisation (hope I spelled that right).

Just my thoughts,

Regards,

 

Pacman

>.....what their choice of caustic on an interdigital soft corn would be?
The patient believes Silver nitrate will do the trick as this is what a previous chiropodist treated her with, giving her 12 solid months of relief. She suffers from underactive thyroid, ........

I agree with Twirly.
> Personally I would not apply caustics in an I/D area. I would advise astringents to reduce maceration though as I have found this may help.

Silver nitrate is a protein pricipant and although often classified as a caustic it is really a very strong astringent and in the presence of macerated skin the concentration of the Silver Nitrate is diluted. Silver nitrate sticks are easy to use particularly when dealing with inaccessible areas and is probably the safest application under the circumstances. In the normal course of events a practitioner uses silver nitrate to form an eschar which they can easily remove with their scalpel. It is a chemical aid to minute disection and forms no other functions.

You say the patient is happy with the treatment and can go 12 months painfree this would make me think they either have a high pain threshhold or the condition is minor. The silver nitrate application would appear to act as a placebo.

Caustic solutions such as phenol or nitric acid can be used (but not recommended, in my opinion). In my experience these increase the risk of pain and other complications. The use of heavy caustics necessitate very short return dates anyway and this may not be suit your client. Also the benefit of caustic care ios to help the practitioner managed the bulk of the skin lesion and if this is insignificant then safer alternatives should be preferred.

Caustion of interdigital lesions has remarkably little research behind it and has tended in more recent times to be grouped into compensatory models which designates it as co-moribund to pronatory pathology. I cannot recall the chap's name but there was an occassional paper published in the 50/60s where the author observed the metatarsal formulae (Morton) and recorded i/d lesions were more likely to appear on feet with long fourth and short fifth metatarsals. This does explain unilater lesion where there is a difference in the metatarsal formulae from one foot to the other.

I enulcleate the lesion then apply silicone toe orthoses to aid the windlass action of the digits and tone up the lumbricals and plantar interossei in the hope of derotating the fourth toe. To achieve this end, I use serial two props applied to the three middle toes with the foot held in a stjn position. Review every six weeks and measure the toe positions in the subsequent silicone casts. Never fails.

toeslayer

 

Pacman

Agree with previous posts. I have used silver nitrate with some success over the years.

It is particularly useful for patients who cannot reach feet to treat maceration themselves.

 

i often used silver nitrate on id corns, and never had any adverse reactions, although over time it would leave a black discoloration, the patients never minded as it seemed to slow down the return of the corn.
i agree though that there has been very little research done on this issue, and i certainly would not use agno3 on an open wound, diabetic or circulation compromised patient.
an otoform/silicone idw works GREAT, make it first as another member said then the corn will rest in the depression, the premade silcones work "ok" but as they are not made especially for the patient they are more just for palleation.
a lot of the time an ennuclation, otoform and agno3 have resolved the corn in one treatment for me.
footwear has to be evaluated and if the shoe is too narrow the corn will never resolve.
i have seen also corn caused by the nail on the adjacent toe being a little sharp - usually the 5th toenail as the patient cant ever reach it properly so they always leave a little edge which aggravates the tissue on the toe next to it - although this is not a true heloma molle.

i have also tried alcohol or witch hazel daily rubs, which seemed to help dry up the area in some cases.

 

Hi pacman,
The answer to your original question is "none".
I would treat by purely mechanical means.
I have seen some horrendous reactions caused by self treatment with caustics in this area, especially in diabetics.
Years ago we used gentian/crystal violet in 70%IMS to reduce maceration and it was very effective. It also had the advantage of being very visible and therefore highlighting the treated area! Unfortunately it is no longer available after some concerns being raised about it being a carcinogen.
regards
Dido

 

Thanks to all.