i.d corns

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Lately I have seen a lot of pts with i.d corns, both heloma dura and heloma molle, who have come to me after having been treated several times by the dermatologist with liquid nitrogen. No enucleation, no relief of i.d pressure, no advice to see a podiatrist, just quite a few treatments with liquid nitrogen. By the time they come to me the area is a big mess. There is usually no hint of a wart at all to give the dermatologist a reason to think that its a wart.

Am I missing something here? Why would they even consider liquid nitrogen here?

Thanks
Hill

 

All you can do is face palm, shake your head and roll your eyes all at the same time!

 

Maybe we can speculate upon his rationale. That might be fun.

Possibly when he saw the patients there was no corn present but some other dermatological lesion susceptible to freezing such as the ubiquitous interdigital verruca? It is even possible that the resulting corn is an acceptable side effect of heroic management of the original possibly life threatening inter-digital lesion?

However assuming that there was corn present before freezing and that it was correctly diagnosed what could the rationale for freezing be?

Thinking of a corn in this situation as the long term outcome of a soft tissue sandwich where the heads and/or bases of the relevant metatarsals and/or phalanges (often enlarged) and footwear increase the pressure resulting, in the long term, in reduced tissue vitality leading eventually to corn production.

Even if the pressure is reduced, say by the patient acting upon footwear advice or a magical interdigital wedge, the vitality of the soft tissue underlying the corn will remain permanently reduced which means that even the reduced forces applied are still likely to result in corn production.

So possibly his idea was to destroy the area of soft tissue with reduced tissue vitality believing that as it healed the new soft tissue would have a higher level of tissue vitality and would be more able to absorb the applied forces without producing a corn. We all know how the tissue vitality is markedly improved in patients who have suffered frost bite.

Of course so far this rationale doesn't quite extend to the pressure focusing effects of any exostoses or swellings on the underlying bones. However back in the dim and distant I do remember a treatment being advocated within chiropody for the management of subungual exostosis which consisted of cutting back the nail and applying silver nitrate stick to the area of skin overlying the exostosis. The rationale was that the irritation caused by the silver nitrate would result in the absorption of the exostosis. Possibly the same rationale applied here?

No, No. I think it's highly likely that he did a great job under very difficult and trying circumstances and as far as the patients are concerned well they can like it or limp it.

Bill