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Hi, please move me if i'm in the wrong place...

I have been visiting a chap in his 30's regularly for treatment of neurovascular corns on both his 5th mets. He is a keen cyclist, cycles probably about 20-30 miles a day. He suffers terribly with these corns and I have a lot of trouble enucleating them as he cannot tolerate the pain. I am just wondering if there is anything to assist with neurovascular corns on a home visit. Podospray is out and the cycling shoes are not deep enough to accommodate any insoles.

Also.... same guy different question. He has been looking at heat mouldable cycling shoes. Has anyone had any experience of these positive or otherwise.

Many thanks

 

Hi Jen,

A Colleague i used to work with put forward that these corns are hypersensitive due to the fibrous nature of underlying tissue, one technique he showed me was to rub liquid phenol over the corn and immediate surrounding area for 60-90 seconds which would desensitized the corn enough to allow enucleation.

I'm have to say it works a treat and is my treatment of choice for this condition.

Best of luck
Steve

 

I've sent you a private message jenkelly

 

Why not give him an injection of local anaethetic to facilitate enucleation - whether on a home visit or in the clinic?

Bill

 

WP Ointment - pyrogallic acid in wheatgerm oil works brilliantly (if you can get hold of it)
area has to be masked off and kept dry for a few days but over a fairly short period of time the area is often pain free and softened - it has a cumulative action so you have to rest the tissue from the treatment after 3 sessions.

 

Thanks for your replies. Has anyone used a spray local anaesthetic? Also is WP Ointment available in the UK?

 

Jenkelly. Why wouldn't you just use infiltration anesthesia/analgesia to numb the area to allow you to enucleate?

Bill

 

i would refer this patient for orthopeadic surgery in the hope of a permanent cure. you need the answer to the question why is he getting such bad corns for a young chap. when you have the answer a referall path will become clear. we are here to help patients and sometimes we cannot offer what the pt may need.

 

Such a pity that on this site podiatric surgery is not recommended. However, even if an orthopaedic surgeon is consulted, that will be better than an 'orthpeadic' surgeon who will doubtless be equally unimpressed with the 'referall' path. (There is a spell checker on this system).

Bill Liggins

 

Bill thanks for your spell check . i dont use podiatric surgeons because the nhs in my area has none. and would i not send a patient privateley to someone miles away .
I have good relationships with the foot specialist consultants in my area and have confidence in sending them nhs and private referrals why would i want to change. i have sent many patients with terrible corns to orthopods and have seen some excellent results post surgery so whats wrong with the referral path, or should i just tinker with the corns during home visits for a few extra quid and keep the patient suffering.