One of the most common foot problems shoe-wearing humans develop is the infamous ‘corn’ This thickening of the skin over the toes has long been a source of pain, and is often a cosmetic concern for many people. This article will discuss the exact nature of the corn, and how it can be treated.
A corn is a type of skin growth exactly similar to a callus. The only difference is that a corn is defined as a thickening of skin on the toes, whereas a callus is generally located on the bottom or side of the foot. Regardless of location, a corn is simply a thickening of the outer layer of the skin, compressed into many layers one on top of the other. This compression leads to the development of a hard, thick layer covering the skin’s surface. The reason corns develop is mostly related to pressure on the skin from bone below and the shoes above. One’s skin is particularly sensitive to abnormal pressure. When extra pressure is applied to the skin over a long period of time, the skin responds by thickening up its top layer to create a sort of armor to cover the surface and reduce the damage caused by the increased pressure. Unfortunately, sometimes this thickening makes things worse, and the presence of an extremely thick corn can produce pain when pressure is reapplied to it. In extreme cases, the skin underneath the corn can start to erode and a wound is created.
The pressure that causes corns to grow can come from many sources. The most common source is from the combined presence of a toe deformity like a hammertoe, and a tight fitting, shallow shoe. When someone has a hammertoe, the first ‘knuckle’ of the toe has risen upward, and is much more prominent over the top of the foot. As soon as a shallow shoe is worn, which includes most women’s dress shoes, the pressure of the shoe on the top of the toe starts an irritation process that eventually leads to the formation of a corn after awhile. Depending on the tightness of the shoe and the height of the hammertoe, this time period can be as short as an afternoon or as long as a few weeks. The corn will continue to enlarge as long as the pressure is present. Some people develop corns quickly, while others take months to enlarge. Eventually, the end result is pain, and an unsightly thick pad on the top of the toe. Depending on the toe shape and position, both ‘knuckles’ can be involved.
Another common type of corn appears not on the top of the toe but rather on the side. While a hammertoe is still usually at fault for this, the shoe becomes less of a factor. These corns are usually due to the pressure that one toe places on the other toe next to it. When the toes are contracted and not in a straightened position, the sides of the toe bones at the ‘knuckles’ can become prominent along the side skin of the toe. When the toe next to this toe has the same problem, the combined pressure of the two toe bones pushing from side to side on the skin of both toes can result in a corn that develops on either toe (or both at the same time in some instances). This results in a corn between the toes that is painful even when barefoot, but especially painful when tight shoes squeeze the toes together. A variation of this corn can also lie in the web space directly between the bases of the two adjacent toes. Often this corn is not hard, but rather soft and overly moist. This is due to the excess moisture usually found in the skin of the toe web space. This corn can unfortunately become deeply imbedded into the skin instead of growing outward, and a wound or sore often develops in its center. Treatment of corns is fairly straightforward. One must either externally reduce the pressure on the toes, or change the internal pressure of the underlying bone. Changing the external pressure can involve a number of different things. First, one’s choice of shoes needs to be altered. A roomy shoe with plenty of wiggle room for the toes is a must, and the toe space needs to be wide enough to not put side to side pressure on the end of the foot. This involves wearing a shoe that is properly sized for one’s foot. Of course, one must not wear a shoe that is too small. However, one must also not wear a shoe that is sized too big either. This will cause pistoning of the foot in the shoe, which in turn will irritate the toes. A qualified shoe clerk can find one’s proper size, and use that to find a quality shoe. Shoes with narrow, pointed toes should be avoided. One must make sure that they are buying a shoe with the proper width as well as length. The numeric shoe size takes width into account, but is generally a measurement for length. Each shoe size should come in multiple widths, and most quality shoe stores will carry this variety of widths. Athletic shoes and oxford shoes generally will have enough room to ease pressure on the toes. High heels and many flats are not as accommodating, and should be avoided. The second way to reduce external pressure is to pad the corn so the immediate pressure is not as great. This author recommends the use of elastic toe sleeves that contain a layer of gel underneath. These sleeves fit over the toes, and cover the corn with a cushioned gel layer. The elastic nature of the sleeve helps it to stay on. Medicated corn pads should be avoided, especially if one is diabetic, as the medication is generally a mild skin acid that can cause a chemical burn if used improperly or for too long. For corns in between the toes, gel or foam toe separator pads are a great way to keep one toe from touching another. All of these products are readily available at many medical supply stores and pharmacies in the foot care section.
Altering the external pressure can help, but does not permanently address the underlying bone deformity which irritates the skin in the first place. For some, padding and deeper shoes are all that is needed to provide relief. For others, correction of the actual toe deformity is necessary, and can provide the most permanent relief. This correction comes in the form of a minor foot surgery to straighten the toe out and reduce the prominent bone. The most common procedure done to address this involves removal of a small part of the toe bone that is causing the pressure, allowing the toe more room to straighten out. This in turn eliminates the pressure on the top of the toe, as well along the side to eliminate corns in between the toes as. Sometimes, a little more bone along the side of the toe needs to be shaved down to produce the best result. The toes are held in a straightened position during recovery either with a dressing splint or a temporary surgical wire. Most people can return to regular shoes from a healing sandal within three to four weeks, and the likelihood of complications is fairly low.
While corns can be quite bothersome, they are a natural part of how the skin deals with pressure. Corns can develop in both the young and the old, and are not a reflection of the aging process. Treatment is effective, and can be permanent depending on how far one wants to go to deal with this common foot problem.
Author Resource:-
Dr. Kilberg provides compassionate and complete foot and ankle care to adults and children in the Indianapolis area. He is board certified by the American Board of Podiatric Surgery, and is a member of the American Podiatric Medical Association. He enjoys providing comprehensive foot health information to the online community to help the public better understand their feet. Visit his practice website for more information.
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