What is a corn? A corn is an accumulation of the thick outer layers of dead skin which forms a circular area of callous tissue over a bony prominence. The term "corn" is used to describe this process when it occurs on a toe. When this same process occurs on other areas of the foot (like on the bottom of the forefoot), the condition is referred to as a callus. The corn is nature's way of protecting the skin from trauma. If pressure becomes constant with little or no time for the skin to recover, the area becomes ulcerated.

What Causes a Corn? There are several types of corns and therefore several causes. I will discuss the most common ones along with their treatment.

• Abnormal Pressure Over Normal Bone: The bones in the toes are normally irregularly shaped with a lot of rough edges. These edges develop a corn if shoes are worn that are too tight, or not appropriate for the foot and activity. The treatment here, naturally, is to remove the abnormal pressure by wearing properly fitted and appropriate shoes.
• Corns Caused By Contracted Toes: This condition develops due to shortening of one or more of the tendons in the toe. A corn may develop on the top of the toe as well as on the end of the toe. This is the beginning stage of a hammertoe. The treatment here is to lengthen the shortened tendons. This is a very quick and easy office procedure done through a small incision. Normal shoes may be worn and normal activities may be resumed the next day. It is wise to correct this condition early to prevent a hammertoe deformity which has a more involved treatment.
• Corns Caused By Hammertoe Deformity: One of the most common causes of corns is a hammertoe deformity. In this condition, the toe joint is contracted (hammered) resulting in excessive shoe pressure, and the resulting corn. This can involve only one toe, or the second, third, fourth, and fifth toes together. The treatment for a hammer toe is removal of a part of the bone and release of the contracted tendons. Sometimes a fusion is necessary. The bones are held together with either a metal pin or an absorbable pin. The metal pin is removed in 6 weeks and the absorbable pin dissolves over a period of time.

• Mallet Toe Deformity: This condition is similar to hammertoe but it involves another joint (this joint is known as the distal interphalangeal joint). Many times there is also a corn on the end of the toe. In early stages, when the joint is mobile and not stiff, lengthening of the tendon is a simple procedure that gives excellent results. When the joint is stiff, a surgery similar to the hammertoe procedure is indicated.
• Soft Corns: This is the name given to corns that occur between the toes. They stay soft because of the moisture created in this area. Corns on the top of the toe stay dry and are sometimes referred to as hard corns. Soft corns can be very painful and are frequently confused with blisters or warts because of the usual small, round appearance. Soft corns are caused by one sharp edge of bone in one toe pressing against another sharp edge of bone in the opposing toe. Soft corns are often associated with bunions which cause the toes to rub together as the big toe drifts toward the second toe.  Treatment here consists of avoiding tight, pointed shoes, and application of non-medicated pads. If the corn persists, removal of the offending sharp bone and correction of the bunion deformity if present is necessary.

 

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