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Hyperkeratosis is a thickening of the stratum corneum layer of the skin as a protective response to mechanical irritation of the skin. This results in the formation of a callus or corn.
Corns, heloma durum, are calluses that have been compressed so much that they get very hard, like a dried kernel of corn.
Continued pressure applied to calluses and corns can cause symptoms, such as pain, when irritated or touched.
Rubbing forces causing calluses in the feet include poor fitting shoes, loss of fat cushioning, overuse, bunions, hammertoes and toes rubbing each other. Toes rubbing together can produce an interdigital callus or corn formation.
All calluses and corns between the toes should theoretically form in pairs, but this doesn’t always happen. There must be a mechanical basis for this, but it does not change the available treatment options whether one has one or two calluses or corns between the toes.
Corns and calluses between the toes always occur in between the widest parts of the toes at the joints. These occur most commonly between the fourth and fifth toes and between the first and second toes. Kissing corns is a phenomenon when corns are produced on each toe opposite the offending joint.
These skin issues can be quite painful and problematic. Patients tell me almost universally they cannot believe how something so small can hurt so much after I show them the culprit after treatment.
Treatment options for calluses, corns, or kissing corns between the toes are fairly limited. Shaving or debriding the lesions from time to time is an acceptable solution, but the lesions will return if the cause of the toes rubbing is not addressed. Shaving a corn or callus does not cure it.
Using proper soft spacers on a routine, daily basis with wider toebox shoes can help eliminate the rubbing of the toes, but must be performed daily. Toe spacers will not “train” the toes to remain separated on their own. Patients often misunderstand the concept of shaving and using spacers as leading to a cure, and thus become disappointed.
The last treatment option is surgery and should be used only when attempts at debridement and the use of spacers fails to provide adequate relief. Surgery usually involves an arthroplasty, or removal of one or both joints in the toes responsible for the issue. The procedures are minor, but can be painful during recovery, become infected, and fail to achieve the desired result.
There are many “gimmicks” sold on TV, on the Internet, in the Sunday paper, and in help catalogues for these issues that claim to offer a cure. There are no curative devices for corns and calluses other than uccessful surgery.
Toe spacers are a safe and effective tool for alleviating symptoms, but again, they are not a cure, but instead a maintenance method to provide relief from pain.
David B. Raynor. DPM, is a podiatrist in Inverness and can be reached at 352-726-3668 or at www.AdvanceAnkleandFootCenters.com with questions or suggestions for future columns.