From the Guidelines
The most effective treatment for heloma durum (hard corns) on bilateral toes is a multifaceted approach that includes reducing pressure on the affected areas, using properly fitted shoes, and seeking professional treatment from a podiatrist for debridement and orthotic devices as needed. This approach is supported by the most recent and highest quality study, which emphasizes the importance of well-fitted walking shoes or athletic shoes that cushion the feet and redistribute pressure 1.
When managing heloma durum, it is essential to address the underlying mechanical cause of the condition, which is typically repeated friction and pressure causing hyperkeratosis (thickening of the skin) over bony prominences. Key components of treatment include:
- Reducing pressure on the affected areas using donut-shaped foam pads or corn pads with salicylic acid (typically 40% strength) applied directly to the corn for gradual keratolysis
- Soaking feet in warm water for 5-10 minutes before gently filing down the thickened skin with a pumice stone or emery board
- Wearing properly fitted shoes with adequate toe box width to prevent friction and pressure
- Seeking professional treatment from a podiatrist for debridement (paring down the corn with a scalpel) under local anesthesia if needed
- Prescribing orthotic devices to correct foot mechanics and redistribute pressure
It is crucial to avoid home remedies like cutting corns with sharp objects, as this risks infection, especially in patients with diabetes or peripheral vascular disease 1. By prioritizing a comprehensive and professional approach to treating heloma durum, patients can reduce the risk of complications and improve their overall quality of life.
From the Research
Treatment Options for Heloma Durum on Bilateral Toes
- The treatment for heloma durum (hard corn) on bilateral toes can involve various methods, including subdermal injection of glutaraldehyde cross-linked collagen (Keragen implant) 2 and surgical excision of the lesion 3.
- Subdermal injection of Keragen implant has been shown to provide significant reduction in pain and keratoses associated with heloma durum, with most lesions requiring only one injection for correction 2.
- Surgical excision of plantar keratoses, including heloma durum, can be an effective treatment option, with modest evidence supporting the use of primary closure or healing by secondary intention 3.
- The choice of treatment may depend on the severity of the condition and the presence of any underlying factors, such as viral or mechanical causes 3.
Considerations for Treatment
- The incidence of pain, keratoses, and both pain and keratoses among treated sites can remain significantly lower than among control sites for up to 12 months after treatment with Keragen implant 2.
- Surgical excision of heloma durum may be performed in combination with other bony surgery, and the emerging hypothesis that many of these lesions are viral in origin rather than mechanical may imply the need for prospective studies with cross-reference to lesion excision by anatomical site and histopathologic confirmation of the diagnosis 3.
- It is essential to note that not all studies are directly relevant to the treatment of heloma durum on bilateral toes, and some may focus on other conditions or treatments, such as debridement, antibiotics, irrigation, and retention (DAIR) of the prosthesis after hip hemiarthroplasty infections 4.