What is the recommended treatment for a corn?

Treatment of Corns

The recommended first-line treatment for corns is salicylic acid preparations of 15-26%, applied daily after removing the thick keratin layer, with occlusion if possible, continuing for 3-4 months. 1

What is a Corn?

A corn (heloma) is a localized area of hyperkeratosis with a central core that extends downward in a cone-shaped point, causing notable pain and discomfort. Patients often describe the sensation as walking on a small stone or pebble. Corns typically appear on pressure points of the feet, particularly on or between toes or on the soles.

Treatment Algorithm

First-line Treatment:

1. Salicylic acid preparations (15-26%)
   • Apply daily after removing thick keratin layer
   • Use with occlusion when possible
   • Continue for 3-4 months
   • Strength of recommendation: A 1

Second-line Treatments:

1. Professional debridement by a podiatrist

   • Manual paring of the corn with a scalpel
   • Should be performed conservatively to avoid making underlying skin susceptible to increased tenderness 1

2. Cryotherapy

   • Keep wart frozen for 15-30 seconds
   • Repeat every 2-4 weeks for at least 3 months
   • Strength of recommendation: B 1

Additional Treatment Options:

• Urea-based preparations: FDA-approved for hyperkeratotic conditions including corns and calluses 2
• Padding and offloading: Address pressure distribution to reduce corn recurrence 1

Evidence for Treatment Effectiveness

A randomized controlled trial comparing 40% salicylic acid plasters with scalpel debridement found that at 3 months, 34% of corns had completely resolved in the salicylic acid group compared with 21% in the scalpel group (p = 0.044). Additionally, 83% had reduced in size in the salicylic acid group compared with 56% in the scalpel group (p < 0.001). Time to corn recurrence was longer in the salicylic acid group, and pain was significantly lower at 3 months (p < 0.001). The economic analysis indicated that corn plasters were a cost-effective intervention 3.

Prevention and Self-Care

• Wear properly fitting shoes with adequate width and length (1-2 cm longer than the foot) 1
• Avoid tight shoes or shoes with rough edges and uneven seams 1
• Use padding to redistribute pressure 1
• Regular inspection of feet and shoes 1
• Do not use chemical agents or plasters to remove corns without professional guidance 1

Important Cautions

1. Diabetic patients: Corns should be treated by healthcare professionals due to risk of complications. Self-treatment is not recommended 1

2. Overdebridement risk: When performed by a podiatrist, debridement should be conservative to avoid making the underlying skin susceptible to increased tenderness 1

3. Neurovascular corns: These are rare but very painful and difficult to treat. Debridement can cause pain and bleeding 1

4. Avoid home remedies: Do not use over-the-counter chemical agents or plasters without professional guidance, especially in high-risk patients 1

The evidence strongly supports salicylic acid as the first-line treatment for corns, with professional debridement as an alternative approach. Treatment should be combined with addressing the underlying cause, particularly pressure from ill-fitting footwear, to prevent recurrence.