What is the recommended treatment for a patient with two corns on her foot?

Treatment Recommendations for Foot Corns

The recommended treatment for corns on the foot includes gentle debridement with a pumice stone after soaking in warm water, followed by the application of emollients and appropriate footwear modifications to reduce pressure on the affected areas. 1, 2

Initial Management

Self-Care Approaches

• Foot soaking and debridement:

  • Soak feet in warm water for 5-10 minutes to soften the corns 3
  • Gently debride the thickened tissue using a pumice stone or emery board 1
  • Avoid excessive debridement which can make the underlying skin susceptible to increased tenderness 1
  • Apply moisturizer after drying feet thoroughly 3

• Pressure redistribution:

  • Use toe sleeves or toe spacers to relieve pressure on corns 4
  • Consider metatarsal pads if corns are on weight-bearing areas 4
  • Avoid walking barefoot, even indoors 3

Topical Treatments

• Keratolytic agents:
  • Over-the-counter salicylic acid preparations (6%) can be effective for corn reduction 5, 2
  • Application instructions:
    • Apply thoroughly to affected area at night after washing
    • Cover the treated area overnight
    • Wash off in the morning
    • If excessive drying occurs, apply a bland moisturizer 5

Footwear Modifications

• Proper shoe selection:

  • Choose shoes with adequate width and a rounded toe box 1
  • Ensure shoes are 1-2 cm longer than the foot 3
  • Width should equal foot width at the metatarsal phalangeal joints 3
  • Use shoes with flexible flat soles and heel support 1
  • Consider shoes with adjustable features to accommodate any dressings 1

• Orthotic devices:

  • Use cushioning insoles or orthotics to redistribute pressure 1, 3
  • Custom orthotics may be beneficial for recurrent corns due to foot deformities 6

When to Seek Professional Care

• Indications for podiatry referral:

  • Corns that are too painful or too thick for self-management 1
  • Recurrent corns despite appropriate self-care 6
  • Presence of underlying foot deformities 7
  • Diabetic patients or those with compromised circulation 3

• Professional debridement:

  • Should be performed by a podiatrist using scalpel debridement 1
  • More conservative approach is recommended to prevent increased blistering 1

Prevention of Recurrence

• Ongoing care:
  • Regular use of moisturizers to prevent skin dryness 3
  • Continued use of proper footwear and orthotic devices 1, 6
  • Periodic gentle debridement of recurring hyperkeratosis 1

Cautions

• Avoid over-debridement which can lead to increased pain and blistering 1
• Do not use excessive amounts of salicylic acid as this can cause local irritation and systemic effects 5
• Avoid prolonged foot soaking which can lead to skin maceration 3
• Surgery is rarely indicated and should only be considered when conservative measures fail 6

The evidence strongly supports that most corns can be effectively managed with conservative approaches, focusing on reducing pressure and friction through proper footwear and gentle debridement of hyperkeratotic tissue 1, 2, 6.