Management of Corns: Treatment and Prevention Strategies
Professional debridement by a podiatrist is the primary treatment for corns, combined with addressing underlying causes through proper footwear and orthotic interventions. 1, 2
Understanding Corns
- Corns are localized areas of hyperkeratosis with a hard, yellow nucleus or plug of keratin that extends downward in a cone-shaped point, causing notable pain similar to walking on a small stone 1
- Corns form due to continuing friction as a direct hyperproliferative response of keratinocytes 1
- They differ from calluses by having a central core that extends downward in a cone shape 2
- Soft corns (heloma molle) typically occur between toes where moisture is present, while hard corns (heloma durum) develop on weight-bearing surfaces 2
First-Line Treatment
- Manual debridement by a podiatrist is the primary treatment for corns 1, 2
- For painful or thick corns, blade or scalpel debridement by a podiatrist is recommended 1
- Podiatrists should be conservative in their approach, as overdebridement can make the underlying skin susceptible to increased blistering and tenderness 1
- After debridement, apply emollients and non-adherent dressings to protect the skin 1
- Self-management can include gentle filing with an emery board or nail file for minor corns 1
Addressing Underlying Causes
- Identify and correct the source of pressure and friction causing the corn 3
- Properly fitting footwear with adequate toe box width and height is essential 1, 2
- Orthotic interventions such as toe separators or silicone devices can help redistribute pressure between toes 2
- Assess and correct weight distribution with cushioning to reduce hyperkeratosis build-up 1
- For interdigital corns, addressing predisposing factors like toe deformities is important 4
What to Avoid
- Never use chemical agents or plasters to remove corns, especially in patients with diabetes or peripheral neuropathy 1
- Avoid barefoot walking, wearing socks without shoes, or thin-soled slippers 1
- Do not wear tight shoes with rough edges or uneven seams 1
Special Considerations for High-Risk Patients
- Patients with diabetes require more careful management due to higher risk of complications 1
- For diabetic patients, treat any pre-ulcerative sign on the foot, including corns, promptly 1
- Patients with peripheral neuropathy need more frequent monitoring and professional care 1
- Referral to a foot care specialist is recommended for patients with PAD or diabetes for ongoing preventive care 1
Prevention Strategies
- Daily foot inspection, especially between toes 1
- Regular washing and careful drying, particularly between toes 1
- Wearing properly fitting shoes and socks without seams 1
- Regular application of emollients to lubricate dry skin (but not between toes) 1
- Cut toenails straight across to prevent additional pressure points 1
Emerging Treatments
- For recurrent interdigital corns in non-weight bearing areas, hyaluronic acid gel injections may provide long-lasting relief 5, 6
- This minimally invasive approach has shown considerable improvement without adverse reactions in case studies 6
Most corns can be successfully managed with conservative treatment, but they tend to recur if the underlying mechanical causes are not addressed 3. Regular podiatric care and proper footwear are the cornerstones of both treatment and prevention 2.