What is the treatment for a seed corn (heloma durum) on the bottom of an 11-year-old boy's foot?

Treatment of Seed Corn on Bottom of Foot in 11-Year-Old Boy

The primary treatment is professional debridement (paring) by a trained podiatrist using a scalpel, followed by addressing the underlying mechanical causes with proper footwear and potentially orthotic devices. 1, 2

Initial Treatment: Professional Debridement

• Manual paring with a scalpel by a podiatrist is the first-line treatment for removing the hard keratin plug that characterizes seed corns (heloma durum) on weight-bearing surfaces 1, 2
• After debridement, apply emollients and non-adherent dressings to protect the treated area 1, 2
• This approach provides immediate pain relief by removing the cone-shaped keratin point that causes the sensation of "walking on a small stone" 1

Addressing Underlying Mechanical Causes

Without correcting the mechanical forces causing the corn, it will rapidly recur despite repeated debridement. 3, 4

Footwear Modifications

• Ensure properly fitting shoes with adequate toe box width and height to reduce pressure and friction on the affected area 1, 2
• The shoes should accommodate the shape of the child's feet without creating new pressure points 5

Orthotic Interventions

• Consider custom-made insoles or orthotic devices to redistribute plantar pressure away from the corn site 1, 2
• These interventions are particularly important if there is any underlying foot deformity contributing to abnormal pressure distribution 5, 2

Alternative Treatment Option

Supervised use of 40% salicylic acid plasters is an evidence-based alternative that may be more effective than scalpel debridement alone:

• Salicylic acid plasters showed 34% complete corn resolution at 3 months compared to 21% with scalpel debridement alone, with significantly longer time to recurrence 6
• This treatment should only be used under podiatric supervision and is applied after initial debridement 7, 8
• Never allow home use of chemical corn removers without professional supervision, as this increases infection risk 2

Prevention Strategy

• Daily foot inspection to identify early recurrence 1, 2
• Regular washing and careful drying of feet 1, 2
• Consistent use of appropriate footwear, avoiding barefoot walking or thin-soled slippers 2
• Apply emollients to dry skin areas (but not between toes) 2

Common Pitfalls to Avoid

• Do not allow the child or parents to attempt home removal with blades or chemical products 2
• Do not treat the corn in isolation without addressing footwear and biomechanical factors, as this leads to rapid recurrence 3, 4
• Avoid tight or ill-fitting shoes that perpetuate the mechanical stress 4, 8

Follow-Up

• Re-evaluate if the corn recurs quickly after initial treatment, as this indicates inadequate correction of underlying mechanical forces 4
• Consider referral to a pediatric orthopedic specialist if significant foot deformity is present that cannot be managed with conservative measures 5