What are the treatment options for corns?

Treatment of Corns

Professional debridement by a trained podiatrist using a scalpel is the primary treatment for corns, followed by emollients and protective dressings, with footwear modification and orthotic devices to address underlying mechanical causes. 1, 2

First-Line Treatment: Professional Debridement

• Manual paring or scalpel debridement by a podiatrist is the cornerstone of corn treatment, removing the hard keratin plug that extends downward in a cone-shaped point causing pain. 1, 2
• After debridement, apply emollients and non-adherent dressings to protect the treated area and promote healing. 1, 2
• The debridement technique differs based on corn location: hard corns (heloma durum) on weight-bearing surfaces require removal of the central keratin core, while soft corns (heloma molle) between toes need attention to moisture and friction. 1, 2

Critical Safety Warning

• Never allow patients to use over-the-counter chemical corn removers or plasters—these significantly increase infection and ulceration risk, especially in diabetic patients. 3, 2, 4
• Patients should never attempt self-treatment by cutting corns at home; professional care is mandatory. 3, 2

Second-Line Treatment: Addressing Mechanical Causes

Footwear Modifications

• Properly fitting shoes with adequate toe box width and height reduce pressure and friction that cause corn formation. 1, 2, 4
• The shoe should be 1-2 cm longer than the foot, with internal width equal to the foot width at the metatarsophalangeal joints. 3
• Patients should be fitted while standing, preferably at the end of the day when feet are most swollen. 3

Orthotic Interventions

• Toe separators or silicone orthotic devices redistribute pressure between toes for soft corns (heloma molle). 1, 2, 4
• Custom therapeutic shoes or insoles are mandatory when foot deformities or pre-ulcerative signs are present. 2, 4

Adjunctive Topical Treatment (Limited Role)

• Salicylic acid 6% can be applied to hydrated skin at night after washing, covered with occlusion, then washed off in the morning. 5
• However, topical salicylic acid plays only a minor adjunctive role—professional debridement remains the primary treatment. 1, 2
• Excessive repeated application does not increase therapeutic benefit but can cause local intolerance and systemic salicylism. 5

Special Considerations for High-Risk Patients

Diabetic Patients and Those with Peripheral Arterial Disease

• A conservative debridement approach is essential due to significantly higher complication risk. 2, 4
• Corns are pre-ulcerative lesions in patients with loss of protective sensation or PAD and require aggressive preventive management. 3, 2, 4
• Referral to a foot care specialist for ongoing surveillance every 1-3 months is mandatory for high-risk patients. 3, 2, 4
• Therapeutic footwear is not optional but required for patients with neuropathy, foot deformities, callus formation, or poor circulation. 3, 2

Prevention Strategy

• Daily foot inspection, especially between toes, identifies early corn formation before pain develops. 3, 1, 2, 4
• Daily washing with careful drying between toes prevents moisture buildup that contributes to soft corns. 3, 1, 2, 4
• Never walk barefoot, in socks only, or in thin-soled slippers, whether indoors or outdoors. 3, 2, 4
• Apply emollients to lubricate dry skin, but never between the toes where moisture increases maceration risk. 3, 2, 4
• Change socks daily and wear socks with seams inside-out or without seams to minimize friction. 3

Common Pitfalls to Avoid

• Do not confuse corns with plantar warts—gentle paring reveals soft, granular dermis projecting into epidermis if the lesion is a wart. 6
• Avoid applying moisturizers between toes, as this creates a moist environment promoting soft corn formation and maceration. 3, 2
• Do not rely solely on topical treatments without addressing the underlying mechanical cause—corns will recur unless pressure and friction are eliminated. 7, 8
• Surgery is rarely indicated and should only target correction of abnormal mechanical stresses, not simple corn removal. 7, 8