What is the emergency management of a painful heloma (corn)?

From the Guidelines

For emergency management of a painful corn, debridement of the lesion by a podiatrist using manual debridement or paring of hyperkeratosis is recommended, as it is a procedure that can provide relief from pain and pressure, especially if the area is too painful or too thick for self-management 1. When managing a painful corn, it is essential to prioritize methods that reduce pressure and discomfort while avoiding further irritation or infection.

• Soaking the foot in warm water for 10-15 minutes can help soften the hardened skin, making it easier to manage the corn.
• Applying emollients and using nonadherent dressings after debridement can protect the debrided skin and promote healing, as suggested by the evidence on foot care in epidermolysis bullosa 1.
• Assessment and correction of weight distribution, with cushioning to reduce hyperkeratosis build-up, can also be beneficial in managing corns, especially in patients with conditions like epidermolysis bullosa 1.
• Over-the-counter pain relievers like acetaminophen or ibuprofen can be taken as needed for pain management, following the recommended dosages.
• It is crucial to avoid home remedies that could lead to infection, such as cutting the corn oneself, and instead, seek professional medical care if the corn is severely painful, infected, or if there are underlying health conditions like diabetes or poor circulation. The use of hot water immersion for pain relief, as suggested by first aid guidelines 1, may also be considered, but the most recent and highest quality evidence supports a more conservative approach to debridement and management, especially in vulnerable patient populations 1.

From the FDA Drug Label

The preferable method of use is to apply Salicylic Acid 6% thoroughly to the affected area and to cover the treated area at night after washing and before retiring. There is no information about emergency management of painful corn in the provided drug label.

• The label provides information on the dosage and administration of salicylic acid for the treatment of corns, but it does not address emergency situations.
• It does not provide guidance on how to manage pain associated with corns in an emergency setting. 2

From the Research

Emergency Management of Painful Corn

• The management of painful corns can be achieved through various methods, including the use of salicylic acid plasters and scalpel debridement 3.
• A study comparing the effectiveness of salicylic acid plasters with 'usual' scalpel debridement of corns found that the use of corn plasters was associated with a higher proportion of resolved corns, a prolonged time to corn recurrence, less pain, and reduced corn size over the first 6 months 3.
• Debridement, including scalpel debridement, is a vital component of wound bed preparation and can be used to facilitate wound healing 4.
• The choice of debridement method depends on the individual patient's needs and the specific characteristics of the corn, with salicylic acid plasters offering an effective alternative to scalpel debridement in some cases 3, 5.
• In the emergency department, the treatment of acute pain, including pain from corns, should be tailored to the patient's specific condition and underlying risk factors, with a range of pharmacological and non-pharmacological alternatives available 6.

Treatment Options

• Salicylic acid plasters: can be used to treat corns and have been shown to be effective in reducing pain and promoting corn resolution 3, 5.
• Scalpel debridement: can be used to remove dead or unhealthy tissue from a wound, including corns, and facilitate healing 4.
• Other debridement methods: may be available, including autolytic, enzymatic, and mechanical debridement, and the choice of method will depend on the individual patient's needs 7.

Considerations for Practice

• Nurses should adopt an evidence-informed approach to wound care, including debridement, and be aware of the importance of following a comprehensive, holistic approach when treating chronic wounds 7.
• Emergency physicians should be aware of the numerous opioid and non-opioid alternatives available for the treatment of acute pain, including pain from corns, and provide care that is tailored to the patient's specific needs 6.