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Corns: Treatment & Medication
Updated: Jan 18, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
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Treatment
Medical Care
When treating hard corns, the primary objective is to debulk or pare the lesion without drawing blood. Following preparation of the skin with alcohol or iodine, a No. 15 surgical blade can be used with or without anesthesia to gradually remove sequential layers of keratin.3 The final treatment goals are to remove the central keratin core for short-term pain relief and to reshape the skin to provide long-term prevention of excess friction.4,5 Regular debridement in high-risk populations, such as diabetic patients, may decrease the incidence of ulceration and, consequently, the need for surgical intervention.17
Soft corns are often difficult to treat because they develop from underlying pressures in between the fourth and fifth digit, caused by bony prominences.2 Soft corns are best treated with properly fitting footwear and better foot hygiene in order to decrease the likelihood for infection. Applying an antifungal or antibacterial powder after washing the area and using lamb’s wool or a toe spacer are additional techniques used to treat soft corns.5 A good option in patients with coexisting dermatophytosis complex is 20% aluminum chloride hexahydrate solution (Drysol).
Following are additional treatment modalities:
- Keratolytics: Products that can be applied to affected areas include 40% salicylic acid pads and plaster, 40% urea cream, and 12% lactic acid cream.5,18 However, patients with peripheral neuropathies should avoid or use topical salicylic acid with caution.19
- Filler injections: A retrospective evaluation of the use of fluid silicone in treating loss of plantar fat reveals a unique treatment option for corns and calluses.20,21,22 Balkin reports he treated more than 1500 patients from 1964-2005 with silicone injections to digital and plantar sites. He found that 60-80% experienced some form of pain relief and elimination of calluses. Booster treatments are often needed, and the only complication reported was skin discoloration.22 Injection of 0.1 mL of medical-grade liquid silicone below a clavus and above the bone has been reported to have good results,23 but it is not presently approved by the US Food and Drug Administration.24 Whether other filler substances can achieve the same success is unknown.
Overall, removing or adjusting the mechanical stress causing the corn—finding footwear that matches the length and width of a foot—is the first step towards treatment of this condition.3,25 Patient awareness of his or her footwear is critical to the prevention of future corns. Conservative treatment can be continued at home and may consist of using a pumice stone for minor debridement, practicing good foot hygiene, and using soft spacers or a silicone sleeve, which can be bought at most retail stores.2,18
Surgical Care
Surgery to remove the bony prominences is indicated only if all conservative measures fail.3,4,14 Surgical procedures include bunionectomy, syndactylization, osteotomy, and arthroplasty.2,14 Long-term improvement for lateral fifth-toe corns and interdigital corns has been achieved with partial and complete condylectomy.14
Consultations
If patients do not respond to conservative treatment, further evaluation by a podiatrist or orthopedic surgeon is recommended. Extensive orthoses are available to help remove mechanical stresses on the foot, and an orthopedist or podiatrist should be consulted.
Diet
Weight loss may reduce pain from corns and improve biomechanics in patients who are obese.
Activity
Patients are advised to reduce or eliminate certain mechanical forces or motions. However, certain activities, particularly work related, may be unavoidable or patients may be reluctant to make the necessary changes.
Medication
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Keratolytic agents
These agents cause the cornified epithelium to swell, soften, macerate, and then desquamate.
Salicylic acid (Clear Away, Compound W, Dr. Scholl's Corn Removers)
A keratolytic, bacteriostatic, and fungistatic agent. Its main clinical use is as a keratolytic agent and as an agent that increases the percutaneous absorption of combined drugs by removing the stratum corneum. The keratolytic activity results from solubilization of the intercellular ground substance in the stratum corneum and shedding of the scales, which are bound by it. Commonly available in concentrations of 10-40% in a cream or lotion base.
Adult
>12% solution: Apply to affected area for 4-6 wk
Pediatric
Apply as in adults
With systemic absorption, may increase toxicity of acetazolamide, anticoagulants, heparin, hypoglycemics, methotrexate, and moxalactam; may decrease efficacy of bumetanide, captopril, and probenecid; may increase clinical efficacy of topical corticosteroids, anthralin, and tar by increasing penetration of the drug into skin
Documented hypersensitivity; breastfeeding
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Avoid use during pregnancy and breastfeeding unless clearly indicated; allergic responses may include urticaria, anaphylaxis, and erythema multiforme; with high concentrations, local irritation or inflammation may occur; contact allergic dermatitis may occur; systemic absorption may result in symptoms of salicylism, including tinnitus, nausea, thirst, sweating, hyperpnea, fatigue, fever, and confusion
Lactic acid (AmLactin, Lac-Hydrin, Lactinol)
Provides beneficial effects on dry skin and severe hyperkeratotic conditions. Indicated for moisturizing and softening dry, scaly skin.
Adult
Apply qd/tid
Pediatric
Apply as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Avoid use during pregnancy or breastfeeding unless clearly indicated; avoid contact with eyes, lips, and mucous membranes; mild stinging, burning, or peeling may occur on sensitive, inflamed, or irritated skin areas
Urea (Aquadrate, Calmurid, Carmol, Nutraplus)
Keratolytic, bacteriostatic, bactericidal, and fungistatic agent. Topical treatment for dry skin and ichthyosis. Also used as a skin moisturizer.
Adult
Apply to affected area prn
Pediatric
Apply as in adults
May increase clinical efficacy of topical corticosteroids, anthralin, and tar by increasing penetration of drug into skin
None reported
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Avoid during pregnancy and breastfeeding unless clearly indicated; may cause burning and irritation if applied to inflamed or broken skin
More on Corns |
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| Differential Diagnoses & Workup: Corns |
 Treatment & Medication: Corns |
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References
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Murphy GA. Lesser Toe Abnormalities: Corns (Helomata and Clavi). In: Canale ST, ed. Canale: Campbell's Operative Orthopaedics. 10th. St. Louis, Mo: Mosby; 2003:4063-5.
Singh D, Bentley G, Trevino SG. Callosities, corns, and calluses. BMJ. Jun 1 1996;312(7043):1403-6. [Medline].
Snider RK. Corns and Calluses. In: Greene WB, ed. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 2001:437-41.
DeLauro TM, DeLauro NM. Corns and Calluses. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, eds. Fitzpatrick's Dermatology in General Medicine. 7th ed. New York, NY: McGraw-Hill; 2008:97.
Kennedy CTC, Burd DAR. Mechanical and Thermal Injury. In: Burns T, Breathnach SM, Cox N, Griffiths CE, eds. Rook's Textbook of Dermatology. 7th ed. London, England: Blackwell Science; 2004:22.
Williams ML, Elias PM. Enlightened therapy of the disorders of cornification. Clin Dermatol. Jul-Aug 2003;21(4):269-73. [Medline].
Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol. Mar 1 2004;159(5):491-8. [Medline].
Menz HB, Morris ME. Footwear characteristics and foot problems in older people. Gerontology. Sep-Oct 2005;51(5):346-51. [Medline].
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Habif TP. Warts, Herpes Simplex and other Viral Infections. In: Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 4th ed. St. Louis, Mo: Mosby; 2004:374-5.
Mann RA, DuVries HL. Intractable plantar keratosis. Orthop Clin North Am. Jan 1973;4(1):67-73. [Medline].
Coughlin MJ, Kennedy MP. Operative repair of fourth and fifth toe corns. Foot Ankle Int. Feb 2003;24(2):147-57. [Medline].
Menz HB, Zammit GV, Munteanu SE. Plantar pressures are higher under callused regions of the foot in older people. Clin Exp Dermatol. Jul 2007;32(4):375-80. [Medline].
Coughlin MJ. Common causes of pain in the forefoot in adults. J Bone Joint Surg Br. Aug 2000;82(6):781-90. [Medline].
Sage RA, Webster JK, Fisher SG. Outpatient care and morbidity reduction in diabetic foot ulcers associated with chronic pressure callus. J Am Podiatr Med Assoc. Jun 2001;91(6):275-9. [Medline].
Cordoro KM, Ganz JE. Training room management of medical conditions: sports dermatology. Clin Sports Med. Jul 2005;24(3):565-98, viii-ix. [Medline].
Foster A, Edmonds ME, Das AK, Watkins PJ. Corn cures can damage your feet: an important lesson for diabetic patients. Diabet Med. Dec 1989;6(9):818-9. [Medline].
Balkin SW. Silicone injection for plantar keratoses. Preliminary report. J Am Podiatry Assoc. Jan 1966;56(1):1-11. [Medline].
Balkin SW. Injectable silicone and the foot: a 41-year clinical and histologic history. Dermatol Surg. Nov 2005;31(11 Pt 2):1555-9; discussion 1560. [Medline].
Field LM. Letter: injectable silicone for painful interdigital neurovascular clavi and verrucae. Dermatol Surg. Dec 2006;32(12):1535. [Medline].
Narins RS, Beer K. Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg. Sep 2006;118(3 Suppl):77S-84S. [Medline].
Richards RN. Calluses, corns, and shoes. Semin Dermatol. Jun 1991;10(2):112-4. [Medline].
Dockery GL, Nilson RZ. Intralesional injections. Clin Podiatr Med Surg. Jul 1986;3(3):473-85. [Medline].
Further Reading
Keywords
clavus, clavi, mechanical hyperkeratosis, soft corns, hard corns
