Corn before paring.
Corn before paring.
Corn after pairing showing a clear center.
The corn is a painful, hard keratotic papule that occurs as a result of constant pressure. Paring with a #15 blade reveals a central, translucent core. This feature helps distinguish it from a wart, which upon paring reveals black dots. Underlying every corn is a bony prominence. Corns typically occur over the metatarsal heads of the distal sole. Another common area is the lateral aspect of the 5th toe. These are hard corns because the keratin is dry. A soft corn may occur in the web space between the 4th and 5th toes. It is called a soft corn because the keratin remains hydrated.
The patient often expects the health care provider to "cut the thing out". Indeed, the corn may be pared down (but not surgically removed) to decrease the pain, but the corn will recur without preventive measures. The main intervention is reducing direct pressure on the area. This may be accomplished with changing the foot wear or by using over the counter pads shaped like a donut. This shape directs the pressure to the adjacent skin and reduces or eliminates direct pressure. Inserts into the shoe with a hole cut at the site of the corn may help. In severe cases, surgery may remove the bony prominence. For corns on the distal tip of a hammer toe, a simple device to lift the toe and reduce pressure may be purchased.
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