Corns On The Tips Of Your Toes 101.
Foot corns that live on the end of your toes are called Apical corns. A nice demonstration is in the picture below:
Like with all corns, they are there for a reason: something has caused them.
Apical foot corns have a few common causes:
1- Poor shoe wear. We had a patient that had been visiting our competition for years. He had very painful and large apical foot corns. We tried a lot of treatment methods. But we noticed when he put his foot into his shoes he had trouble with it. He stated that he was a size 10 and had bought shoes in that size "for ever". But when we checked his foot size we noticed that he was a size 11. His toes were crunched up into those shoes- hitting the end of the shoe causing trauma. In time that trauma turned into callus and then corns.
However when he did buy new shoes we found that the corns reduced in size and pain, but because he had been treated for so long and with so many different medicaments, his corns turned into a long standing problem.
When shoes are too tight the toes crunch up and can cause apical corns. Some soccer players believe that they should have a tighter shoe, but corn formation is common, fractures as well because of the closeness of trauma (hitting a ball) to the toes.
If the shoe is not a lace up or fastened using lace or Velcro then the foot has a good chance of slipping and sliding around in that shoe. This is common with slip-on shoes. Another one is the court shoe- or high heeled shoe. The heel is pushed up into the air and forces the toes down and into the front of the shoe where trauma occurs.
2- Specific jobs or hobbies. Just like soccer causing some foot problems there are many hobbies and jobs which can cause apical foot corns. Ballet is noted as a high problem with children, also stop starting sports can cause a problem, where the foot stops quickly pushing it to the end of the shoe- tennis is a good example.
There are also some jobs that can cause apical corns. Most of these involve the steel toe capped shoe. Being so hard the toes just get subjected to trauma. This has the other consequence of thickening up the toe nails in response to the trauma sustained, rather than a fungal infection present.
3- Clawing. Sometimes there are illnesses like Arthritis that can cause your toes to claw. Sometimes the type of foot that you have also causes clawing, and again slip on shoes causes clawing. What happens is (with the exception of Arthritis) is that your foot moves around ever so slightly, backwards and forwards. The body doesn't want this, so what it does to stop this movement is to claw the toes. This then adds to stability. But it also makes the tips of the toes hit the floor.
4- Long second toe. Perfectly common and usually found in ladies, it is where the second toe is longer than the first. The body doesn't like this and in time it will bring back the second toe so that the first becomes the longest. Now that second toe is clawed and the end of it hits the ground and corn formation starts.
In all aspects, when the tips of the toes hit the floor they kick start a trauma mechanism. The body doesn't want to be hurt or hit, so it starts to lay down hard skin. Great, the body thinks, but what happens then is the hard skin causes extra pressure to that area, so again the body lays down more hard skin...and the cycle continues. However when you get rotational movement, where your toes move a little to the left and a little to the right...you get corn formation.
The best ever method of treatment for an apical foot corn is to figure out what is causing it and remove or adjust that factor.
Unfortunately what usually happens, is that you need to get the corn removed. I would never do that with "over the counter preparations" e.g corn plasters/ corn paste/ silver nitrate. Stay away from these devices. The problem comes in the fact that they contain an acid which is supposed to remove the corn. However as many times the manufacturers put a warning on the box not to be touched by insufficient circulation and neurologically reduced patients, they invariably do and the consequences are a big problem.
Because it is an acid, it will wipe out the corn but it will wipe out the surrounding healthy tissue and will only stop when it becomes painful (you taking the treatment off your toe) or when it becomes neutralised by blood. If you are neurologically compromised then you will not feel the effects of the acid and will leave it on until you get an ulcer. If you are vascularly compromised then you will have a tough time healing and repairing the damage left behind.
A good Chiropodist/ Podiatrist will remove the corn quite easily and it should be pain free. Once they have done that you can then do the prevention methods to stop the thing from coming back.
There are only a few extra prevention methods, but one of the best methods is the silicone device.
A silicone device can last for a very long time (up to a couple of years), is washable and works very well. In our clinic we usually make a temporary version, then bring the patient back 6 weeks later and then find out how they did with the felt device. If they liked the toe feeling much better, without pain, they always go for the permanent silicone device.
They work by lifting up the toe(s) very slightly so that they are not hitting the ground and therefore the factor which causes the hard skin/ corn cycle stops.
There are problems though. They are only made by the Chiropodist, but if that Chiropodist doesn't make them that well or doesn't like to- then you will get a poor device. Secondly, if you insert the device wrongly onto your toe it will become ineffective.
The device is a preventative measure- if you have a apical foot corn then apply a silicone device it will not work because the corn is there. So it will actually add pressure to the area. It prevents or slows the corn down from coming back- so it needs to be worn all the time (apart from bed and baths/showers). Some patients like them, some do not like something "different" on their foot so they resist the device and remove it.
Some people have used corrective insoles to stop the clawing of the digits due to a certain foot type. This is a good preventative measure as long as the clawing is temporary rather than permanent. If it is permanent then corrective insoles will not work that well.
Some other people have used cushioning insoles. This is fine, however the cushioning has to sufficiently thick for it to be useful because those toes are still hitting the floor.
Other patients have used silicone caps:
These are good in theory, but as all corns you need to remove them first before you can do any preventative measures.
If you add anything solid to a corn it will just make it worse, and it will be more painful.
I don't mind silicone caps but again they are not the golden bullet that they are made out to be.
1. They can be tight and if they are too tight they could, with someone who has poor circulation, reduce that blood supply even more.
2. Having something attached to your toe all day in unhygienic and can dicolour the toenail and 2 can cause occlusion. This is where the skin becomes all macerated and damp causing an additional problem.
Places where you could have a corn.