Corns have a reason for them to be there. However when you remove all of those reasons, it is still there. Now there are a few deeper reasons why it may be still there.
It may not be.
Sometimes if you have tried all the treatments under the sun for a specific condition and it is still there, is it therefore the initial condition you were thinking of?
Foot corns (FC) have been notoriously confused with foot warts. We have lost count on the amount of patients who have been treated for foot warts and only to find out they have got foot corns...and vice versa. A good Chiropodist should know the difference. Basically, areas of high pressure = foot corn. If you press on the lesion and is painful = FC. If you pinch the area it is a foot wart.
FCs, as we have seen, can be notorious, painful and troublesome. The problem then comes in the fact that people will try anything to get rid of them. This is bad, but it becomes worse when a professional does it, for a fee.
When a FC is blasted with chemicals, poked and prodded and cut out endlessly then it doesn't react well to it. The body doesn't want to be hurt. So when the clinician digs down and tries to get the FC out every 6 weeks you know that in a few years time the body will react badly...and it does. Constant probing beyond the skins natural baseline leads to scarring.
Scarring occurs when the skin is cut too far down...either chemically or mechanically. Now surgeons have known this for years, and we know it as well. When we have a deep cut or go in for a surgical procedure then we know we will have a scar. Now it is exactly the same for a FC.
Once you do get scar tissue then you can not reduce the scar tissue to normal tissue. Then you have to be accommodating. The best method of treatment for this type of corn is an insole with a cut out to that area. What happens here is that the cut out within the insole allows the problematic area to rest just above the ground. This then reduces foot pain and the duration to which the corn will come back.
And that is the problem, the FC will come back because you have scar tissue present. Unfortunately because you will not wear your insoles all the time, your foot will press onto the floor at some point, Therefore pressure build up occurs and hard skin gets laid down. So you will probably need to have the FC reduced to alleviate that pressure. But without the insole the corn will come back regularly- the insole is there to reduce pain levels and to reduce the length of time that you will need the corn reducing.
Sometimes you can do everything to a patient to get rid of a FC, but ultimately the little things leave you stumped. If you have removed what you think is causing the FC and applied orthotic devices then there has to be something that is causing the foot corn other than the usual pressure application.
If all avenues bring up a blank, the next best cause is a small bony lump. These are actually on the foot bones themselves and they are tiny. It is just where the bone has grown usually in demand to stress, but these bony outgrowths are very small, but it is a point that adds extra pressure to an area from the inside of the body.
These are difficult to treat because of the process that is needed for the ultimate treatment: surgery. The patient needs to be suitable, the corn needs to be affecting their life which calls for intervention, X-Rays, postop treatment to name a few factors which can influence a treatment decision. Also clinicians may not elect for you to have an X-Ray thinking a FC may not be worth it, or that too much X-Rays are a bad thing- or they might not even think of a bony bump.
Surgery is the best treatment but again the next best thing is the orthotic, which alleviates the pressure from that area. You may have to have the FC reduced or enucleated to prevent pain build up. However the applications of medicaments over a long period of time will induce scar formation.
These are very problematic for the patient and for the clinician.
A neurovascular FC has nerves and vessels wrapped around it. So when a clinician actually tries to enucleate the corn, the corn tends to bleed quite easily and are also very painful when they shouldn't be (FCs are hard skin with no nerve supply).
There are only a few treatment methods for this type of corn, which is a very long standing FC because of vessels have grown into it.
A good one is the trusty orthotic to reduce the pressure away from the area.
The second and front line treatment is the use of an acid. The acid numbs the nerves so that removal of the FC is as painless as possible and it also helps to reduce the vessels to the area. The acid needs to be applied by a Chiropodist/ Podiatrist a day before enucleation so that the acid can be most efficient.
The problem comes in the fact that this treatment only works if the Chiropodist is competent enough to 1) apply the acid properly and 2) prescribe an orthotic to reduce FC growth rates.
Again the unfortunate problem with this treatment method is the likeliness of scar formation especially if the patient "needs" the acid treatment at every clinic appointment for FC enucleation to occur.
With long standing FCs there is little that the clinician to do to remove the FC for good. An increase of clinic intervals and a reduction of pain and the possibility of breakdown under the corn should be the clinicians ultimate goal in deciding treatment options.
Places where you could have a corn.