Corns

Like calluses, corns are thickened areas of skin that form in response to excessive pressure and friction. They are one of the ways in which the body protects its skin, or the structures beneath it, from injury. They are usually hard and circular-shaped, with a polished or translucent centre, like the kernel of corn from which they take their name. They may become painfully inflamed in response to persistent excessive pressure or friction, or ulcerated when they rub against one another.

There are two types of corns. The first and most common develops on the tops and tips of the toes, and along the sides of the feet. These are known as heloma durum or hard corns. They are caused primarily by improper-fitting shoes and toe deformities. The second type develops between the toes and is sometimes referred to a "kissing corn". Physicians call them as helloma molle or soft corns. They usually are the result of slightly different bone abnormalities in the toes.
 

Heloma Durum (Hard Corns)

In many people, the toes do not lie flat, but instead curl downward. This wouldn't present a problem if the person always walked barefoot. However, trying to fit curled toes into shoes with tight toe boxes is one of the main reasons why hard corns develop. The toes remain curled inside the shoe, and the tops of toes press against the inside of the shoe, usually right at the toe joints. Additionally, the tip of the curled toe presses against the sole of the shoe. Neither of these areas is configured to sustain the forces this places on them. As a result, the skin compensates by thickening at the point of contact and heloma durums develop to protect the underlying structure damage.
 

Heloma Molle (Soft Corns)

Heloma molles can develop between any two toes but typically occur between the fourth and fifth. They form when one of the toe bones (phalanges) is slightly too wide. Normal phalanges are hourglass-shaped, with their tips wider then the middle. Kissing corns result when the ends of the toe bones are too wide, causing friction in the interspace between the toes. A soft corn often develops because of this irritation. The problem can easily be aggravated by tight-fitting shoes. Even people with normal-shaped toe bones can develop soft corns. This condition is especially common in women who wear high-heel shoes, which shift the body's weight to the front of the foot, thereby cramming the toes into a narrow, tapering toe box.

Treatment

Heloma Durum

Because hard corns usually are caused by a combination of narrow-toed shoes and toe deformities, they can be treated in two ways. One is to wear wider shoes, even sandals, when possible. The other is to fix the bone problem in the toes. If the toes are flexible and can be straightened, the use of an orthotic may enable the toe to return to a normal position. Small pads also can be used to try to straighten the toes. These may work, but are seldom a permanent solution.
When the toes are not very flexible, surgery may be an option. A toe may be held in an abnormal position because the soft tissue around the bones has grown stiff. If the soft tissues can be released, the toe may straighten. This surgery is explained in full under the section on Surgery .  

Heloma Molle Treatment

People with soft corns caused by excessively wide toe bones can switch to wider shoes with more room between the toes. Usually, however, this is not very successful. A new surgical procedure that can be done in the physician's office holds promise for soft corn sufferers. In it, the podiatrist makes a small incision in the skin of the toe and then grinds down the piece of bone that is causing the irritation. A couple of stitches are all that is needed to close the incision. The procedure is very quick, the recovery time is short, and most patients obtain relief almost immediately. This surgery is explained in full under the section on Surgery .

Although surgery may seem excessive to relieve the discomfort of corns, the only other option is have them cut or burned off with a topical acid solution or plaster when they become too painful. Unfortunately, this does nothing to relieve the underlying problem that caused the corns in the first place, so they will likely grow a new one eventually.

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