Corns

Question 1

Define Hypertrophy

Answer 1

Increase and growth of cells

Question 2

What is a corn?

Answer 2

A small deep concentrated mass of immature ‘cornified’ cells

Question 3

What is parakeratosis?

Answer 3

keratosis whereby the keratocytes retain the nucleus in the stratum corneum

Question 4

What are characteristics of Heloma Durum?

Answer 4

• Clinical Abbreviation = HD
• Small well circumcised hypertrophy of the epidermis with parakeratotic core
• Conical or crescent shaped
• Normally occurs on dorsal aspect of IP joints, under metatarsal heads, and apices of digits
• Usually looks yellow/gray
• Callus normally overlies the lesion/core

Question 5

What is the etiology of Heloma Durum?

Answer 5

• Intermittent compression / Shear
• Extrinsic factors - poor / ill fitting shoes, high level physical activity, toe deformities
  *

Question 6

What are characteristics of Heloma Molle

Answer 6

• Clinical Abbreviation = H Molle
• Soft corn
• Located interdigitally, normally between 4th and 5th digits
• Has a macerated, white appearence
• ‘Rubbery texture’

Question 7

What is the etiology of Heloma Molle?

Answer 7

• Normally intermittent compression, due to:
  
  • Tight footwear
  • Digital deformities
  • Hyperhidrosis - excessive sweat

Question 8

What are characteristics of Heloma Millare?

Answer 8

• Clinical Abbreviation = H Mille
• Can occur on weight bearing and non-weight bearing areas

Question 9

What is the aetiology of H Mille?

Answer 9

• Thought to occur in response to a combination of forces
• Common areas are Calcaneous and 2nd MTPJ
• Usually chronic
• Can present as asymptomatic - sometimes patients do not report pain
• Normally occur at the periphery of weight-bearing areas

Question 10

What are characteristics of Heloma Vasculare

Answer 10

• Clinical Abbreviation = H Vasc
• Is a corn with intrusion from vascularised dermal tissue. Extravasation can be present
• Common locations:
  
  • Digital apices
  • Dorsal IPJ
  • Plantar 1st MTPJ

Question 11

What is the aetiology of H Vasc?

Answer 11

• Normally excessive mechanical stress:
  
  • Excessive intermittent compression
  • Deep shear
• Digital deformity
• poor footwear

Question 12

What are characteristics of Heloma Neurovasculare?

Answer 12

• Clinical Abbreviation = HNV
• Is a Heloma Durum with intrusion of vascularised dermal tissue into the epidermis, with nerve involvement
  *

Question 13

What is the aetiology of HNV?

Answer 13

• Chronic mechanical stress - excessive intermittent compression
• toe deformities

Question 14

What are characteristics of Fibrous Corn?

Answer 14

• Clinical Abbreviation = HFib
• Long standing corn with presence of fibrous tissue in the dermis
• Can perpetuate chronic irritation of tissue
• Can lead to more fibrosis

Question 15

What is the aetiology of HFib?

Answer 15

• Excessive deep shearing
• Intermittent Compression

Question 16

What are characteristics of Durlachers Corn?

Answer 16

• HD, typically lateral to the 5th toenail
• Also known as Listers
• often looks like an extension to the nail, patients often present issue as ingrown toenail or fungal infection

Question 17

What ist the aetiology of Durlachers Corn?

Answer 17

Often deformity, associated with the 5th digit which has rotated and lies underneath the 4th digit

Question 18

What is the initial step in the management of treating corns?

Answer 18

Establish the cause

• Diagnostic examination
• Full history of the lesion
• Foot shape
• Shoe size and style
• any marks on the shoe?

Question 19

What different treatment options are there for corns?

Answer 19

• Sharp scalpel debridement / enucleation
• Podospray
• Patient advice
  
  • footwear apprasial
  • emolient use
• Caustics - e.g. Salycilic Acid
• Marigold Therapy
• Surgery
• Padding/Strapping
• Silicones/Otoforms to correct deformities
• Orthotics

Question 20

What is Podospray, how is it used?

Answer 20

• Is is a drill which sprays water out when used, the aim is for the water to reduce friction and therefore reduce pain when the corn is enucleated