Corn / Clavus

A Corn (also termed clavus) is a thickening of the skin due to intermittent pressure and frictional forces. The extensive thickening of the skin in a corn may result in chronic pain, particularly in the forefoot ; this thickening may result in ulcer formation.

Corns are often seen in athletes and in patient populations exposed to uneven friction from footwear or gait abnormalities, including elderly persons, diabetic patients. Abnormal foot mechanics, foot deformities, high activity level also contribute to the formation of corns

Irregular distribution of pressure and repetitive motion injury (especially in athletes) are believed to be the main inciting causes. Inappropriately shaped or constrictive footwear in the presence of bony prominences may exacerbate corn formation.

Complication

Complication include secondary bacterial or fungal infection in patients with diabetes or in patients with immunosuppression.

Corns are often in close proximity to joints and bones, increasing the chances for septic arthritis or osteomyelitis to occur if left untreated.

Patients with diabetes, may have ulcerations from chronic pressure can lead to infection and cellulitis.

Laboratorium test

Blood glucose testing is required when diabetes mellitus is suspected. Rheumatoid factor testing for deformities consistent with rheumatoid arthritis may be indicated.

Imaging studies are required in clavus patients only to detect underlying bony abnormalities.

Treatment

Treating clavus, the primary objective is to debulk or pare the lesion. Treatment should be aimed at reducing symptoms such as pain and discomfort with walking. Paring of the lesions immediately reduces pain gradually remove sequential layers of keratin

The final treatment goals are to remove the central keratin core with local anesteshia

Reduced friction may be accomplished with the use pads. Insoles may be made of silicone or soft plastics.

Shoes with extra length are required for toe deformity, and shoes with extra width are required for lateral toe clavus. Shoes should be soft inside without seams that rub or press.

Overall, removing or adjusting the mechanical stress that causing the corn—finding footwear that matches the length and width of a foot—is the first step towards treatment of this condition.  Patient awareness of their footwear is critical to the prevention of future corns