Digital Corns and Callouses
Continuing our recent theme of debunking some long held theories about common foot problems, the subject in question today is digital corns. Again our online sources identify YOU as the source of the problem, or more specifically your inability to choose a shoe that doesn’t crush your toes (insert eye roll emoji).
Ok, I think we have all tried on a shoe that was a little tight for a special occasion but for general everyday life, most individuals have sufficient intelligence to know better.
Daily, we encounter patients who are suffering from painful corns on the tips of their toe, in between, or on the top of one of their toe joints. They report gradual formation of the corns over time and often they are wearing good quality correctly fitted shoes, so what happened?
In the vast majority of cases a mechanical functional instability results in overuse of the long digital flexor and extensors muscles.
This influence during the gait cycle causes the toes to contract (curl/claw) so that the tips of the toes are driven in to the ground, or the joints of one toe rub against the bony expansion of the joint on the neighbouring toe. Sometimes the toes contract so much, or the toes are pulled up (retracted) into the top of the shoe causing pressure and the associated callous and corn is born.
Whilst observing out patients standing/weight bearing often there is little or no evidence to support this claim, unless the offending toe is become fused or hammered. However, viewing the individual walking barefoot with our Pedigait system (our digital video gait analysis system) we can see stride after stride in slow motion showing exactly how the lesion was formed and which were the contributing structures. Additionally, If these forces are allowed to persist long enough and in combination with other systemic illnesses like diabetes, they can result in tissue breakdown, ulceration, infection, loss of locomotion and a huge undesirable change in the quality of life.
Treatment must be based on a clear understanding of the underlying cause; otherwise, without addressing this, most interventions will be futile and unsuccessful in the long run.
