Several times before, we’ve written about painful corns and callous formation.
Our skin always responds to abnormal or increased pressure over a bony prominence by an increase in thickness and depth. Initially, the build-up serves to form a protective layer, but gradually, that same thickening and hardness increases the pressure, causing inflammation and pain.
One frequent location of just such activity involves the 5th or small toe. Occasionally, this can be found in between the 4th and 5th toes; other times, it is at the top of the toe where it bends at the joint. This presentation occurs at the outside tip of the 5th toe and along the edge of the nail plate. The corn can be so hard as to be indistinguishable from the nail plate beside it.
To explain how this happens, I’m going to cheat and use an excerpt from one of our previous blogs on Why You Might Want To Chop Off Your Little Toe!
Let’s start with a very quick biomechanics lesson. There are three primary muscles responsible for controlling the amount our feet pronate (roll inwards). One of those is called Flexor Digitorum Longus (FDL). The more the foot pronates, the greater the pull on FDL and the more contracture or curling in the toes.
With the 5th toe now in this curled and slightly rotated position, the pressure from the ground now rests on the tip of the very fine and pointed distal phalanx (Bone) in the toe. Unsurprisingly, this fine point of extreme pressure can cause a very deep and fibrous corn, not to mention an excruciating amount of pain.
Management of such a condition starts with a bit of fancy yet painless scalpel work to reduce the size and depth of the corn. Next, and most importantly for long-term resolution, we identify how the lesion was caused. To achieve this, it’s back to our physical examination and the Pedigait Lab to find the answers. Once achieved, we share the findings with our patient, presenting short and long-term treatment options, realistic expectations and answer any questions that will arise.
Treatments may be as simple as regular palliation, footwear changes, topical medication, functional orthotic intervention or surgical correction.
Whatever the final choice our patients make, it will be based on a clear understanding of their condition and the treatment option that best suits THEIR unique needs.
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