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Recently I have seen a few patients of Afro-Caribbean origin who have the most profound corns. After many years of treatments including salicylic acid, silver nitrate, orthoses and electrosurgery these things continue to develop.
The lesions are so bad that the patients have to return to clinic for debridement every two weeks!!! A huge inconvenience to them!
The underlying skin looks rather more like scar tissue which I assume has formed due to many years of chemical bombardment. Is there anything that can be done to reduce the pain of these lesions in the long-term??? Any ideas?
My bet is that they are, as these are always the worst corns that I see - usually a chronic, recurrent, painful problem until they cease smoking. The recurrence rate is lightning fast, even with orthoses/footwear changes etc.
I tend to find that whatever you throw at them, they don't improve till smoking is ceased. Then, somewhat miraculously, they dissapear within about 6 months of quitting smoking.
There is a definite Masters/PhD in this for someone to explore more thoroughly .
It may be kelloid tissue in which case there is no cure, but I would recommend skin reduction with silicone plugs. Keep the routine ie 14 day return, but begin to expand the time between treatments (by a week) as the condition appears to improve. The plug hydrates the skin and makes it easier to reduce the overlying callus. If you search the previous threads you will see what to do.
Hi, I have seen a lot of that too and also in patients of Indian background. My observations on these clients is that they are mostly in the same age bracket (40 - 60), clients have flat feet (? typical for their background), lesions can appear on non-weightbearing areas and often have a darker than normal skin colour appearance on top but the very white scar-like base. I have had discussions with other podiatrists about this previously, we wondered if there was a viral component or other cause rather than tissue stress. Most effective treatment seems to be regular debridement, some benefit from WP ointment. Kath :-)
Kate,
I've found that Marigold Mass ie Tagetes works very well in these patients.
You have follow the regime tried and tested by the Khan family at the Royal Lonodn Homoeopathic hospital and I believe you can only purchase it if you've attended one of their courses. This is in keeping with our insurance cover via SOCAP.
Maire
Hi have one patient, Asian origin lesions again on non w/b areas? tried everything? Eventually worked out some of his lesions are from the scuffs and " footthongs / flipflops he wears. These cause pressure medially and laterally distal heel and arch area, that in most other ftwr would not cause pressure there. hj
It is frequently cited that callus around the heel is due to interaction with the heel base of the shoe. The implication being the bulk of the heel padding overlaps the base of the heel template and in some way this causes hyperkeratosis. However when you think about this it is unlikely and would infer the heel remained plantargrade throughout contact and we know dynamic friction is necessary. Instead the lateral and medial callus occur with the heel pendulum as it rolls from inversion to eversion. Ground reaction to the skin movement creates dynamic friction and when this destroys the nuclear envelope of the keratin cells this trigger repair by hyperkeratosis. Where we see callus at the rear of the heel is likely to arise at heel strike and where there is ankle equinus. The rolling movement causes tensile stress across the thickened skin and where there are fatique lines, fissures will result. A lack of heel support, as in thongs, would do little to prevent this type of hyperkeratosis. Sadly the prognosis remains poor although regular reduction and application of creams can improve the situation for short periods of time.
I shall take all ideas and discuss with the rest of the team a new treatment plan for these patients. The point on smoking and use of silicone plugs is very interesting and could well prove useful.
I think we are intending to have a case conference on this type of patient at a team meeting in the near future so we can all get our heads together and see if there has been any success. I shall keep y'all informed!!!
Oh and Maire could you give me any more info or guide me in the right direction of accessing some regarding the Marigold treatment?
No doubt load bearing on a pressure point or hard surface such as in the heel or more commonly under the Metatarsal Phalangeal Joints! I have read somewhere years ago that the sustaining cause of the hard-corn was in fact that the cells within and making up the corn were not dead and had not died as they should have done before they reached the skin surface!
In fact the cells still had a live nucleus. Living cells not dead tissue due to be shed! Conclusion if my memory serves me was Psoriasis. The corn was a form of Psoriasis!!!
Not a very good diagnosis for us because they haven't got a cure for Psoriasis, have they? But as a good Scot Cameron I have seen someone use an old favourite and it cured the itch. Not only that this person is a diabetic and it cured the age spots and discolouration on her legs as well!
Not a dead lump of corneous tissue at all it seems but a live and kicking lump of live tissue. A reason why it sometime I could swear reproduce it self after a deep controlled parring of the material. I really mean hacking it off you know folks!
Possibly why corns tend to stay for such a long time with patients. They enjoy the stimulation of pressure with motion. Also if the cells are still alive with their nuclei at the surface that would account for the high cell count in the corn and possibly why we have trouble murdering them on each visit?
I will attempt to find that paper if anyone is interested. A silicone plug in the cavity in certain circumstance will also help to kid the foot that it hasn't really got a hole in it after all. But looking on it in another way if you get rid of the live one's what is left will be inhibited/constricted by the plug. Giving time perhaps, just long enough to throw what is left of the live cells into regression???
But that was another paper out of the same stable years before State Registration so a lot of people would not know of these conclusions perhaps.
Corns or Scar tissue in Afro-Caribbeans?
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