Corn removal surgery

Corn removal is a treatment for removing corns.

Corn (also called clavus) is a thick, hardened area of skin having a visible translucent core that generally develops on the feet, especially around the toes. Sometimes, it may also occur on the fingers and hands. It develops naturally due to constant friction or pressure against the skin on top of prominent bones. While it is not dangerous, corn can be irritating and even painful.

In many cases, corns can be removed using home remedies such as soaking in warm water and upon softening the corn, rubbing it with pumice stone or emery board. Creams with salicylic acid may also be used for this. However, while following home remedies, the person should not attempt to remove the corn directly. Further, persons with pre-existing conditions such as diabetes, arthritis, foot deformities, suffering from neuropathy or immunocompromised patients should consult a doctor before using any cream.

In some cases, corn removal by way of surgery is a better option.

Indications for getting corns removed by a doctor include:

• Failure of home remedies and chronic foot pain. If no improvement occurs within three weeks of using home remedies, it is better to consult with a doctor
• The person has diabetes or arthritis
• The person has heart disease or cardiovascular condition
• If the corns are very painful
• Infection occurring in the corns - swelling, redness, worsened pain, pus (Read more: Swelling in feet)
• If bleeding starts from the corn
• There are deformities in the foot such as hammertoe, bone spur, bunion, etc. (Read more: Heel spur)

The following are the contraindications to corn removal:

• Active infection
• Uncontrolled diabetes
• Peripheral vascular disease
• Neuropathy in the foot

Where corn removal necessitates correction of deformities in the foot, the doctor may need to discuss the possible risks with the patient.

Corns are managed by general surgeons or orthopaedic doctors. A complete history of the patient is taken that includes the symptoms, any pre-existing medical conditions and medication history. additional history about their footwear, daily activities, gait, home remedies followed, etc is also asked.

A physical examination is done that assesses the size, number and location of the corns.

If the doctor suspects any underlying bony abnormalities, they may require imaging studies such as an X-ray or CT scan. Other tests that may be carried out are:

• Pedobarographic test to assess the distribution of pressure across the foot
• Dermoscopic examination before and after trimming for confirming the diagnosis of corn
• A biopsy may be carried out to rule out warts and other skin disorders

The procedure is a daycare admission and is a short one. Various procedures can be employed to deal with corn depending on the presentation and cause of the corn. Written consent is taken by the doctor from the patient before the procedure.

Medical care involves paring the corn without drawing blood. The affected area is cleaned with iodine or alcohol and a local anaesthetic is applied. The corn is then shaved off using a sterile scalpel, directed to remove the central keratin core of the corn. This immediately reduces pain.

An alternative procedure is a punch incision, which involves rotating a single-use disposable punch biopsy instrument vertically over the skin with a twirling motion. Upon penetration of the instrument through the dermis into the subcutaneous fat, the instrument is removed.

In the case of diabetic patients, regular debridement decreases the chances of ulcers and, hence, the requirement for surgical intervention.

Laser removal can also be used for paring deep corns.

The procedures above may be used along with certain topical medications and may take more than one session.

In case corns are found to have developed due to deformities or bony bumps, surgery is carried out to correct these. These are directed towards realigning the foot, minimising mechanical stress and preventing painful lesions from occurring. A few of the surgical procedures are:

• Arthrodesis: Parts of the toe that have arthritis are removed. This involves straightening out the damaged joints and removing the cartilage. Thereafter, screws are put in the toe to hold the bones together while they heal.
• Osteotomy: This is typically used to realign the bones around the big toe. Small incisions are made in the bones. Then, the toe joints are realigned using screws and pins.
• Arthroplasty: This surgery is used to restore the function of a joint. It typically involves resectioning or removing a part of the toe.

The above procedures are usually day-care. In case of surgeries, the patient would not be able to drive themselves home post-discharge.

By itself, corn removal is a very safe procedure with minimal risks and complications. However, the accompanying surgeries used for correcting deformities in the toes can result in a few complications such as:

• Infection
• Inflammation
• Bleeding
• Nerve damage
• Blood clots
• Improper healing of the bone

Procedures for corn removal are day-care procedures and the patient is usually discharged within a few hours after the procedure. Discharge instructions include:

• Advice on wound care such as hygiene and applying antiseptic cream
• Staying completely off of the feet till the incision heals (typically 3 to 4 days) or applying minimal pressure
• Limiting activities causing mechanical stress
• Wearing surgical shoes or boots with padding for a few weeks post-surgery

In case surgery is performed, the doctor prescribes additional instructions, such as the timing of removing sutures or pins, etc.

The recovery time depends on the extent of the surgery. In the case of a less invasive procedure, it may take about a week, while in the case of extensive surgery or where surgery to correct deformity is also performed, it may take some weeks to a few months for complete healing.

Periodical follow-up is important to ensure that there are no complications, especially in the case of diabetic patients, the elderly and amputees.

To ensure that corns don’t recur, the situations giving rise to friction or pressure need to be addressed:

• Wearing socks and shoes that fit properly
• Keeping the toenails trimmed
• Using a corn pad – helps protect against extra friction or pressure around soft corn. Usually, this is doughnut-shaped and comes with an adhesive backing
• Foot hygiene – keeping the feet clean, washing them daily with soap and then drying them
• Use creams to keep the feet, fingers and hands moisturised. This prevents dryness and friction
• Wearing gloves while doing manual work
• Cover the corns in bandages, pads or silicon toe sleeves

Corns are hard, thick bumps on the skin usually appearing on the toes and sometimes on the fingers and hands. They are non-cancerous, however, in patients with certain pre-existing conditions, could be an indication of a complication. They require surgery if other conservative or non-invasive measures are not effective, there is excessive pain or the corns are large in size. In case the affected continues to be exposed to pressure or friction, corns can recur.