Nancy Wingo wrote:
-------------------------------
My husband has a corn or something resting in the crevice of his baby toe. It's hard like a corn and we have tried to remove it like a corn. He's had it for about a year now and it continues to grow back. Can you help us with a solution?
==============
DISCLAIMER:
THE FOLLOWING IS OFFERED AS GENERAL INFORMATION ONLY, AND MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER'S PROBLEM. IT IS NOT BASED ON ACTUAL KNOWLEDGE OR EXAMINATION OF THE QUESTIONER AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION. ONLY THROUGH HANDS ON PHYSICAL CONTACT WITH PATIENTS CAN ACCURATE MEDICAL ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER SHOULD CONTACT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS FORTHCOMING HEREIN.
HEY . . This one's a real GIMME, as most any first-year pod student could give an answer to this one. It would appear obvious that you have not had this looked at by a foot specialist, as he surely would have know what to do.
What you have clearly described is what is commonly known as a soft corn. As with any corn, it is the result of pressure on the skin overlying or superficial to a bony prominence or bump. But, unlike the corn produced by a hammertoe, where in the pressure on the bony prominence created by the toe deformity is supplied by the upper of toe box of the shoe, the soft corn is produced by bone to bone contact between two adjacent toes as the shoe pushes the toes toward each other. A soft corn is so-called because it frequently becomes spongy, and "soft" from the maceration produced by inter-toe perspiration. But it's bain is anything BUT "soft."
Treatment generally involves surgery, which I will describe in a moment. But surgery is not applicable for all patients due to such complicating issues as circulatory insufficiency, uncontrolled diabetes, etc.
Also, some patients simply refused to submit themselves to surgery, which is perfectly their right. For these patients, the corn should be mechanically reduced by a professional and padding place in the digital interspace to lessen the inter-digital pressure. This is not generally curative and most often must be repeated periodically, Generally, chemical debriders such as salicylic acid plasters, drops or creams are best avoided as the maceration to which I earlier alluded can really do a job in combination with salicylic acid, resulting in a nasty ulceration.
As far as the surgery is concerned, I'm sure we'll heard differing views from our friends of the MIS persuasion, but since you've describe the location to the corn as the "crevice" of the "baby toe," I assume you are describing its location as deep within the web space between the 4th and 5th toe. This soft corn is most often the result of impingement of the medial portion of the head of the proximal phalanx of the fifth to on the lateral portion of the base of the proximal phalanx of the fourth toe when the toes a re pressed together by the shoe. There are five possible surgical approaches:
1. Partial resection (removal) of the head of the proximal phalanx of the 5th toe.
2. Total resection (femoval) of the head of the proximal phalanx of the head of the 5th toe (this is also known as an arthroplasty)
3. Partial resection of the lateral portion of the base of the proximal phalanx of the 4th toe.
4. A combination of 2 and 3.
5 Surgical joining of the 4th and 5th toes by creation of a flap and suturing, with or without some bone removal.
Unfortunately, I had to use specific medical language to describe the above and I hope everyone is still with me.
Just to cover all bases, although your description does not lend itself to this diagnosis, there are commonly seen soft corns which present adjacent to the medial aspect of the head or base of the proximal phalanx of the 5th toe and/or lateral aspect of the head of the proximal phalanx or the middle phalanx of the 4th toe. This is one of those time when I go with an MIS procedure, and in my hands, unless the corn is in the nail groove, where results seem to vary, it works exceedingly well. A burring procedure know as an osteotripsy wherein a bur is introduced into a stab incision into an appropriately numbed and surgically prepped toe, just beneath the soft corn of the 5th toe and the sharpened or protruding aspect of the bone is smoothed. Post operative complaints are generally minimal and, as previously mention the success rates are very high.
The good news is that the condition, especially when surgery is performed is generally easily correctable.
|
