Mechanical factors, friction, pressure and the introduction of foreign substances may induce distinctive skin changes on the foot.
Clavus (Corn): It is a Kapha-Vataj disorder that also vitiates Meda and Rakta dhatu. (Source of the photo: John Cox Chiropody/Podiatry Clinic)
Corn is a circumscribed, conical and horny thickening with a central translucent pit, found on the dorsa of the toes, soles and between toes. It has a base on the surface and a central penetrating core that causes pain in the subjacent structures. Corn may disappear spontaneously if pressure is removed. Corn can be Hard and Soft. It is more frequent over the dorsolateral aspect of the fifth toes, soft being more common in 4th interdigital space of the foot. Soft cores are whitish thickenings due to maceration.
Differential diagnosis: Callus unlike corn is a larger, more diffuse thickening and lacks central penetrating core. It is either asymptomatic or painful on pressure with a feeling like walking with a pebble in one’s shoe. Corn may cause a severe knife like pain on downward pressure or a constant dull discomfort. If the corn is palpated, an underlying bone prominence is always found. Pain is elicited in Wart on lateral pressure and in Corn on direct pressure.
- Padding or corrective footwear to relieve the pressure and friction.
- Soaking the feet in hot water and reducing the surface by debridement with a scalpel blade or pumice stone. A topical anaesthetic cream can be applied before debridement with a scalpel.
- The use of keratolytic plasters is often helpful in case of corns and painful callosities. Leave overnight or for 5 to 7 days depending upon the thickness of the lesions and the season. Remove the plaster and soak the feet in hot water. Rub the white macerated skin and reapply a new plaster. Continue this until the corn is gone.
- Alternatively, an ointment containing Shuktibhasm, Shuddh Sphatika and Yavaksara can be used rather than the plaster. The medication is carefully painted on the paired site of the corn and allowed to dry each day until cure. This should be followed by Vrana-vat treatment. This is effective for interdigital soft corns.
- Alternatively, application of 2 parts propylene glycol to 1 part water under an occlusion moistens fissured calluses of the feet.
- Application of a paste made by combining one teaspoon of Aloe Vera gel with quarter to half teaspoon of Turmeric. Leave overnight under an occlusion. Massage with Kaaseesadi oil/Jatayaadi oil once daily.
- Caution should be taken if the patient is having diabetes, because such a patient is prone to develop infection and ulceration.
- Weight management should be done.
— Dr Malika Ahuja