HELOMA INTERDIGITAL PDF

A heloma molle is a soft callus or corn that commonly occurs at the fourth interdigital space, between the fourth and fifth digits. The callus may be located at other sites, depending on the anatomy and biomechanics of the individual. A callus forming at the webbing of the interspace is most often associated with a short fifth metatarsal. With heloma molles, patients often complain about pain at the site of the lesion that is aggravated by tight shoes, pressure, and ambulation. If ignored, a heloma molle may develop into something more serious such as an infection, sinus tract to the bone, even a bone infection. The first line of treatment for a heloma molle include, padding that would separate the digits, local debdridement and possible keratolytics that would keep the callus down.

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NCBI Bookshelf. Ahmad M. Al Aboud ; Talel Badri. Authors Ahmad M. Al Aboud 1 ; Talel Badri 2. A corn, also known as a "heloma" or "focal intractable plantar hyperkeratosis," is a type of callosity. This latter is a common, uncomfortable, thickened skin lesion that results from repeated mechanical trauma due to friction or pressure forces.

In the literature, confusing terminology is often used to call different types of hyperkeratotic skin lesions. Nevertheless, a corn should be distinguished from a callus, which is a more diffuse type of callosity. Thus, a corn is a well-delimited focal area of hyperkeratosis. This condition often is seen in athletes and in patients who are exposed to unequal friction force from footwear or gait problems, including older adults, patients with diabetes, and amputees.

It should be regarded as a symptom rather than an effective disease. Corns typically result from repeated accumulated mechanical trauma as well as other contributing factors like ill-fitting footwear, the presence of bony prominences foot deformity , and certain physical activities.

They are most common on the feet: on the dorsum of the toes, in the last interdigital web space, as well as on the soles. Individuals with darkly pigmented skin are more prone to developing corns. They have been reported to affect older age groups with a slight female predominance due to wearing narrow shoes. The repeated friction and pressure of the skin overlying the bony prominences leads to a hyperkeratotic thickness.

This latter is a protective body reaction that produces an excess of horny epithelial layer to prevent skin ulceration. This explains the preferential location of corns next to the condyles of the metatarsals and phalanges as well as the occurrence of corns in patients with a foot deformity.

Histopathologic examination of a corn is usually not needed, but on a few occasions, it might be helpful to differentiate corns and calluses from other diseases like a plantar wart. A biopsy specimen from corn will show proliferation of all epidermal layers acanthosis , including the stratum corneum, cells at the stratum corneum layers will return their nuclei parakeratosis indicating premature differentiation. The granular cell layer may be diminished or absent. The dermis may often show dense fibrous tissue with hypertrophied nerves, and scar tissue may extend to the subcutaneous fat.

Corns are primarily diagnosed on clinical presentation. It is also easier to diagnose corns by inspection and palpation because of their rough hyperkeratotic texture. They are located over a bony prominence. They are painful on walking and standing but are asymptomatic to touch. Some authors add to these two variants a third one, called a seed corn, which manifests as multiple nonpainful keratotic plugs within plantar calluses in non-pressure-bearing areas of the soles. Corns sometimes are difficult to distinguish from plantar warts.

In corns, the plantar skin lines may be observed within the lesions, as opposed to plantar warts. Furthermore, if the physician exerts a digital pressure perpendicularly to a plantar corn, this latter will come into contact with the bony prominence, and the patient will feel pain. This maneuver is generally nonpainful in the case of warts.

Finally, the absence of capillary dotting called "Auspitz's sign" after paring hard corns distinguishes them from plantar warts. Dermoscopy may help make the diagnosis showing areas of hyperkeratosis without vascular or hemorrhagic structures that are mainly seen in warts. Pressure studies of the feet can highlight areas of excessive plantar pressure associated with plantar corns.

Other tests, like fasting glucose level and rheumatoid factor, may be done to find the etiology of foot deformity in some patients. The treatment aims to reduce the pain and discomfort resulting from corns.

Management begins with prevention. Patients should avoid ill-fitting shoes and mechanical trauma to the affected area. Directed toward the removal of the underlying cause for corns like bony prominences.

Usually, it is indicated in case of failure of other conservative treatment modalities. Although corns and calluses are a chronic, recurrent issue, most of them gradually go away when the repeated friction or pressure causes them to be eliminated. Patients with peripheral neuropathies should try to avoid the application of plasters that contain salicylic acid because these plasters might cause sloughing of normal skin if placed in a wrong way.

The treating provider should refer the case to an orthopedic surgeon to evaluate for underlying bony abnormalities in lesions that are recalcitrant to treatment or recurrent. Calluses and corns are not caused by viruses and are not contagious.

Patients should be instructed to trim their nails to avoid any pressure or repeated trauma, which might lead to the development of corns. The following specialties are involved directly or indirectly in the treatment plan for cases of corn: dermatology, neurology, orthopedic surgery, endocrinology, and podiatrists. One of the frequent pitfalls seen in clinical practice by some dermatologists is using liquid nitrogen cryotherapy for treating cases of corns.

This, unfortunately, can lead to aggravation of the problem, and it can add more to the patient's suffering since liquid nitrogen damages normal skin surrounding the corn and does not help in healing the lesion. The management of corns is interprofessional. Patients may be treated by the nurse practitioner, dermatologist, primary care physician, or podiatrist.

The key in all cases is to eliminate the continuous pressure on the foot. Patients with peripheral neuropathies should try to avoid the application of plasters that contain salicylic acid because these plasters might cause sloughing of normal skin if placed in the wrong way.

The treating provider should refer the patient to an orthopedic surgeon to evaluate for underlying bony abnormalities in lesions that are recalcitrant to treatment or recurrent. Foot care nurses are often involved in the diagnosis and treatment of corns.

They should educate the patient as to proper foot care and follow up to ensure resolution. Pharmacists often recommend over the counter products and should also educate the patients. To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term.

Corns Ahmad M. Author Information Authors Ahmad M. Affiliations 1 King Abdullah Medical City. Introduction A corn, also known as a "heloma" or "focal intractable plantar hyperkeratosis," is a type of callosity. Etiology Corns typically result from repeated accumulated mechanical trauma as well as other contributing factors like ill-fitting footwear, the presence of bony prominences foot deformity , and certain physical activities.

Epidemiology Individuals with darkly pigmented skin are more prone to developing corns. Pathophysiology The repeated friction and pressure of the skin overlying the bony prominences leads to a hyperkeratotic thickness. Histopathology Histopathologic examination of a corn is usually not needed, but on a few occasions, it might be helpful to differentiate corns and calluses from other diseases like a plantar wart.

History and Physical Corns are primarily diagnosed on clinical presentation. This location often leads to maceration of the corn, with sometimes, the occurrence of a bacterial or fungal infection. Evaluation Dermoscopy may help make the diagnosis showing areas of hyperkeratosis without vascular or hemorrhagic structures that are mainly seen in warts. Radiographs of the feet may help to show bony prominences.

Removing the central plug, under local anesthesia, if necessary, reduces the pressure on underlying dermal nerves, thus alleviating the pain. Patients should be advised to trim the previously treated lesions weekly, using an emery board or pumice stone, after immersing the feet in warm water for twenty minutes.

Topical keratolytic medications, including salicylic acid These techniques are more effective for a few lesions of interest. Topical keratolytic agents may also facilitate lesion paring by softening the corns. Ablative laser therapy may also be used to treat corns instead of paring them with a scalpel. The carbon dioxide laser has been reported to be efficient by some authors. The 2, nm erbium-doped yttrium aluminum garnet laser has been used to treat corns with minimal thermal tissue damage.

However, recurrence of lesions may be observed in some patients, especially if the trigger factors are maintained. This involves proper footwear and soft cushions silicon sheet, sheepskin , which reduce friction and improve comfort. Differential Diagnosis The differential diagnosis of a corn includes: Plantar wart.

Prognosis Although corns and calluses are a chronic, recurrent issue, most of them gradually go away when the repeated friction or pressure causes them to be eliminated. Pearls and Other Issues Patients with peripheral neuropathies should try to avoid the application of plasters that contain salicylic acid because these plasters might cause sloughing of normal skin if placed in a wrong way. Enhancing Healthcare Team Outcomes The management of corns is interprofessional.

Despite treatment, corns are recurrent. Questions To access free multiple choice questions on this topic, click here. Figure Plantar corn. Contributed by Ahmad M. Al Aboud, M. References 1. J Wound Ostomy Continence Nurs. Effect of debridement of plantar hyperkeratoses on gait in older people - An exploratory trial. Arch Gerontol Geriatr. Foot disorders in the elderly: A mini-review.

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What is a Heloma Molle?

Metrics details. Descriptions of the techniques for condylectomies via minimally invasive surgery MIS to treat interdigital helomas of the lesser toes are scarce in the literature. This study aimed to define and describe this surgical technique. This observational study was performed using the Delphi method. We collected the anonymous opinions of a multidisciplinary international panel of ten experts by answering a items questionnaire via e-mail. Three rounds were needed to reach consensus on proposed items.

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