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What is that lump on my foot? Do I have a corn? Or is it a wart? It is common to misdiagnose corns, callus and warts, as they can appear similar to one another, and often cause similar pain symptoms. So how can we tell the difference?

Corns

• The lines on your skin (call skin striations) will continue through the lesion
• Generally smaller/round/well defined
• Contain a central plug which is very hard
• Do not bleed on debridement (removal of the tissue using a scalpel blade)
• Corns are painful on direct pressure or friction
• Corns only penetrate to the epidermis- they are more shallow than a wart

Treatment of corns:

Debridement- using a scalpel blade, a Podiatrist can remove the hard skin and the central plug, creating symptom relief. This is generally a pain free treatment and provides almost immediate pain relief.

Offloading high pressure areas- as corns as painful with direct pressure, offloading the area will help to reduce pain, and can also help to reduce the regrowth of the corn. Offloading can be done many ways – using deflective padding, fabricating orthotics that reduce pressure from alignment issues and footwear changes are all different techniques Podiatrists will use to reduce pressure in an area.

Smoking cessation – there is documented correlations between smoking and suffering with painful corns

 

Warts

• Warts are caused by a virus known as Human Papilloma Virus (HPV) This is non curable and remains systemic long term. Stress, a suppressed immune system or trauma may trigger HPV flaring.
• Warts will generally bleed on debridement
• Skin lines will pass around the wart
• Not specific to pressure areas- warts can appear anywhere on the skin
• Warts generally have a cauliflower appearance
• Warts are commonly seen more in children
• Warts are contagious and are able to be transferred to other people

Treatment of warts:

Chemocautery- chemocautery consists of debriding the wart and applying topical solutions that will actively destroy the wart tissue. Acid pastes and cyrotherapy (liquid nitgroen) are often used.

Curettage- Curettage is the surgical removal (scraping or cutting) of wart tissue using a small, sharp, spoon-shaped tool. Curettage usually requires local anesthetic and is often a second or third line of treatment, after chemocautery is trialled.

Needling the wart- using a method called Falknor’s technique, a hollow needle is used to repeatedly penetrate the base of a wart under local anaesthetic, into the subcutaneous tissue, until there is no longer resistance to puncturing. Needling causes extensive destruction of keratinocytes and the release of high levels of viral protein into the surrounding tissue. Deep penetration of this viral protein into the subcutaneous tissue increases the likelihood of developing a systemic immune response against the virus (1).

No treatment- warts can often resolve on their own without treatment- however, as some warts can be painful to walk on, treatment is often indicated to reduce pain in the area.

 

Callus

• Callus is thick, hardened layers of skin that develop when your skin tries to protect itself against friction and pressure
• Usually found on weight bearing areas such as the outside of the smallest toe, ball of the feet and heels.
• Caused by pressure and friction
• Often appears yellow in colour and is dry and thick in appearance compared to rest of skin
• Generally it is a larger area of thickened hard skin but can vary in size.
• May or may not be painful, depending on where the callus forms, and the size of the callus.

Treatment of callus:

Debridement of thickened skin to reduce pain and pressure using a scalpel. This is a pain free treatment – often the scalpel actually tickles a little during treatment!

Pressure distribution using footwear or offloading to reduce the build up of callus.

Footwear advice to ensure pressure areas are not causing callus build up.

Topical cream application to soften skin- urea based creams are best for this.

 

Darwin Podiatry can perform an assessment and provide a treatment plan for the diagnosis and management of your concern. Call us on 8941 9955 to make an appointment today.

 

(1) Schimmel J. Needling for the Treatment of Warts. Skinmed. 2020 Mar 1;18(2):91-93. PMID: 32501791.