1. Nails, Corns and Stuff*
*(or how I spent an afternoon listening to the most boring lecture topic on the planet)

2. The Common Corn
• Also known as an heloma
dura lesion on the toe or a
tyloma on the bottom of the
foot
• Commonly have bursa
underneath with nerve
entrapment

3. The Common Corn
How do you cut these things (and what’s the big deal)?
When do you stop? [blood is a good guide that you’re done, bone is a definite]
What if they’re too painful to cut? [possible use of local block before and
cortisone in the bursa after]
What makes these things occur [bone spur and contractures with poor shoes]
How can I keep them from coming back? [Δ in shoe gear and padding
if minor, surgical resection of spur if chronic and debilitating]

4. The Common Corn
• What if it walks like a corn and
quacks like a corn, but isn’t a
corn? [hammer toe without heloma dura
lesion formation]
• How do you treat stuff like this?
[padding, shoes, emollients]
• Can you keep it from coming
back? [pressure causes the problems,
relieving pressure will ameliorate it if not
alleviate it]

5. The Uncommon Corn
• This is Charcot
neurotrophic
osteoarthropathy
with sub-navicular
prominence and
callus from weight-
bearing.

6. The Uncommon Callus
• The IPK (intractable
plantar keratosis)
• Deep core
• Associated with
plantarflexed
metatarsal head and
contractures

7. Callused skin
• Xerotic skin
• Can be associated
with genokeratosis
disease states such as
Diabetes Mellitus,
Unna-Thost and
variants, certain
heavy metal poisoning
• Do you debride this?

8. Nail Problems
• Thick, nasty, brittle and
hard
• Often seen in Diabetes
Mellitus patients
• Pressure upon nail bed
can lead to ulceration
• Either thin the nail or
surgically remove

9. Nail Problems
• Fungus allows lysis
from the underlying
nail bed
• Definite hazard to
catching on sock
and traumatically
avulsing

10. Nail Problems
• Ingrown nails can
cause a more
involved infection
• Long-term relief
involves surgical
resection and
cautery of the
matrix
• Procedure is
painless if the initial
block is good

11. Nail Problems
• After care includes
Epsom salt soaks
and light dressing
with antibiotic.
• If adequate
matrixectomy was
done, the nail
shouldn’t regrow

12. Thank you!