You get various types of corns, they all present differently but are essentially the same – caused by pressure. Corns have a well-delimited focal area of hyperkeratosis (hardened central core)
For more information of the different types of corns, please have a look at my previous blog by following the link:
https://dessiefhp.com/2023/08/04/lets-talk-about-corns/
However, today I want to look at Subungual Corns.
I remember very vividly being presented with my very first subungual corn. I thought to myself “what is this? What am I dealing with? How will I treat it?”
Luckily my training kicked in after the initial panic subsided and I was able to successfully treat it and alleviating the pain the patient was experiencing.
What is it?
So, we know that a corn is thickened dead skin (unless it is a vascular corn – for more info please click here
Where are they found?
Subungual is just a fancy medical term for underneath and in this case underneath the nail plate. Anywhere under the nail plate. For example:
- in the groove at the side of the nail plate, where the nail interacts with the skin tissue as the foot is moved about
- in the midline third of the nail (almost in the middle of the nail)
So, what happens?
The corn growth detaches the nail plate and causes painful pressure.
How do you treat it?
Corns that occur under the toe nails are very difficult to treat. It is impossible to get to the corn with the nail still in place. Therefore, to get to the corn, the nail (either in part or in full) needs to be removed. Once removed the corn is cut back, Ideal treatment would be clearance of the keratin plug and a dressing if needed. However, this is not always possible, in such cases clinical explanation and paring down should be attempted the patient should be reviewed every 3-4 weeks to make sure the corn is cut back and that the nails grow back in the correct manner. Although corns can be chronic, recurrent issues, most of them gradually spontaneously remit when treated at regular intervals.
But I never had one, why do I have one now? How do they develop?
That is a good question, but more important question to ask is, what has changed to cause extra pressure on the area? Have a changed my shoes? Have a recently had an injury that caused my gait to change?
By way of further explanation:
Anormal mechanical stresses comes in two forms. Intrinsic and extrinsic.
Intrinsic – inside
Extrinsic – outside (think exit)
a) Intrinsic stresses would include bony prominences (a thing that projects from something) such as hallux rigidus (stiff big toe), faulty foot mechanics, old fractures, hammertoe deformities, cavovarus foot deformity (a condition in which the foot has an abnormally high arch and the heel slants inward), Hyperextension at the distal interphalangeal joint, loss of the fatty pad exposing the bony prominences to pressures – just to name a few.
b) Extrinsic – include poor foot-wear (e.g., tight shoes, irregularities in the shoes, open shoes) and a high level of physical activity (e.g., in athletes).
The bones in our feet have many projections, especially around the toes (particularly at the condyles of the heads and bases of the metatarsals and phalanges) See image below to see which area I am talking about. The skin that covers these bony projections undergoes pressure as we walk and wear tight shoes. As the abnormal pressure increase on the skin, the body protects itself by increasing keratolytic activity through a process referred to as physiological hyperkeratosis. To simplify – it means laying down extra skin to protect itself. Skin is keratin and eventually whilst lying down extra skin, the keratin plug presses into the dermis (healthy skin) and causes pain ( the underlying dermis undergoes a significant degeneration of collagen fibers and a proliferation of fibroblasts)
In summary :
Subungual helomas may require regular appointments and an investigation into the cause.
For any questions or appointments please contact me on :
WhatsApp: 07856577897
Email: contactme@dessiefhp.com
Website: https://dessiefhp.com