*(or how I spent an afternoon listening to the most boring lecture topic on the planet)

Nails, Corns and Stuff*

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

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]

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]

The Uncommon Corn

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

The Uncommon Callus

• The IPK (intractable plantar keratosis)

• Deep core• Associated with

plantarflexed metatarsal head and contractures

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?

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

Nail Problems

• Fungus allows lysis from the underlying nail bed

• Definite hazard to catching on sock and traumatically avulsing

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

Nail Problems

• After care includes Epsom salt soaks and light dressing with antibiotic.

• If adequate matrixectomy was done, the nail shouldn’t regrow

Thank you!