Is it a corn or a verruca?

Many of our patients are unsure that the unusual lesion on their foot is a corn or a verruca, this confusion may lead them to applying conservative self-treatment that may not be appropriate for the lesion that they have, or in fact aggravate or exacerbate their issue. To a Podiatrist, who see’s hundreds of these cases every year they can easily diagnose the lesion from clinical examination and taking a detailed medical history from the patient.

It is important to highlight the differences between the two diagnoses and to educate the patient of the specific presentation in order for patients to have awareness and seek medical treatment if this lesion arises on their foot. Unfortunately patients do not receive this information until they are in the treatment room itself. This is why we would like to share and educate the wider public on this particular problem.

Corns- or most common a hard corn is called heloma durum ,it is a conical area of epidermal skin than can penetrate towards the dermo-epidermal junction within the skin layers, it is often formed in response to mechanical trauma (intermittent pressure and friction) that may arise from inappropriate footwear, abnormal mechanical forces to the skin due to foot structure, overlying bony prominences of the foot or with certain skin conditions causing an abnormal buildup of skin e.g. intractable plantar keratosis. There is often a yellow/darkened nucleus to the corn with overlying hard skin build up hence why many patients describe the feeling of “walking on a stone”. Corns cause localized pain, especially when walking barefoot or with excessive pressure to the lesion and can lead to tissue breakdown. Where corns can exacerbate into chronic cases of wounds is where an individual may have vascular or neurological issues due to conditions such as diabetes, peripheral arterial disease or neuropathy, this is why early diagnosis, intervention and prevention is key. Podiatrists are trained to remove these painful lesions using surgical skills but most importantly is to understand why the lesion is there in the first place. Unfortunately the corn will keep returning even after removal of the lesion if the cause is not identified and addressed, this is why many patients’ biomechanics is assessed in order to identify any anomalies within the foot and ankle complex that is causing excess pressure on a particular point.

Verruca or a viral wart, is caused by the human papilloma virus which develops a raised plaque-like skin lesion of the epidermis of the skin (top layer), the virus infects the healthy cells causing thickening of the skin, interrupting the normal striations of the skin and creating villi pegs (cauliflower appearance) mosaics to the tissue. Frequently there are black dots that are visible these are thrombosed capillaries and often very painful when pinched or high pressure applied. This virus can be contracted by direct or indirect contact- this can be from stepping on an area where a previous contaminated individual has left viral cells behind e.g swimming pools/shower areas of gyms or where the skin itself has been damaged/ more permeable (excess sweating) and the virus takes an opportunity to penetrate into the skin itself. Children are most susceptible to the virus as it takes time for the body’s immune system to develop a resistance to the virus so early diagnosis and intervention is crucial. Verruca’s can sometimes resolve by themselves due to the body’s immunity mechanism but more often than not they persist and establish themselves due to the virus disguising itself within the cells. Verruca’s can remain for years on an individual’s foot if not treated, then can even multiply or spread to others or affect a person’s walking or sporting activities.

If either of these 2 lesions are causing you pain please seek medical attention from your Podiatrist to diagnose, treat, and prevent this issue.

So remember, “A problem shared is a problem halved”.

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