Bunions, corns and calluses, and ingrown toenails

What is a Bunion?

A bunion is a deformed big toe that points inwardly, leading to a bump on the outside edge of the foot. It is associated with pain, warmth, swelling, redness and limited joint motion. Factors that may contribute include arthritis, foot structure, abnormal joint motion and pressure, injury and poor fitted shoes. Bunions are 10 times more common in women than in men, which may likely be due to narrow, pointed-toe shoes. A bunion on the little toe is called a bunionette.

What can be done?

Early treatment to stabilize the joint is important. Identifying the cause of the lesion is the most important step. Improper shoe fittings are a common cause. Pads and cushions can be used to relieve pressure and pain, such as bunion sleeves. Insoles may help redistribute the weight and relieve pressure from the affected joint. 

Applying an ice pack wrapped in cloth to the affected area for 10 minutes at a time several times a day, along with pain medications such as over-the-counter Tylenol (acetaminophen), Advil (ibuprofen) or Aleve (naproxen) can help with swelling and pain. If the pain doesn’t improve or it worsens, prescription corticosteroid injections may be helpful. Sometimes surgery may be needed to correct the problem. 

What is a corn and a callus?

Corns and calluses result from friction and pressure from the skin rubbing against bony areas of the foot leading to thick, tough layers of skin. They can be seen in most age groups. 

Corns are often found on or between the toes. Often pea sized or slightly larger, the base of the corn can be seen on the skin surface with its top pointing inward, causing discomfort, tenderness and pain. 

They are categorized as hard or soft based on their appearance and location. Hard corns are often yellowish and are found on the tops of the toes, side of the 5th toe and on the soles of the feet. Sometimes confused with plantar warts, warts often have pinpoint bleeding when the top layer of skin is removed, and ridges of the skin pass through a corn whereas they pass around a plantar wart. Soft corns are hard corns that have absorbed moisture from sweat. They are whiter and softer in appearance and are often found between the toes, particularly between the 4th and 5th toe. Although sometimes confused with the fungal infection athlete’s foot, soft corns are often painful, instead of being the characteristically itchy athlete’s foot.

Calluses are similar to corns, but they occur when force is exerted over a larger area. They are often found on the soles of the feet (such as the heel or the ball of the foot) and sometimes on the hands. Unlike corns, they tend to have an even thickness. Calluses are generally symptom-free but there may be a mild burning sensation and pain. Causes include improper footwear, the method of walking, foot structure and too much weight placed on the area. 

What are the treatments available?

Identifying the cause is the most important treatment step. Oftentimes, a simple change in footwear is the main thing required

Relieving pressure to the affected area helps. This can include pads with a hole in the middle to be placed over the affected area to reduce pressure. Lambswool, soft cotton, moleskin and web spacers between the toes may minimize the pain of corns. Insoles that provide support may help evenly distribute the weight. For repetitive hand tasks that injure the skin, wearing gloves can be helpful. 

Some people should not attempt to self-treat corns or calluses without the supervision of their doctor. These include diabetics, those with impaired circulation, those with nerve issues in their extremities, and those who are immunocompromised. Complications can arise. 

Reducing skin thickness can be achieved with pumice stones or a callus file. Pumice stones are used on wet skin, whereas files are used on dry skin. When using a pumice stone, it is recommended to soak the area in warm water for around 10 minutes (with or without sodium bicarbonate). It is never recommended to cut a corn or callus on your own. Keratolytics like urea (Uremol 10, Dermal Therapy with urea) can assist with the removal of dead skin. They should only be applied to the top layer of the skin and to undamaged skin. When applied to dry or cracked skin, it can cause a burning or tingling sensation.  

Castor, olive, sesame seed or wheat germ oils can be applied to corns or calluses to help soften them. Be watchful of excessive moisture though, particularly in regards to soft corns. 

Salicylic Acid in up to 40% is available over the counter and can be used to self treat if the lesion is causing too many issues, or if you’re unable to wait until it regresses on its own once the cause is removed. The liquid formulations are typically used once daily or twice daily whereas the plasters are typically applied every 2 days, repeated up to a maximum of two weeks. It is important to make sure any healthy skin is protected, either through use of vaseline, applying bandages, or trimming the plasters to fit the exact shape and size of the lesion. If the healthy skin becomes irritated due to incorrect use, stop the medication until the skin is healed before attempting again. Salicylic acid can be irritating and can burn, it is flammable and shouldn’t be applied to irritated or infected skin. 

Evidence should be seen within 10-14 days. Inspect the area at least twice weekly until healing is complete. If there is no improvement, or the area becomes infected, you should follow up with a doctor. 

What is an ingrown toenail?

Ingrown toenails occur with the toenail digs into the skin at the end or side of the toe. It often affects the outer edge of the big toe, but any toe may be affected. The toenail may be red, inflamed, and possibly infected. 

The most common causes of ingrown toenails are poor fitted shoes and improperly trimmed nails. Other causes include genetics, trauma, and fungal infections of the nail that cause the thickening or widening of the toenail to occur. Males are two times more likely to experience ingrown toenails than women, with the highest incidence occurring between ages 10 to 30. 

What can be done to help?

Depending on the severity of the ingrown toenail, conservative management may be helpful at the beginning. Ten minute warm water or Epsom salt soaks three to four times daily may help minimize pain. Keep the nail elevated by placing cotton, gauze, or dental floss between the nail and skin until the swelling goes away. Topical antiseptics (alcohol 70% swabs, povidone-iodine and chlorhexidine gluconate 0.05%) can be used to disinfect the skin. Wash feet twice daily with soap and water. Avoid footwear that exacerbates the pain (ideally wear sandals). 

Depending on the severity, surgical removal of the nail portion in question may be required, as well as a course of antibiotics. A doctor will be able to assist and assess the best treatment option for you.

For prevention of recurrence, it is important to ensure nails are trimmed straight across (no rounded corners), that proper footwear is worn, and that the feet are kept clean and dry. 

What is a proper shoe fit?

Women are four times more likely to develop foot problems. Finding appropriate footwear is very important. Wear the correct shoe for the correct activity (hiking, running, etc). Try on shoes at the end of the day when the feet are most swollen to ensure the best fit. Both shoes should be tried on with stockings (and orthotics, if worn), as one foot tends to have a different fit than the other. Ensure that the toe box is wide enough to prevent tightness and rubbing within the shoes, and that there is 1.25cm (½ inch) between the end of the shoe and the longest toe. The heel shouldn’t slip during movement, but should fit snugly. High heels should be less than 3.75cm (1.5 inches) to prevent crowding of the toes and forward pressure. Ideally, shoes should not be slip-ons but should be made of a flexible material like canvas. Shoes should be lightweight and flexible with good cushioned soles that will help absorb shock. 

References are on page 2.

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