Corn Excision from the Foot: Clinical Presentation, Surgical Management, and Outcomes – A Case Report

Abstract

Foot corns are localized hyperkeratotic lesions that develop in response to chronic pressure and friction, most commonly over weight-bearing areas of the foot. They frequently cause pain, discomfort during ambulation, and impairment in daily activities. Although conservative management with footwear modification, keratolytic agents, and pressure offloading remains the first-line treatment, persistent or recurrent corns may require surgical excision.

We present the case of a 52-year-old female who presented with a painful plantar corn over the forefoot that had progressively worsened over eight months despite multiple conservative treatment attempts. Clinical examination confirmed a well-defined hyperkeratotic lesion associated with localized tenderness and difficulty in walking. Surgical corn excision was performed under local anesthesia, resulting in complete symptom resolution and restoration of normal ambulation.

This case highlights the importance of accurate diagnosis, appropriate patient selection, and surgical intervention in managing refractory plantar corns.

Introduction

A corn (clavus) is a localized area of thickened skin resulting from repetitive pressure or friction over a bony prominence. Corns most commonly occur on the feet, particularly over the metatarsal heads, toes, and other pressure-bearing regions. They represent a protective response of the skin but can become painful when excessive keratin accumulation compresses underlying tissues and nerve endings.

Foot corns are commonly encountered in middle-aged and elderly individuals and may significantly affect mobility and quality of life. Several factors contribute to their development, including poorly fitting footwear, foot deformities, abnormal gait mechanics, and prolonged standing.

Common risk factors include:

• Ill-fitting footwear
• High-heeled shoes
• Foot deformities
• Prominent metatarsal heads
• Hammertoes
• Abnormal gait patterns
• Repetitive mechanical stress
• Prolonged standing occupations

Pathophysiological mechanisms involved in corn formation include:

• Repetitive pressure and friction
• Hyperproliferation of epidermal keratinocytes
• Excessive keratin accumulation
• Formation of a central keratin plug
• Compression of underlying tissues and nerves

Common clinical manifestations include:

• Localized foot pain
• Difficulty walking
• Pain while wearing shoes
• Hyperkeratotic skin lesion
• Tenderness on direct pressure
• Cosmetic concerns

Although most corns respond to conservative treatment, persistent lesions may require surgical intervention to achieve long-term symptom relief.

Case Report

Patient History

A 52-year-old female presented to the outpatient surgical clinic with complaints of:

• Painful lesion on the sole of the right foot for 8 months
• Increasing pain while walking
• Difficulty wearing closed footwear
• Interference with daily activities

The patient reported gradual progression of symptoms over several months. Pain was initially mild but became severe enough to limit prolonged standing and walking.

Previous treatment history included:

• Salicylic acid preparations
• Foot padding devices
• Footwear modifications
• Periodic paring of the lesion

Despite these measures, symptoms persisted.

Past medical history revealed:

• Mild hypertension controlled with medication
• No diabetes mellitus
• No peripheral vascular disease

There was no history of:

• Foot trauma
• Previous foot surgery
• Neurological disorders
• Rheumatologic disease

Clinical Examination

General Examination

• Blood pressure: 128/82 mmHg
• Pulse rate: 76/min
• Temperature: Afebrile

The patient was clinically stable.

Local Examination

Inspection of the right foot revealed:

• Solitary hyperkeratotic lesion over the plantar aspect of the second metatarsal head
• Well-circumscribed lesion measuring approximately 1 cm in diameter
• Central keratinized core
• Surrounding thickened skin

Palpation demonstrated:

• Significant tenderness on direct pressure
• Firm central keratin plug
• No local warmth
• No discharge or ulceration

The lesion caused discomfort during weight bearing.

Neurovascular Examination

Assessment revealed:

• Intact peripheral pulses
• Normal capillary refill
• Preserved sensation
• No evidence of neuropathy

The remainder of the foot examination was unremarkable.

Clinical Evaluation

Differential Diagnosis

The following conditions were considered:

• Plantar corn (clavus)
• Plantar wart (verruca plantaris)
• Callus
• Epidermal inclusion cyst
• Foreign body granuloma

The presence of a localized hyperkeratotic lesion with a central keratin core and tenderness on direct pressure strongly favored the diagnosis of a plantar corn.

Investigations

Laboratory Evaluation

Routine investigations demonstrated:

• Normal complete blood count
• Normal renal function tests
• Normal blood glucose levels

Foot Radiography

Plain radiographs were obtained to evaluate underlying bony abnormalities.

Findings included:

• Mild prominence of the second metatarsal head
• No fracture
• No osteomyelitis
• No foreign body

Dermoscopic Evaluation

Dermoscopy demonstrated:

• Dense central keratin core
• Preservation of normal skin lines
• Absence of thrombosed capillaries

These findings helped differentiate the lesion from a plantar wart.

Diagnosis

Based on clinical examination and investigative findings, a diagnosis of:

Painful Refractory Plantar Corn (Clavus) Over the Second Metatarsal Head

was established.

Management and Outcome

Initial Management

The patient was counseled regarding available treatment options.

Conservative measures had already failed, including:

• Keratolytic therapy
• Mechanical offloading
• Protective padding
• Footwear modifications

Given persistent symptoms, surgical excision was recommended.

Surgical Procedure

Corn excision was performed under local anesthesia.

The procedure involved:

• Sterile preparation of the operative field
• Local infiltration with lidocaine
• Excision of the hyperkeratotic lesion
• Removal of the central keratin core
• Careful curettage of residual keratinized tissue
• Hemostasis and wound dressing

The procedure was completed without complications.

Postoperative Care

Postoperative management included:

• Analgesics as required
• Daily wound care
• Pressure avoidance instructions
• Protective footwear advice

The patient was advised to minimize excessive weight bearing during the initial healing phase.

Follow-Up and Clinical Course

At 1 Week

• Mild postoperative discomfort
• Healthy wound healing
• No evidence of infection
• Improved weight-bearing tolerance

At 2 Weeks

• Complete epithelialization of the wound
• Marked reduction in pain
• Improved walking ability

At 1 Month

• Complete symptom resolution
• Normal ambulation
• No tenderness at the operative site

At 3 Months

• Excellent cosmetic outcome
• No recurrence of the lesion
• Full return to daily activities

At 6 Months

• Persistent symptom-free status
• No evidence of recurrence
• High patient satisfaction

Discussion

Pathophysiology

Corns develop as a protective response to chronic mechanical stress. Repeated pressure stimulates excessive keratin production, leading to localized thickening of the epidermis.

The central keratin plug characteristic of corns exerts pressure on underlying tissues, producing pain during walking and standing.

Key pathological processes include:

• Chronic pressure
• Friction-induced epidermal hyperplasia
• Keratin accumulation
• Central core formation
• Compression of sensory nerve endings

Persistent mechanical stress promotes recurrence if the underlying cause is not addressed.

Epidemiology

Important epidemiological features include:

• Common in adults and elderly individuals
• More frequent in women
• Associated with inappropriate footwear
• Frequently observed in patients with foot deformities
• Common among individuals with prolonged standing occupations

The prevalence increases with age due to progressive biomechanical changes of the foot.

Clinical Manifestations

Patients typically present with:

• Localized pain
• Walking difficulty
• Tenderness during weight bearing
• Thickened skin lesion
• Footwear intolerance

Characteristic signs include:

• Hyperkeratotic lesion
• Central translucent core
• Localized tenderness
• Absence of inflammatory changes

Pain is usually more pronounced with direct pressure.

Diagnostic Considerations

Diagnosis is primarily clinical and based on:

1. Detailed patient history
2. Physical examination
3. Dermoscopic evaluation
4. Radiographic assessment when indicated

The most important differential diagnosis is plantar wart, which often demonstrates interrupted skin lines and thrombosed capillaries.

Treatment Modalities

Conservative Treatment

Initial treatment generally includes:

• Footwear modification
• Pressure redistribution
• Orthotic devices
• Salicylic acid therapy
• Periodic debridement

These approaches are effective in many patients.

Surgical Excision

Surgical treatment is considered when:

• Conservative measures fail
• Pain significantly affects function
• Recurrence is frequent
• Underlying pressure points require correction

Benefits include:

• Immediate removal of the lesion
• Rapid symptom relief
• Improved quality of life
• Low recurrence when pressure factors are addressed

Complications

Potential complications include:

• Wound infection
• Delayed healing
• Scar formation
• Recurrence
• Persistent pain

Appropriate postoperative care significantly reduces these risks.

Prognosis

The prognosis is generally excellent following complete excision and correction of mechanical pressure factors.

Factors influencing outcomes include:

• Adequacy of excision
• Footwear modification
• Underlying foot anatomy
• Patient compliance

Most patients experience substantial improvement in pain and mobility.

Conclusion

Plantar corns are common hyperkeratotic lesions that may cause significant pain and functional limitation. Although conservative treatment remains the cornerstone of management, persistent symptomatic lesions may require surgical excision for definitive relief. This case demonstrates the successful management of a refractory plantar corn through surgical excision, resulting in complete symptom resolution, restoration of normal ambulation, and excellent long-term outcomes. Early recognition, appropriate patient selection, and correction of underlying mechanical factors remain essential for preventing recurrence and optimizing patient satisfaction.

References

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