A corn, also known as a heloma is a small area of callus which has become over stimulated and a deep central mass of cornfield cells called a nucleus is formed. Nuclei vary in shape and size but usually form an inverted cone shape. (Frowen, O’Donnell, Lorimer & Burrow, 2010) Corns press into the deeper layers of skin and can be painful. Common causes of mechanical stresses to the feet tend to be from friction and pressure of tight or poor footwear or from any bone deformities of the toes and feet. All these tend to cause corns on the top of the toes and to the side of the little toe. (http://www.patient.co.uk/showdoc/23068875) There are four different types of possible presenting corns. These are hard (heloma durum), soft (heloma molle), vascular (heloma vascular) and neurovascular (heloma neurovascular). If your patient was presenting a heloma durum (hard corn), after disinfecting the foot using an antiseptic agent, carefully remove the corn with a suitable scalpel to clear the area of the thickened skin, followed by the removal of the nucleus centre. Use of protective padding such as oval cavity pads and horseshoe crescent padding is necessary to remove pressure from the area. Heloma molle which are thicker, rubbery skin which can be found between the toes needs to be carefully removed with a scalpel blade and then mediation should be applied to dry the skin. If the skin is moist astringents should be used to improve the condition. Alternatively, if the skin is dry it is best to use emollients to soften and retain moisture in the skin. These methods should be followed twice daily. Pressure relief can be achieved through the use of a soft silicone interdigital orthotics device. (Turner & Merriman, 2005) When vascular or neurovascular heloma is present extra care needs to be taken. These types of lesions can be found over interphalangeal joints and beneath metatarsal heads. In vascular lesions careful enucleation of the corn can be performed with a scalpel or application of 50% solution of silver nitrate over several visits both are effective. The application of silver nitrate can be very painful for neurovascular lesions and as an alternative, 25% pyrogallic acid in white soft paraffin should be applied, then masked and padded suitably. This treatment should be repeated weekly for up to four weeks. (Turner & Merriman, 2005)

If after treatment of heloma durum the skin begins to thicken up again, the patient can prevent recurrence by soaking the foot in warm water for 20 minutes to soften the skin and then using a pumice stone or emery paper rub down the skin. This should be carried out once a week. Also using a moisturising cream where a corn has been treated will keep the skin soft, making it easier to rub down. (http://www.patient.co.uk/showdoc/23068875)