Write a properly referenced essay on the treatment and management of a patient with corns.

General principles of treatment and prevention of corns are (1) to provide pain relief (2) to discover and correct the cause of increased mechanical stress (3) to recommend appropriate footwear and orthotic devices and (4) to recommend surgery if conservative approaches fail (Buttaro et al, 1999). Treatment of hard corns begins by corn enucleation with a scalpel to reduce the pain. Treatment of soft corns requires removal of the soft, dead tissue with a scalpel. Following this, either an antiseptic agent, salicylic acid plaster or protective pad is applied. Holed or u-shaped padding can be used to reduce the duration of tissue loading and redistribute mechanical stress. To absorb shear, orthoses and similar devices such as polymer gel pads and silicones can be used. In the case of soft corns where sweat collects between the toes, and the toes rub against each other to cause the corns, there is often need for a toe separator allowing sweat to evaporate and to stop the toes rubbing together. Enucleation will leave a dimple or hole in the tissue of the foot. In time, with healing, the body will naturally fill this up with healthy tissue. However, whilst the healing process is occurring, the cavity is usually filled with a gel (polymer, silicon or acrilyic) to discourage further corn formation (Tortora & Derrickson, 2011). The application of a caustic preparation known as silver nitrate can also help by shrinking the cavity.
Neurovascular corns are corns that have both nerves and blood vessels in them. As most corns have only dead tissue in them, this makes neurovascular corns more difficult to treat. Firstly they are sensitive and can be painful to treat and secondly they can bleed if removed. As such, they are usually removed under local anaesthetic. Neurovascular corns need extensive excision to get rid of them and bleeding may occur. A caustic such as silver nitrate can be used to help to destroy the corn tissue.
The best way however, to contribute to the management of corns is through proper education of the patient. Patients should be advised to have proper fitting footwear with the inside of the shoe being about 1 cm longer than the foot allowing sufficient toe space. The shoe should allow an even distribution of body weight over the plantar surface of the foot and should provide a shock absorbing quality that absorbs pressure and friction rather than creating it. Gait and posture are other considerations and dietery advice may be necessary if the origin of the problem is poor quality skin caused by insufficient nutrient intake. The patient can also be advised to use powder for keeping the feet dry in order to avoid friction caused by wetness in the feet. Other measures for preventing corns include using padding or foot orthotics and supports to relieve the pressure under the foot, the use of proprietary plasters and the regular paring down of large lesions on the foot using a pumice stone or foot file, and in some circumstances surgical correction of the bony prominence that may be causing the high pressure area and the corns to return. (Rose & Martorana, 2011)
References:
Buttaro, T. et al. (1999) Primary Care: A collaborative Practice. 4th Ed. Missouri: Elsevier Mosby.
Rose, J,. Martorana, V. (2011) The foot book. A complete guide to healthy feet. Baltimore: The John Hopkins University Press.
Tortora, G,. Derrickson, B. (2011) Principles of Anatomy & Physiology. Asia: John Wiley & Sons