Post by seekerofwisdom on Jul 11, 2009 5:18:43 GMT
Hi Robert and Bill.
This seeker is not the origional poster, but appreciates the anonymity.
Robert good idea the seeker bit but perhaps 'seekers' should also adopt 'handles'.
I think that the question is reasonable in that it specifically asks "in relation to aetiology and treatment" rather than simply a definition or differential diagnosis. There must be many legit. pods who are not totally up to speed on the latest treatments and may be interested in what others are doing.
You are correct, if this forum is to flourish there needs to be less suspicion and IMO a 'simpler' approach to answering questions, a bit like the difference between the formal lectures at conferences and the chat in the bar afterward.
IMHO there is little difference in the aetiology. They are all chronic but n.v. and 'neurological' are most usually seen in the elderly patient with dystrophic skin, whilst fibrous are generally noted in patients with 'better' tissue. The predisposing factor is shearing stress, frequently associated with abduction and eversion during gait, (sorry to be old fashioned you functional characters) and flexion deformity of the affected digit.
I seem to remember that all corns are due to 'intermittent compressive stress over a bony prominence', so would disagree with your 'shearing stresses', which I remember as causing callus and/or blisters. Constant pressure causes ulcers. This is my very simplistic take on skin mechanics and I explain to customers as tapping rubbing and bed sores.
On anywhere other than the plantar surface the cause is footwear, it is footwear that provides the intermittent compressive stress every time the foot takes a step. So yes flexion deformities of affected digits predispose to corn formation but are not the etiology, a bit pedantic perhaps?
I had not thought about the presentation of fibrous corns and NVs as being age related but I think you may have a point.
Rather I see the presentation of chronic corns as an escalation of inappropriate treatment.
Inappropriate in two ways, a failure of the treatment modality and a failure to address the underlying cause.
This can be patient centred, those who have relied on corn plasters and razor blades, or practitioner centred, those without adequate skill and knowledge to do the job properly.
I suppose that there are as many treatments as pods. but the aim is to deal with the underlying factors. Fixed flexion deformities can be dealt with by surgery, the mechanical dysfunction can be dealt with by appropriate diagnosis and orthoses. For non fixed deformity the atavistic amongst us used to use wheatgerm and pyrogalic oitment - now banned. Good reports have latterly been made of fulguration and laser cautery in the case of vascular and n.v. corns.
The use of what P Read used to call medicaments continues to be contended between the dreaded SCP and the appropriate bodies, however I believe good progress has been made, so watch this space.
I hope this helps, and perhaps Dewdrop and others will care to weigh in with their favoured treatments.
At the risk of Roberts wrath I have found Marigold therapy to be very effective in sorting out 'the disrupted dermis' for that is what has happened in the case of chronic corns, followed by in the case of non plantar corns sale of a shoe stretcher. Plantar, Plastazote is very cheap!
Problem with all of this is it reduces the time between appointments often to infinity so reduces income.
Shy.
This seeker is not the origional poster, but appreciates the anonymity.
Robert good idea the seeker bit but perhaps 'seekers' should also adopt 'handles'.
I think that the question is reasonable in that it specifically asks "in relation to aetiology and treatment" rather than simply a definition or differential diagnosis. There must be many legit. pods who are not totally up to speed on the latest treatments and may be interested in what others are doing.
You are correct, if this forum is to flourish there needs to be less suspicion and IMO a 'simpler' approach to answering questions, a bit like the difference between the formal lectures at conferences and the chat in the bar afterward.
IMHO there is little difference in the aetiology. They are all chronic but n.v. and 'neurological' are most usually seen in the elderly patient with dystrophic skin, whilst fibrous are generally noted in patients with 'better' tissue. The predisposing factor is shearing stress, frequently associated with abduction and eversion during gait, (sorry to be old fashioned you functional characters) and flexion deformity of the affected digit.
I seem to remember that all corns are due to 'intermittent compressive stress over a bony prominence', so would disagree with your 'shearing stresses', which I remember as causing callus and/or blisters. Constant pressure causes ulcers. This is my very simplistic take on skin mechanics and I explain to customers as tapping rubbing and bed sores.
On anywhere other than the plantar surface the cause is footwear, it is footwear that provides the intermittent compressive stress every time the foot takes a step. So yes flexion deformities of affected digits predispose to corn formation but are not the etiology, a bit pedantic perhaps?
I had not thought about the presentation of fibrous corns and NVs as being age related but I think you may have a point.
Rather I see the presentation of chronic corns as an escalation of inappropriate treatment.
Inappropriate in two ways, a failure of the treatment modality and a failure to address the underlying cause.
This can be patient centred, those who have relied on corn plasters and razor blades, or practitioner centred, those without adequate skill and knowledge to do the job properly.
I suppose that there are as many treatments as pods. but the aim is to deal with the underlying factors. Fixed flexion deformities can be dealt with by surgery, the mechanical dysfunction can be dealt with by appropriate diagnosis and orthoses. For non fixed deformity the atavistic amongst us used to use wheatgerm and pyrogalic oitment - now banned. Good reports have latterly been made of fulguration and laser cautery in the case of vascular and n.v. corns.
The use of what P Read used to call medicaments continues to be contended between the dreaded SCP and the appropriate bodies, however I believe good progress has been made, so watch this space.
I hope this helps, and perhaps Dewdrop and others will care to weigh in with their favoured treatments.
At the risk of Roberts wrath I have found Marigold therapy to be very effective in sorting out 'the disrupted dermis' for that is what has happened in the case of chronic corns, followed by in the case of non plantar corns sale of a shoe stretcher. Plantar, Plastazote is very cheap!
Problem with all of this is it reduces the time between appointments often to infinity so reduces income.
Shy.