A ‘Durlacher corn‘ is a particular type of corn (heloma durum) that occurs adjacent to proximal lateral aspect of nail of the little toe. It can be often difficult to see clear distinction between the corn and nail. It can often be confused with the nail.
This type of corn is named after Lewis Durlacher (1792-1864), a chiropodist from the United Kingdom. In the USA, this type of corn is often called Lister’s corn.
A corn is focal area of hyperkeratosis (skin build up) in response to too much pressure. When the pressure is higher, the skin becomes thicker to protect itself (think about chopping wood and getting a callus on the hand). If that pressure continues the skin gets so thick it becomes painful. Generally, if its over a wider more diffuse area, its a callus. If its over a more focal area, it becomes a corn.
Causes of a Durlacher’s Corn
Too much continual pressure on the area next to the lateral side of the nail on the fifth or little toe is the cause of a Durlacher’s corn. There could be a number of reason for this higher pressure. It could be due to a rotational deformity of the toe. It could be due to an exostosis (enlarged bone) on the bones in the toe. It could be due to the shape of the toe box of the shoe relative to the shape of the foot increasing the pressure on that particular spot. It could be that the foot is wider than the shoe results in more pressure on that area of the fifth toe.
Treatment of a Durlachers Corn
The treatment for Durlacher corns will involves addressing the underlying factors contributing to their development. A Podiatrist can easily and expertly debride the corn and give instant relief, however what ever caused the corn in the first place is still there and will need to be addressed or it is going to come back again and be painful again. Corns do not have “roots” that they grow back from if the root is left in. They come back again because what caused them (the higher pressure) is still there.
The medicated corn pads are not going to be helpful as they just eat away the corn and normal skin with an acid (which is risky in those with vulnerable skin or diabetes) and do nothing to address the cause of the Durlachers corn.
That higher pressure can be addressed with the use of felt pads, silicone gel pads or custom moulded silicone pads that get pressure of the area. It could be addressed with the use of better fitting shoes. It could mean a surgical derotation of the the fifth toe or a surgical removal of an enlarged piece of bone that is causing the pressure.
Is a Durlacher’s Corn Really a Corn?
There is a little bit of controversy surrounding a Durlacher’s corn and if it is even a corn due to pressure at all. There have been a few publication in the dermatology literature calling what podiatrists see as a corn as an ectopic nail or a ‘double nail of the fifth toe’. This was addressed here and is still probably not resolved if its a corn or an double nail.
Personal Opinion:
I think they are more likely to be corns than an ectopic or double nail. If you do actually get rid of the pressure, over the long term it is gone – that would not happen if it was a nail.
Author:
University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger, dad.
