Suggest treatment for recurrent plantar corns

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Posted on Fri, 19 Jun 2015 in Lump
Question: Hello Dr,
I had this corn (is what I had assumed at that time) on my right foot, (which hurt like hell) in January 2015. I went to a podiatrist in February and he treated me with salicyclic acid on a weekly basis. While this was happening on a weekly basis, I got another bump below my big toe (bottom of the big toe) and he started treating that applying acid there as well. Every week he would apply acid and the following week, he will debride and then apply acid again. This has been going on for a while now (almost 4 months) and I asked him to refer me to a dermatologist. I met him earlier this week and he cut a part of one of those lesions and sent it to biopsy and asked me to return in two weeks. The word biopsy is driving my anxiety and following are some of the questions you can help me with:
a. I am having a hard time to walk - do these plantar warts hurt like hell i.e. can they be very painful?

b. My lesions are not tender, they are very rough and hard and if i touch it they do cause discomfort and pain. Is that usual?
c. Because the doctor did not see an improvement or because it failed to respond to acid treatment, did the dermatologist suspect anything? or is this a usual procedure to biopsy this? My mind is conceiving several different things and I hope you can help to tone my anxiety down. Thanks in advance.

Regards, XXXXXXX
doctor
Answered by Dr. Hari Charan Perigela 7 hours later
Brief Answer:
They are typical Plantar corns.

Detailed Answer:
Hi
I saw the pic. They are typical corns.
a)They are very painful in few.
b)Usually, they are rough and hard and tenderness can be elicited by pressure
c)As the Dermatologist was not sure of the diagnosis, he did Biopsy. I am sorry to say that it was not necessary.
In my opinion, it has to be removed completely till the root.It will be CONE shaped.It has to be removed completely to prevent recurrence.
I have seen many cases of corns with complete cure after Surgical excision under local anaesthesia.
Please do not worry about Biopsy.It's 100% Corn.
Hope I answered your query. If you have any questions, I will clarify further.
Wish you good health.
Regards
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Hari Charan Perigela 8 hours later
Thanks a ton for your reply doctor. Few other questions:

a. What would make this a wart? Reason why I ask this is I can see black dots and when the doctor scraped a little bit, I could see blood streaks.
b. I have attached a few pics explaining the progression: Image 1 – initial stages end of January – when I noticed only one. Image 2 – another one popped up below the big toe and it was at this time, the podiatrist had been applying acid and the picture was taken at may be 2 months into treatment. I noticed that the original one and the newer one had gone bigger. Is this normal? Image 3 – is the one I took yesterday i.e. 3 days after biopsy.
c. Aside from corns or warts, what other conditions (growths) are potentially possible in that area given those pics. I know this can be difficult but anything you can provide will be helpful.

Thanks again Doctor.
doctor
Answered by Dr. Hari Charan Perigela 43 minutes later
Brief Answer:
Corn cannot turn into wart.

Detailed Answer:
Hi

Corn cannot turn into wart. Black colour is usually due to dust particles. Once the outer layer is cut, blood vessels will be seen. It is natural.
I have seen the pics. They are typical of Corn. As they have not responded to medical treatment, they are getting bigger. It is also normal.
Implantation Dermoid cyst can occur in those areas due to trauma. Skin over the Cyst wall will be normal in Dermoid cyst, where as it will be rough in Corn.
In my opinion, you get the Corns excised completely and send them for histopathological examination ( Biopsy ).
Wish you good health and speedy recovery.
Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Hari Charan Perigela 28 minutes later
Thanks again for your support Doctor. I am a little anxious and hence these questions. Few more, I promise this will be the last set, if you do not mind:

a. Do they hurt or can it get painful when they debride? Mine does hurt every time they debride.
b. Also, as you might have seen in the picture, the dermatologist only partly cut one of the lesions for the biopsy? Is this usual and will the results be accurate?
c. The biopsies are used to confirm if it’s a wart or a corn?

Thanks again for all your support.
doctor
Answered by Dr. Hari Charan Perigela 21 minutes later
Brief Answer:
You better take Regional anaesthesia.

Detailed Answer:
Hi

Debridement is removal of dead and necrotic tissue. There is no role of Debridement in Corn. Complete excision under Anaesthesia is the better option. With out anesthesia , any procedure is painful. You better ask for Regional anaesthesia.

Only part of the lesion/ulcer/growth will be removed for histopathological examination ( Biopsy ). Results depend on the diseased tissue that the doctor has removed.There is no role of partly removing the lesion in your case as it is a Corn which has to be excised completely.
Biopsy will differentiate Corn from wart.Warts will typically present as exophytic growth above the skin surface. There is no warty growth in your pic.
Please relax. Corn is not related to cancer.

Wish you good health.
Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Hari Charan Perigela 15 minutes later
Thank you so much Doctor. I will keep you posted in two weeks time. Thanks again.

doctor
Answered by Dr. Hari Charan Perigela 4 minutes later
Brief Answer:
You are welcome.

Detailed Answer:
Hi
Thank you for your appreciation.
You will be alright in very short period of time.
Nothing to worry. Just relax.
Wish you speedy recovery.
Regards
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Hari Charan Perigela 5 hours later
Doctor,
Hope you are well.

I wanted to ask you this question you can help me with: May be I should stop researching the Internet:P

What is an amelanotic melanoma? Have you seen or heard of cases where they misdiagnosed this for a wart or a corn on the foot?
doctor
Answered by Dr. Hari Charan Perigela 4 hours later
Brief Answer:
Amelanotic melanoma 's are malignant lesions.

Detailed Answer:
Hi
Melanoma is a cancer which occurs commonly from Moles and are black in colour.Amelanotic melanomas are not black.
They cannot be misdiagnosed as Corn or wart.I have seen many cases of Amelanotic melanoma.Your pics doesn't look like Amelanotic melanoma.
Let's wait for Biopsy report.If you come back after Biopsy report, I will clarify further.
Regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
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Dr. Hari Charan Perigela

General Surgeon

Practicing since :1995

Answered : 2534 Questions

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