Thursday, April 28, 2011

Corns -What to do : Cut them off and what?

Corns and callus have been around since the beginning of civilisation. Foot physicians have been known to exist since Egyptian times and the Greeks are credited with inventing the corn scrapper which evolved into the surgical scalpel. To the ancient Greeks the only way to reduce discomfort from hyperkeratosis was to remove it by scraping away the excess keratin when it built up. Corn cutters continued in the same manner throughout the Middle Ages; and the clinical approach is still to the fore in modern podiatry. Seems however according to Dr Karl B Landorf scalpel debridement of painful plantar calluses has minimal effect on its own. In a paper delivered at the Australian Podiatry Conference he described a study with eighty participants (80) aged 65 years and older with painful forefoot plantar calluses. Participants were randomly allocated to one of two groups: (i) normal (experimental) scalpel debridement or (ii) sham (control) scalpel debridement. Participants were followed for six weeks after their initial intervention appointment. Both participants and assessors were blinded to the intervention. The primary outcomes measured were the difference between groups in pain (measured on a 100 mm visual analogue scale) and barefoot peak plantar pressure (measured using a MatScan® System). Secondary outcome measures included tests of balance and functional ability. The sample size was pre-specified using an appropriate sample size/statistical power calculation. Statistical comparison between the groups was made using a linear regression approach to Analysis of Covariance (ANCOVA) and analysis was by intention to treat. Both groups experienced large decreases in pain following intervention (up to a 41.9 mm decrease in pain on a Visual Analogue Pain Scale (VAS). A systematic, but small beneficial effect on pain was noted in favour of the normal scalpel debridement group immediately post-debridement to 4 weeks post debridement (from 6.0 to 7.2 mm ANCOVA adjusted mean difference between groups). There was no difference in peak plantar pressure or balance and functional ability between the two groups at any time-points. There were no adverse events of note. In conclusion Landorf described a systematic effect favouring scalpel debridement but according to the researchers the benefits were small and not statistically significant. They believe scalpel debridement in conjunction with padding may provide greater benefits to patients with hyperkeratosis.

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