Corns, Bunions, and Callosities—How they Originate—Nature of the
Skin—Various Causes of Corns—How to Remove Them—Quotations from the
Medical Books—Nature and Treatment of Bunions.
We come now to another class of difficulties to which the foot is
subject, though they affect the outside mainly, not its structure,
and which appropriately call for a notice here, and for some hints
concerning their nature and treatment. Almost every one, at some
period in a lifetime, forms their unpleasant acquaintance; and to
know how to avoid them entirely, or to destroy and remove them at
pleasure, may be considered information worth possessing. Although we
lack the familiar practical knowledge of the man who makes corns his
profession, the reader shall have the benefit of as much as we are
able to supply.
A common corn is caused by friction or irritation of the skin—the
chafing and pressure of the foot against the leather of the boot,
or the crowding of the toes against each other. The skin thickens
and hardens to protect itself in the same way that it does upon
the hands or other parts of the body exposed to rough contact, the
fact and law of which are familiar to everybody. As the irritation
is continued the skin continues growing harder and thicker, until a
large and ugly corn is produced. To understand its nature more fully,
and why it assumes a sharp point, thus turning its protection into a
torture, it will be necessary to explain something more of the nature
of the skin itself.
There are two layers of membrane composing the skin—the _cutis vera_,
dermis, or true skin, which is the inner portion; and the cuticle,
epidermis, or scarf-skin, which is the outside layer. The dermis, or
true skin, consists mainly of a net-work or web of fibrous material,
having outside of this a net-work of capillary blood-vessels and
lymphatics, interwoven with still another net-work, of nerves, both
blood-vessels and nerves terminating in projecting or upright loops,
each loop formed of a blood-vessel and a nerve-cord, the two being
together side by side. These loops, which are the most extremely
sensitive portion of the skin, are called _papillæ_, and they form
the projecting fine ridges that are seen on the palm of the hand,
where their abundance gives the hand its superior sense of feeling or
touch. All these parts—the fibrous meshes, the blood-vessels, nerves,
and loops of papillæ—are microscopically minute.
The outside skin or cuticle has no blood-vessels or nerves, and
hence no life or sensation, but seems to be a _covering_ to protect
the true skin, and to modify or diminish its otherwise too extreme
sensitiveness; besides being of use in other ways to the general
system. It is that part which is raised up when a blister is
produced; and the sensitiveness of the papillæ under it, where it
is taken off, shows its necessity. The matter of which it is formed
is secreted or poured out by the true skin, and is the same matter
which, when dried and hardened in various degrees, becomes the
thick skin on the sole of the foot, the callous place on the hand
or elsewhere, the dandruff of the head, the hair on any part of the
body, the nails of fingers and toes, the hard portion of warts, and
the hard or soft corn. All these are essentially the same thing under
different modifications. It is constantly worn off from the external
surface, and as constantly added to at the under side.
This internal or under-side layer of the cuticle is commonly
distinguished as the _rete mucosum_, and contains a colouring
matter secreted from the true skin, which, as it is greater or
less in quantity gives the different shades of complexion; the
semi-transparent nature of the matter outside allowing it to show
through. The oil tubes and perspiratory ducts take their rise
immediately under the skin, and find their way to the surface, while
nerves and blood-vessels traverse it forth and back.
Some further idea of the nature of the skin may be gained by
observing a piece of thick sole-leather in which that part called
the grain is the cuticle or epidermis, and the thicker portion is the
dermis, or _cutis vera_.
Now, when any portion of these sensitive loops is injuriously
irritated by pressure or friction, they sometimes push entirely
through the cuticle, growing large and covering themselves with hard
cuticular matter, thus forming the warts that appear on the hands
and other parts of the body. Some corns, we believe, are produced in
a similar way—a larger number of the papillæ projecting and being
covered completely and thickly with epidermis, which, becoming dry
and hard, still further pains the sore and sensitive papillæ as it is
pressed upon by the boot. This kind of corn can be cured only as a
wart is removed—by burning the papillæ, or, as they are called in the
wart, the _roots_; thus changing the structure of the skin, or, in
other words, making a scar.
Ordinarily a hard corn commences at a point, or by the irritation of
a small surface of the skin, or only a _few_ of the papillæ. From
this point an increased supply of the cuticular matter is pushed out
in every direction to protect them, growing harder as the process
advances, and being more pressed against by the shoe, while the
increasing external pressure incites the foot to push out a still
larger corn. Thus it grows; and as the matter first thrown out is
the first to become hardened, a point is formed, and the pressure
forces it into the flesh, which is compelled to retire before it. The
longer this is continued the larger the surface of skin that is made
sore, the larger and more conical in shape the corn becomes, and the
farther its point is forced into the flesh.
This description is more especially true of the smaller corns; those
which extend over a large surface being, probably, originated by a
slighter irritation of a larger portion of the skin; hence they have
less of a point and penetrate less deeply.
Soft corns appear between the toes, and are soft for the reason
that, so situated, they are kept moist by perspiration. Some of them
are secretions of epidermis having no centre or point, but thrown
out from the foot at the bottom and sides of the spade between the
toes, and giving a sensation as of some foreign body, like a pea
or a gravel stone, confined there. There may be others that are
accompanied by projections of the papillæ.
It is to be noticed that a corn is thus composed wholly of cuticular
matter, and is entirely outside of the true skin.
It has been suggested that here is an instance in which the remedial
effort made by Nature converts itself into a diseased and painful
action, defeating its primary purpose and creating a worse condition
than the one sought to be relieved. But this is not correct. Nature
does not put the boot on the foot, nor continue its wear after the
corn has originated. On the contrary, if her intimations were heeded,
the boot would be discarded the first time it pinched, and there is
every reason to believe that then the growth of the corn would be
discontinued, and what had already formed would disappear. It is
stated in medical works that persons confined by sickness for a
considerable time have had their corns entirely leave them without
any treatment at all, simply because there was no pressure to keep up
the irritation, and consequently no demand for their existence.
It has been generally considered that tight boots were the great
_cause_ of all the corns and bunions with which the feet have been
tormented, and tight boots have accordingly been cursed from toe to
heel for their mischievous qualities in this respect. Though it is
true that the unnecessary tightness of boots is a principal source
of corns, there are others that may not be overlooked. _Loose_
boots, that allow the heel to slip up and down, or the whole foot
to slide forward at every step, are effective in the production of
these annoyances. Hard, stiff leather is another quite efficient
thing in this way. Whether the boot be tight or loose makes not much
difference, if it be stiff and hard. Large wrinkles over the joint
may sometimes have an effect of the same kind, especially if the
leather is no softer “than it ought to be.” High heels, that pitch
the foot forward, and keep it constantly bearing against the leather
over the toes, have a great tendency to develop corns. The drawing
together of the toes by boots and shoes that are _narrow_ at this
point, forcing the toes to crowd against each other, and pushing out
the great-toe joint, is one of the most productive of all causes.
When occurring upon the bottom of the foot, a peg or some hard
projection of the insole of the boot is the agent to which they may
be attributed. Between the toes they are most frequently developed,
probably by the pressure of a boot that is too narrow, not only at
the ends of the toes, but at their roots or metatarsal joints.
_Bunions_, we believe, are never found except upon the joint of
the great toe, and the projection of this joint, from the wearing
of short and narrow-toed shoes, can not be otherwise than strongly
influential in producing them. From wearing foot-coverings of this
fashion, which is almost the only kind we have at present, there is
the constant tendency of the joint to enlarge, widen, and project.
This increases its pressure against the leather, and may even create
a pressure where there was none at the time the boot was first worn.
It is not strange, therefore, that bunions make their appearance
under such circumstances.
Thus it is seen that, setting aside the habit of wearing boots
that are tight enough to pinch the foot, there is already found
an abundant cause for corns. It ought to be sufficiently obvious
that the principal characteristics of the present foot-covering—the
narrow toes, being often short besides, and the high heels—are
corn-producing in all their tendencies. If to these is added the
practice, as with many persons, of wearing boots and shoes that are
too tight for comfort, and often too narrow on the sole, there is
ample reason for the fact that corned feet are numerous.
We do not know what first induced people to wear boots unnecessarily
tight, unless it was the Chinese idea of taste, which desired to
prevent the full development of the feet, or make them appear as
small as possible. If this be still the motive, it is only necessary
to repeat that a true taste demands that a foot be of a size
proportionate to the size of the whole body, whether that be large or
small. If it is to make the boot fit more smoothly and handsomely,
then the object is more often defeated than accomplished. A boot
that is too tight—tight enough to be uncomfortable—is not the boot
that best fits the foot. It will have as many wrinkles in it as a
loose one, and even more, if the leather be thin, while the foot
can not go into it naturally. The best fitting boot or shoe is one
made of the right shape to adapt it to the particular foot; which is
just snug enough to confine it without any uneasy feeling; and into
which it goes easily and naturally to its proper position. There is
sufficient length to allow the toe to move without pressure on the
nail, and sufficient width to let the toes lie side by side, in which
position they appear much better than when piled one over another.
There are no wrinkles made by loose leather—none by over-tightness.
The room is entirely filled, while at the same time the foot is easy,
and can make its natural movements in walking with ease and grace;
which it can not do when squeezed into a boot that is too tight. A
person wearing a tight boot has a stiff and unnatural walk, which can
not be compensated by any beauty of the fit so gained, provided it
_is_ gained. There are only the soft and fleshy feet that can bear
compression with any benefit to their appearance, and with these
still the same rule is equally good—they must not be squeezed more
than comfort will allow. If complaint is made that the upper leather
stretches out, and the foot treads over the sole, and spreads and
sprawls about more than appears neat and proper, it is only to be
replied that if a shoe of the right shape, and sufficiently wide is
worn, there will be no trouble of this kind.
On the whole, tight-boot-wearing is a humbug. It is entirely
unnecessary, doing no good, while often defeating itself when its
object is to improve the foot’s appearance. Besides the ordinary
discomfort created by it, the whole tendency of extreme tightness is
toward corns and deformity.
How much, now, it may be inquired, is meant by _extreme tightness_?
The answer is—_discomfort_. A new boot or shoe that fits as it
should, may be worn without serious discomfort for several hours, or
half a day, when first put on. After three or four days it may be
worn all the time. It ought not to be expected that it can be worn
constantly at first; for if loose enough, for this it will soon be
too loose for a handsome fit. Then, an article that is tight for a
foot belonging to a weak and delicate organization, with a feeble
circulation of blood, may be perfectly easy to a foot of the same
size and shape belonging to a strong, healthy constitution with an
energetic circulation; and for the same reason a person can wear a
tighter shoe when young than when advanced in life, or failing in
health; but either of these, and at any time, may be governed by the
rule, that positive discomfort indicates extreme tightness. There are
some kinds of material that stretch considerably under the foot’s
pressure, and boots made from these should be a little tighter at
first than those made of firmer stock. Besides, there are some feet
so sensitive that very slight pressure or friction will develope
corns on them, and such must wear a softer material than is worn
by feet that are more hardy. The question of tightness is somewhat
complicated by such considerations. Most of us, however, can usually
tell for ourselves what is tight, and we have no right to decide for
others.
* * * * *
Ordinary hard corns, when young, may be removed by scraping up the
callous skin around the borders and prying out carefully with a
pocket knife. There is no need of cutting through the under skin.
In more difficult cases some further treatment will be necessary,
and for them we quote the following methods, the first from Cooper’s
“Dictionary of Surgery.”
“Wide, soft shoes should be worn. Such means are not only requisite
for a radical cure, but they alone often effect it. Though the
radical cure is thus easy, few obtain it, because their perseverance
ceases, as soon as they experience the wished-for relief.
“When business or other circumstances prevent the patient from
adopting this plan, and oblige him to stand or walk a good deal,
still it is possible to remove all pressure from the corn. For
this purpose from eight to twelve pieces of linen, smeared with an
emollient ointment, and having an aperture cut in the middle exactly
adapted to the corn, are to be laid over each other, and so applied
to the foot that the corn is to lie in the opening in such a manner
that it can not be touched by the shoe or stocking. When the plaster
has been applied some weeks the corn commonly disappears without
other means. Should the corn be on the sole of the foot, it is only
necessary to put in the shoe a _felt_ sole wherein a whole has
been cut, corresponding to the situation, size, and figure of the
induration.
“A corn may also be certainly, permanently, and speedily eradicated
by the following method, especially when the plaster and felt with a
hole in it are employed at the same time. The corn is to be rubbed
twice a day with an emollient ointment, such as that of marshmallows,
or with the volatile liniment, which is still better; and in the
interim it is to be covered with a softening plaster. Every morning
and evening the foot is to be put, for half an hour, in warm water,
and while there the corn is to be well rubbed with soap. Afterwards
all the soft, white, pulpy matter outside of the corn is to be
scraped off with a blunt knife; but the scraping must be left off
the moment the patient begins to complain of pain from it. The same
treatment is to be persisted in without interruption until the corn
is totally extirpated, which is generally effected in eight or twelve
days. If left off sooner the corn grows again.”
The “Hydropathic Encyclopædia” recommends a more summary mode of
dealing.
“These well-known toe-tormenters are produced by tight shoes or
boots. The first principle of cure is to give the feet a respectable
‘area of freedom;’ and the second is, to soak them in warm water and
shave off the horny substance, and then touch them with the nitric or
nitro-muriatic acid. When the corn is inflamed or highly irritable,
the tepid foot-bath should be employed to remove this condition
before the acid is applied. The _aqua-regia_—nitro-muriatic acid—is
the ordinary secret remedy of the ‘corn-curers.’ When the corn is
fully formed, or ripe, a membrane separates it from the true skin,
so that it can be taken off without injuring that surface; and this
circumstance enables professional chiropodists to ‘elevate the grain’
on the point of a penknife, after an application of the acid.”
Another mode, similar in character, is taken from a late work by Dr.
Ira Warren.
“Corns should be shaved down close, after being soaked in warm water
and soap, and then covered with a piece of wash-leather or buck-skin,
on which lead plaster is spread, a hole being cut in the leather the
size of the corn. They may be softened so as to be easily scooped out
by rubbing glycerine on them. Manganic acid destroys warts and corns
rapidly.”
Still another, and one very easy to practice, is from Dr. Calvin
Cutter’s “Anatomy, Physiology, and Hygiene.”
“To remove these painful excrescences, take a thick piece of soft
leather, somewhat larger than the corn; in the centre punch a hole of
the size of the summit of the corn; spread the leather with adhesive
plaster, and apply it around the corn. The hole in the leather may
be filled with a paste made of soda and soap on going to bed. In the
morning remove it, and wash with warm water. Repeat this for several
successive nights, and the corn will be removed. The only precaution
is, not to repeat the application so as to cause pain.”
It is altogether probable that the last treatment here advised for
hard corns would be equally effective for soft ones, if we could
contrive to cover up the surrounding parts with a plaster so as to
admit of its application. The other remedies are, to keep continually
cutting away at them with the knife, or burn them out thoroughly with
caustic.
In all these cures the essential parts of the treatment are, first,
the emollient ointment or warm water to soften the skin and remove
soreness; then caustics—soap and soda, nitric, muriatic, and manganic
acids—to destroy the mass of the corn; after which the remainder is
lifted out with a knife; the leather and felt serving as a protection
from the shoe.
It is said, and with considerable evidence to support the statement,
that ordinary mild corns may be cured in a couple of weeks by winding
a cotton rag around the toe or foot, so as to cover the corn with
several thicknesses, and then keeping this bandage constantly wet
by bathing the feet twice a day in cold water. To which it may be
added, that many corns will probably disappear if constantly kept
moist and soft in any manner, provided the external irritation is
entirely removed.
Very often it is the case that new corns, both hard and soft, grow up
in the places where they have been taken away before, re-appearing,
some of them, several times; and it is a question if the common
practice of putting leather with a hole in it around the corn does
not tend to make the latter grow up again by pressing on the edges
of the cavity. It is perhaps better, therefore, that the leather
or felt be worn for some time after the corn is gone, to keep the
pressure of the boot away from the part till it has regained its
natural condition, and it is well to make the hole in the plaster
_so large_, that even the border of the sensitive cavity will not
be touched. When a surface has been secreting corn-material for a
length of time, it is not strange that it should continue the habit
without much provocation. In these cases where the corn grows again,
it may perhaps be advisable to touch the most central part, or place
of the _point_, with nitric acid or some other caustic, to destroy
the papillæ, and change the structure of the skin, as is done with
a wart; where it is so effectual that the wart never re-appears. It
is not necessary to burn the surrounding surface, or make anything
more than a very small burn anywhere. The acid should be applied with
some sharp-pointed instrument, just wet with it, so there shall be no
danger of putting on too much. If there is any fear of creating too
much inflammation, it can be postponed till the acute sensitiveness
has become somewhat abated.
For soft corns it is doubtful whether any other treatment than
burning will be completely successful, though it may be well to try
some other method first. Burning is rather severe, but reasonably
sure, and a thousand times better, than to suffer from the corn.
But little acid need be applied at a time, and as soon as the under
skin becomes inflamed the desired effect is accomplished; for when
it heals, the corn is “done for” and gone. Something soft may be
put between the toes to separate them, and prevent any unnecessary
irritation during the process.
Corns on the bottom of the foot are amenable to caustic like the
rest, the felt sole with a hole in it being used for protection
during the operation.
Inflamed and suppurated corns are to be cut down as much as possible
and lanced, according to Erichsen—one of the best authorities—though
it would seem to one unacquainted with the matter that they might be
removed like the others. They are intensely painful, and a surgeon’s
skill is necessary to treat them properly.
Some of the medical books represent that there is more or less danger
in using caustics in severe cases, where the patient is an old
person, or one of feeble vitality, or extreme nervous sensibility.
It is always well to proceed safely, and have medical advice before
operating on such a patient.
In addition to the ordinary hard and soft varieties, _black_ and
_bleeding_ corns are described by one writer on the subject, some of
which are reported very difficult to cure and dangerous to manage;
their injudicious removal being liable to result in convulsions, and
even lockjaw and death; all of which frightful consequences may be
accepted as inducements to avoid the productive first causes of the
trouble.
In regard to the treatment of _bunions_, the following from the
“Hydropathic Encyclopædia,” is the only thing we are able to find in
the books.
“This affliction, though generally regarded as a kind of corn, is
really an inflammation and swelling of the _bursa mucosa_,[8] at the
inside of the ball of the great toe; it often produces a distortion
of the metatarsal joint of the great toe, and is produced by the same
causes as corns. The treatment is, warm foot-baths when the part is
very tender and irritable; at other times frequent cold baths; and
when a horny substance, resembling a corn, appears externally, the
application of caustic. I have known bad corns and bunions cease
to be troublesome after the patient had been a few months under
hydropathic treatment for other complaints.”
The straightening of the great toe in the manner previously described
will probably do more toward the relief and cure of bunions than
any other remedy. The material of a shoe for that purpose should,
of course, be soft—the softest kinds of calfskin are good—but not
of _too_ yielding a nature, or the toe and joint will force it into
their own abnormal shape in spite of the form of the shoe, unless
this can be prevented by a stiffening piece of sole-leather at the
ball (see Chapter Four), because the parts tend to assume their old
position, and do so, as far as the leather will allow. With the
ordinary shoe, all that can be done, is to give the foot the softest
of leather—buck-skin, when obtainable, is the best—and make the shoe
over a last having also a big joint upon it, made of sole-leather, in
the exact place to fit that of the foot, and thus allow it plenty of
room.
The callosities that come upon the heel, instep, or other part of
the foot, can almost always be lifted or scraped off, without the
necessity of using caustic, and there is less probability of their
re-appearing after the cause is removed than in the case of corns.
But if the pressure that caused them first is continued, of course
they grow again. When they are so bad as to make it difficult to
remove them without softening, they can be subjected to the same
treatment which softens corns.
Sore insteps, big joints, and corns, when no positive means are
adopted for their cure or removal, may often be made tolerably
comfortable by having the shoe carefully adapted to fit them. This
is done by making leather corns or joints on the lasts before the
shoes are made. Particular places in a shoe can also, generally, be
stretched, so as to render them much more easy.[9]
Trusting that those readers who are not able to avail themselves
of the services of a professional chiropodist, will here find a
sufficient guide for the management of ordinary difficulties of this
kind, attention will next be called to a re-statement of some of the
ideas and points of argument previously advanced in this treatise.
FOOTNOTES:
[8] The _bursa mucosa_ is a synovial membrane lining the joint, and
secreting a lubricating fluid, like similar membranes in other joints.
[9] It will, perhaps, not be amiss here to give a cure for
_chilblains_, taken from a recent work upon the “Movement Cure,” by
Dr. George H. Taylor. It consists in raising the foot, with the shoe
upon it, and giving it thirty or forty smart blows upon the sole with
a heavy stick of convenient length to be handled. The shock upon the
foot dissipates the congestion of blood in the capillary vessels
under the skin, which causes the intense itching and smart. It is so
simple that every one afflicted ought to try it, and is asserted to
be, with few repetitions, a permanent cure.