“What the heck is that white stuff that gets so thick between my 4th and 5th toes? “, a patient asked in my Grapevine, TX office today. She had been experiencing throbbing pain in her little toes for weeks and now her 5th toe was actually red and a little swollen. She couldn’t remember banging her toes, but stated they were very painful. When she looked in between her toes, she noticed the skin was white and thick with a deep fissure. That’s when she called for an appointment.
This patient was experiencing pain from an infected heloma molle., a.k.a. a soft corn. This is a hyperkeratotic lesion (hard skin) that occurs in between the 4th and 5th toes due to shoes rubbing the toes together. Often the patient will have a slightly shorter 5th toe or a previous fracture that causes the toe to be more prominent. Weight gain, foot and ankle swelling or excessive sweating and poor socks can cause increased repetitive stress from your shoes. Shoes that are too small or are not wide enough can also be the culprit!
These can be treated with debridement (removing the hard skin) from the interspace, topical antibiotics and toe spacers (a little sliver of silicone to hold the toes apart). Shoes are the culprit, so often shoe gear needs to be modified or replaced. Let’s face it, most people are wearing their shoes too small and often too long. A worn out shoe or a worn seam is often the culprit. My patient today needed some oral antibiotics because he heloma molle had caused a blister which became infected, hence the red swollen toe!
Occasionally a heloma molle becomes so chronic and recalcitrant that a small piece of bone has to be surgically removed from the 4th and/or 5th toe to make it resolve.
A heloma molle can be just one of life’s small annoyances or can cause a toe amputation from a penetrating infection! Treat early! Save a toe!