That painful callus is called a heloma molle which literally means “soft corn.” When most people picture a corn they think of that hard skin that overlies a knuckle on their toe, and is caused by friction between the shoe and a toe. Heloma molles are slightly different because they occur between toes, most commonly between the 4th and 5th toes a.k.a. the “ring” toe and “pinky” toe.
Heloma Molles form between toes because of the close proximity of bony prominences of adjacent toes. Pressure can begin after arthritis, a healed toe fracture, or when contracted toes from over time. Wearing tight shoe gear can exacerbate pressure between the toes leading to painful corn formation as well. Typically the corn in soft and not hard like those found on the tops of toes because the space between our toes holds moisture very well. This increase in moisture can lead to athlete’s foot infection or more severe bacterial infections if hygiene is poor or treatment is not sought.
The clinical picture of a heloma molle is thick yellow corn usually on the inside of the 5th toe but often on the outside border of the 4th toe as well. Often it appears to have a central core of thickened skin. If the patient sweats a lot or has poor hygiene it can be very moist and sometimes have an odor. As the callous builds it can cause pain and can possibly become infected if left untreated.
Treatment falls into two categories, conservative and surgical. In most cases surgery is not required. A podiatric physician can trim the lesion and remove its central core to healthy skin the office, therefore reducing pain and risk for infection. Afterwards, gel padding and wider shoes can be used to reduce pressure, topical prescription creams can be applied to help soften lesion, and instruction of manual reduction at home can be given.
Padding, creams, manual removal of callus and altering shoe gear is not curative. It only reduces pressure and the rate of recurrence. This is a chronic condition caused by increased pressure of bones that are not changed by conservative therapy.
In the cases of chronic heloma molle formation with severe pain or infection, surgical correction is recommended. Surgery removes the parts of the bone that cause the painful irritation. The surgical procedure allows the patient to return home the same day as procedure and ambulate with the protection of a flat bottomed surgical shoe or boot.
Heloma molle is a treatable condition that you do not need to suffer through. Come see us for evaluation and treatment so you can help eliminate your painful symptoms!