Corns of feet: Can homoeopathy be a better alternative? A narrative review

INTRODUCTION

Corn, also known as heloma, is defined as a horny induration and thickening of the stratum corneum. Furthermore, termed as clavusor focal intractable plantar hyperkeratosis, corns are a hyperkeratotic response to trauma, a circumscribed lesion that may be hard (i.e. heloma durum) or soft (i.e. heloma molle). Corns are usually caused by repeated mechanical trauma due to friction, for example, frequent use of ill-fitting footwear or pressure forces, especially where the bone is prominent and presses the skin against the shoe, ground, or other bones. This condition often is seen in athletes and patients who are exposed to unequal friction force from footwear or gait problems, any bony deformities, including older adults, patients with diabetes and amputees. It should be considered a symptom than a disease.^[1-3] The most common sites for corns are the feet, dorsum of the toes, last inter-digital web space and soles.

Corns present as dry, hard, rough papules with a whitish centre (called the core) located over a bony prominence, painful on movements like walking and standing and asymptomatic or tender to touch. As the skin thickening of corn increases, the tissues under the corn are subject to increased irritation, resulting in further discomfort to the patient.

Hyperkeratotic lesions of the skin of the foot (including calluses and corns) have been reported to affect 30–65% of people aged 65 or older.^[4] The proliferation of all epidermal layers (acanthosis), including the stratum corneum, is seen in corn biopsy specimens. Dense fibrous tissue with hypertrophied nerves is seen in the dermis; sometimes, scar tissue may extend to the subcutaneous fat.

The differential diagnosis of corn includes plantar wart, calcinosis cutis, warty dyskeratoma, hypertrophic lichen planus, palmoplantar keratoderma and lichen simplex chronicus. Plantar warts can be differentiated from corns based on the determination of plantar skin lines observed within the lesions. On examination, digital pressure perpendicular to plantar corn causes pain due to contact with the bony prominence. Warts are non-painful in this manoeuvre. Further, capillary dotting, called Auspitz’s sign, is absent in corns after paring, which distinguishes it from plantar warts.^[5] Treating corns is necessary if they do not subside after removing the repeated pressure or when it causes severe pain or secondary infections. Complications such as ulceration, taenia pedis, septic arthritis and osteomyelitis may occur if not treated timely.

Conventional treatment includes cryotherapy and surgical removal. The liquid nitrogen used in cryotherapy damages the normal skin surrounding the corn, which delays healing.^[5] Surgery carries the risk of infection, scarring of tissues and recurrence. Corns can be managed with homoeopathic treatment in a gentle, cost-effective and permanent manner.

HOMOEOPATHIC CONCEPT

In homoeopathy, foot corn is classified as a one-sided disease, as explained in aphorism 173 of Organon of medicine, having one or few symptoms more of an external kind. It is, further, categorised under external local maladies. Local maladies have been explained by Dr. Hahnemann in the 5^th edition of Organon of medicine in aphorisms 185–186. Local maladies signify a visible change localised to a particular body part. Some local maladies that have occurred a short time previously, solely by an external lesion, may be removed by mechanical means or surgery (aphorism 186). Based on homoeopathic principles, the treatment of any patient is to be based on the strange, rare, uncommon and individualising peculiar symptoms manifested by the patient, which forms the totality of symptoms. Similarly, all other local diseases require internal medicine based on the totality of symptoms. The patient is thus treated as a whole; the local affection is cured simultaneously with the general morbid state. This proves that local affections often depend solely on a disease of the rest of the body and should be regarded as an inseparable part of the whole, as one of the most striking symptoms of the disease.

In Boenninghausen’s lesser writings, a case of corns has been reported. Violent extraction led to inflammation of the whole foot with severe swelling and violent burning. The case improved considerably with Sepia 200 followed by Pulsatilla 200. The same book, Von Boenninghausen, provides indications of Thuja for burning corns.^[6]

Along with individualised homoeopathic treatment, removal of the maintaining cause is necessary. If ill-fitting shoes are the cause, the patient is instructed to wear soft-soled footwear, which improves comfort and reduces friction.

MIASMATIC VIEW

Dr. Hahnemann said, “Psora is most ancient, most universal, most destructive and mother of all the thousands of incredibly various (acute), chronic (non-venereal) diseases.”^[7] According to JH Allen, all skin eruptions are either secondary or tertiary expressions of miasmatic action. Allen opines that corns are, no doubt, due to mechanical pressure, yet every person does not have corns. Therefore, the diathesis, as the predisposing cause, lies behind their appearance. They are found more frequently in those with latent syphilitic and tubercular traits. Allen also states that corns are found in those with pseudo-psoric traits.^[8] Herbert Robert opines that corns and similar hypertrophies are tubercular manifestations. In a study on the miasmatic analysis of foot corns along with its homoeopathic management, most cases had a predominantly psoro-Sycotic miasmatic background.^[9]

FOOT CORNS IN DIFFERENT REPERTORIES

The rubric corns are placed in different chapters in different repertories. In Kent’s Repertory of the Homoeopathic Materia Medica, it is placed in the extremities chapter; in William Boericke’s Pocket Manual of Homoeopathic Materia, it is in the Skin chapter; in CM Boger’s Boenninghausen’s Characteristics Materia Medica and Repertory, it is placed in the Skin and Exterior Body chapter; in Boenninghausen’s therapeutic pocket Book, it is placed in the Skin chapter and in Fredrick Schroyens’s Synthesis repertory, it is placed in the Extremities chapter.

THERAPEUTICS

Homoeopathic treatment comprises the medicine selected based on individualised symptoms. As corns often have very few or no symptoms, the lesions’ size, site and colour along with the presence or absence of pain and other characteristic individualising symptoms help the homoeopath select the most appropriate remedy.

Homoeopathic literature mentions several medicines for corn. Among the most useful are Natrum muriaticum, Antimonium crudum, Ranunculus bulbosus, Thuja occidentalis, Sulphur, Hepar sulph, Ferrum picricum and Silicea.

DISCUSSION

Corn is a local disease that indicates sycotic miasm in the background. It has a high chance of recurrence and has no answer in modern medicine except surgical removal, which is invasive, painful, may cause scarring and destruction of normal surrounding tissues and requires immobilisation for 4–6 weeks.^[5] Homoeopathy can be used for gently treating corns along with auxiliary measures such as using well-fitting footwear and treatment of underlying bony problems.

A study conducted in Assam showed a reduction of symptoms in 63.03% of patients in the treatment group.^[10] In another exploratory study of 50 cases in Ludhiana, 94% of patients responded well to the indicated homoeopathic individualised similimum.^[9] A dissertation study comparing the effectiveness of Homoeopathic constitutional remedy and Antimonium crudum in the treatment of corns stated that constitutional medicine was more effective.^[11] Several case reports have reported the efficacy of homoeopathic medicines in treating corn. The remedies that were found effective in treating corn included Sulphur, Antimonium crudum and Nux vomica.^[12-16]

In the future, randomised controlled trials with a larger sample size will be required to establish the efficacy of homoeopathic constitutional remedies in the treatment of corn.

CONCLUSION

Despite corn being a common foot complaint, there is little evidence for the most effective treatment for long-term resolution. Homoeopathy is a viable alternative for treating corn gently and permanently. A greater number of cases are required to furnish concrete evidence supporting the efficacy of homoeopathy in treating corn.