CHAPTER VIII.
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 protectitself 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—thecutis 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 calledpapillæ, 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 ornerves, and hence no life or sensation, but seems to be acoveringto 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 therete 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 whichthat part called the grain is the cuticle or epidermis, and the thicker portion is the dermis, orcutis 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, theroots; 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 afewof 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 moreconical 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 inmedical 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 greatcauseof 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.Looseboots, 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 arenarrowat 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 agentto 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 bootsunnecessarily 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 itisgained. There are only the soft and fleshy feet that can bear compressionwith 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 byextreme 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 ofthese, 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 allpressure 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 afeltsole 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. Theaqua-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 thickpiece 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 bathingthe 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 plasterso 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 thepoint, 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 thereis 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,blackandbleedingcorns 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 ofbunions, 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 thebursa 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 materialof a shoe for that purpose should, of course, be soft—the softest kinds of calfskin are good—but not oftooyielding 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]Thebursa mucosais 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 forchilblains, 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.
[8]Thebursa mucosais a synovial membrane lining the joint, and secreting a lubricating fluid, like similar membranes in other joints.
[8]Thebursa mucosais 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 forchilblains, 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.
[9]It will, perhaps, not be amiss here to give a cure forchilblains, 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.