Unfortunately, if not initiated early, conservative measures are often disappointing. For more significant deformities, a bony procedure, such as shortening osteotomy or arthrodesis, is necessary. Hyperkeratotic Disorders Corns are hyperkeratotic lesions caused by abnormal pressure over bony prominences. The pressure leads to proliferation of the stratum corneum or horny layer of the skin. Corns are classified as hard or soft.
Soft corns are usually interdigital and form over the phalangeal condyles between the toes.
The keratosis is similar to hard corns, but the overlying tissue becomes macerated because of its location, and the callosity may eventually ulcerate. Hard corns are managed by wearing shoes with a larger toe box size and using padding to reduce pressure and friction. These corns can also be pared down with a pumice stone. Conservative management is generally effective. Treatment of soft corns includes keeping the affected area clean and decreasing friction by using gauze or lamb's wool between the toes.