Podiatrist Questions Corns and Calluses

How are corns under a toenail removed?

My grandmother has a corn underneath her toenail. How are these usually removed? Does it hurt?

16 Answers

Surgical debridement or cutting of the corn after removal of part or all of the toenail. Sometimes there is an exostosis or bone bump/spur on the bone under the nail; this can cause the soft tissue and toenail to be pushed up thus causing pressure and shear friction when wearing shoes.
Your podiatrist will take x-rays to determine of this is the case. If so, surgical removal of the bone bump/spur will be necessary
Hello, and thanks for your question. Corns and calluses that occur at the tip of the toe and/or under the nail are called distal clavi. They are caused by abnormal pressure, usually from a digital deformity. These lesions are normally trimmed or debrided without the need of local anesthetic. This is something that is done in the office. Patients sometime report tenderness upon debridement. If the patient is not able to tolerate the debridement due to pain, then I recommend performing a digital nerve block before aggressive debridement. I wish you and your grandmother the best.
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They can be shaved. Usually requires surgery for a permanent fix.

One doesn't normally see a corn beneath the nail. Is it a growth of some sort? Is it fungus beneath the nail? If it is a growth then the nail will most likely need to be removed to gain access to the lesion.

Dr. Lui
A corn or callus are pressure lesions, the corn is on a toe and a callus is some other area on the foot. Pressure on the skin from a bone to bone or bone to the hard floor, or shoe would produce significant enough pressure to create the lesion. Although you don't typically see corns under the nail, the nail protects the skin from pressure, you do see corns at the end of the toe, when the toe isn't straight and the end of the toe hits the ground pinching the skin between the bone and the floor.  This can be trimmed down, however walking with the toe in that curled position will result in reoccurrence.  The toe would need a crest pad under the toe to lift it up to reduce the pressure causing the lesion, or surgical straightening of the toe would be necessary to alleviate this condition if she is a candidate for such a procedure..
Corns under the nail, or medically referred to as subungual keratomas, develop not dissimilar to other identified corns. There is excessive pressure borne on the nail bed resulting in thickening and keratinizing of the nail bed epithelium or skin. These are challenging to eliminate as they are protected by the overlying nail plate. Frequently, a portion of the nail may need to be removed to gain access. This may be done under local anesthesia if it is too sensitive to be done without anesthetic. As this is not a frequent area to develop these lesions due to protection from the nail plate, it may be wise to biopsy the presentation if there is any suspicion that this is not keratinized skin (abnormal coloration, irregular borders, altered appearance of the surrounding nail bed skin, etc.). If there is any appreciation or local deformity, it may be wise to also obtain an X-ray to rule out a not uncommon bone growth or exostosis that develops on the distal phalanx that can contribute to these lesions (subungual exostosis or osteochondroma). If this is present, the bone enlargement may also need to
be reduced and biopsied.
There shouldn’t be a corn under a toenail unless there is an underlying bone spur. This is not that common. It is more likely that you may have a wart. The treatment of these lesions is variable. Therefore your situation requires a professional evaluation for the correct diagnosis and corresponding treatment.
These corns can be caused by bending of the nail and causing the skin to build up and harden underneath the nail, or it can be due to a bone spur under the nail. See your podiatrist to evaluate this properly.
Usually, they can be reduced with sharp or mechanical means and should not elicit pain.

Ahmad Farah, DPM
Corns under which toenail? Some corns or under the toenails can be removed surgically, other times it is something that needs to be taken care of very conservatively. Please check with your local podiatrist for further information.
There is a chance this is not a corn at all. It may in fact be some kind of tumor and should be seen by a surgeon who will remove the nail and then determine what the growth is, either by biopsy or total resection of the growth. "Corns" are usually caused by friction, which cannot exist under a nail.

Rod Tomczak, MD, DPM, EdD
Sometimes the nail has to be removed (that can be painful), other times it can just be paired down.
A podiatrist will be able to examine it first and determine if it is a corn. Developing corns underneath the toenail is a relatively rare thing. Most often it is a buildup of fungal organisms debris. In either case, I would take her to a podiatrist. They have the most appropriate tools to remove it in the most comfortable way.
Toenails are made of thick Keratin. Corns are dermal conditions. So, the best thing to do in this case would be to have a podiatrist evaluate the condition to see what the problem really is, as I don't believe you can have a corn beneath a toenail.
Corns underneath the the toenail may need to be further investigated. I recommend being evaluated by a foot and ankle surgeon (podiatrist) to determine the cause and the proper treatment. This may involve removal of the nail plate and possibly addressing possible bony prominence contributing to the lesion.
Go visit a podiatrist office near your home and they will exam the toenail and corn and provide proper care!