Surgical Excision of Intractable Plantar Keratoses (Corns) of the Foot: A Scoping Review.

Abstract

Background: Hyperkeratosis is a hypertrophic thickening of the skin. A callus (tyloma) is considered diffuse thickening, whereas a corn-also known as a clavus, heloma durum, or intractable plantar hyperkeratosis (IPK)-is a more focal, circumscribed hyperkeratotic lesion with a central conical core of keratin. Treatment (including surgical excision) of plantar keratoses is often sought because of pain and discomfort. The aim of this study was to collect and chart data regarding the surgical excision of plantar corns. The emerging themes were then mapped so that suggestions for areas of future research could be made.

Methods: A scoping review of the literature was performed using the six-stage methodologic framework (minus stage 6) proposed by Arksey and O'Malley incorporating the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews reporting guideline. A database search by means of the United Kingdom National Health Service Care Advanced Database Search yielded 1,056 articles, 12 of which appeared to be of potential relevance. After removing five duplicate articles, this total was reduced to seven, which were retrieved as full texts. Three were excluded. Thirteen further articles were found through Google Scholar and reference lists from the full texts retrieved to give 17 articles for review. One was discounted as not being in English/irrelevant; and one article did not relate to IPK excision, leaving 15 articles for data extraction.

Results: Iterative charting of the included articles yielded overlapping codes and two main themes. The first theme was closure: by primary intention (with or without a skin flap) or by secondary intention. The second theme was whether excision was performed in combination with IPK excision with other (bony) surgery.

Conclusions: There is modest evidence that excision of the lesion with either primary closure or healing by means of secondary intention can be useful for the management of IPKs. A further consideration is an emerging hypothesis that many of these IPKs are viral in origin, rather than mechanical, which implies that prospective studies are required with cross-reference to lesion excision by anatomical site and histopathologic confirmation of the diagnosis.