The Secrets of Specialists/Chapter 19

Chiropody bears about the same relation to the medical profession today as dentistry did half a century ago; as it was only a few generations ago that physicians deemed dentistry a minor subject, unworthy of any special attention or surgical skill, other than the extraction of teeth, for the relief of pain; yet dentistry, as a branch of the medical art, has developed into one of the worthy and respected professions. If we would only stop to consider that ills caused from ailments of the feet are quite equal to those of the mouth, as nine people out of every ten are afflicted with some disease or discomfort in this part of their anatomy, we would realize that it is time physicians should give this subject more than a passing notice. Through the neglect of this specialty Chiropody has, unfortunately, fallen into the hands of many unskilled "corn whittlers." who style themselves "Chiropodists." While many of these embryo surgeons possess more than ordinary skill in treating disorders of the feet, the majority of them have little or no knowledge of antiseptics and other surgical dressings, and these operations are often followed with the most serious results.

I, personally, have no use for the physician who considers it beneath his dignity to treat the feet, or any other part of the body if he possesses skill to relieve pain, and alleviate suffering. Chiropody certainly offers him a large field for his usefulness.

However trivial the maladies of the feet may appear, and however they may be sneered at and considered beneath the dignity of medical science, they nevertheless demand careful attention the physician will be amply repaid for his services or for any information he may contribute to the ease and comfort of mankind.

In treating corns, as a rule, we have only the four outer layers of the skin to deal with (the epidermis); the true skin is seldom affected, unless it is involved in the sloughing process of suppuration. Corns and callosities appearing upon the feet are caused either by pressure or friction, usually due to the improper selection of footwear. There are two forms of shoes which should be condemned-the high heels and narrow toes. The erroneous idea many women possess of trying to ape the aristocratic Chinese women, by attempting to make their feet appear small, from the use of these shoes, has offered more labor for the chiropodist than any other cause. These shoes force the feet forward, compelling pressure between the toes to a state of friction and produce corns, both between the toes and upon the top surface of the prominent articulation; while tight, narrow-toed shoes induce corns by pressure. Too loose, and poorly fitting shoes, produce corns and callous hardening by irritation. This is the principal cause of all callosities on the heel and bottom surface of the foot.

There has been much said regarding the pathological formation of corns. Most observers are in accord, however, that the pressure on prominent articular surfaces causes an exudation of lymph which coagulates under the epidermis, and through its inspissations, forms the substances of corns. Corns seldom involve the true skin, but their penetration into the cutis vera, and the pressure upon the nerve filaments of the papillæ, cause the annoying pain connected with these growths. Sir Erasmus Wilson says:

"The new position of the formative organ of the epidermis, namely, the corneum, occasions an alteration in the direction of the strata of the epidermis. The strata formed within the cup assumes, naturally, the cup shape, and as they rise to the surface, present the broken edges of a cup, with a small central mass or nucleus, (the eye of the corn) suggesting the idea of vertical fibres rising to the surface and the suggestion is increased by the broken edge of the epidermis that corre​sponds with the border of the cup. The fibrous appearance of the center of the clevice has suggested the idea of roots and the central cup-formed mass of hard and condensed cuticle has been regarded as the core or root of the corn.

The use of the word root in the description of corns has implanted the idea that they grow like a vegetable, and in order to eradicate the difficulty, this filament must be destroyed; this is an erroneous conception, which has often led to great disappointment to the sufferer. Corns have no roots and are only embedded in the sensitive structures of the true skin; they will always reappear if their primary cause is not removed, namely, pressure or friction.

Although most corns are similar in structure they present varieties according to the parts upon which they are formed, or the tissue which becomes involved. We therefore find seven distinct varieties of these growths, namely: hard, soft, festered, nervo-vascular, laminated and fibrous corns, and callosities of these. The hard corns are of the most frequent occurrence. A favorite seat for these corns is on the outer surface of the little toe, and the inner flap of the great toe, although they may occur on any part of the foot where extreme pressure is applied. These corns are deep-seated and very painful.

Soft Corns are somewhat different in nature from hard corns and are always located between the toes, and are supposed to be formed by the perspiration collecting between the toes and the pressure of one toe against the joint of another. They are not deep-seated or as painful as hard corns, the pain being of a stinging character.

Festered Corns are due to pressure, forcing the toes out of their natural position, which frequently occurs in "breaking in" a new pair of shoes. The first indication of this complaint is redness, swelling and inflammation of the afflicted part, which may involve the entire toe. These corns can only be relieved and cured by properly adjusting the footwear, to remove the pressure from the affected surface.

​Nervo-Vascular Corns are generally found in delicately skinned persons with fair complexion; their skin being more vesicular than usual, disposes to inflammatory action even after moderate pressure. These corns are also more frequently found in persons advanced in life with weak vitality. In the early stages they are intensely inflamed; this irritation subsides in a few days if the pressure from the shoe is avoided. After the acute inflammation has subsided the corns can be carefully dissected away and an application of nitrate of silver applied.

Vascular Corns have somewhat the appearance and character of warts; they are spongy and vascular but do not project much beyond the level of the skin. They contain red and black specks which are surrounded by inflamed and swollen integument; they are very sensitive to the touch and attended with great pain.

Laminated Corns, also frequently referred to as black corns, are due to the formation of a blood clot, or coagulated serum underneath the epidermis. These corns adhere very closely to the skin, and are invariably formed like a shell.

Fibrous Corns are more painful than the other varieties. but fortunately they are less frequently met with and their method of removal is the same as with the other varieties.

​Callosities are not of the character of a corn, as there is no change of the integument, other than a thickening of the skin. This may appear on the hands, by sawing, or any other part of the body which is exposed to continuous friction. It is formed on the soles of the feet by the use of too loose shoes. These callosities rarely cause any trouble. If they should become inflamed they can be removed by dissecting, the same as corns.

The treatment for corns consists of both medical and surgical measures. The first and most important step to take is prophylaxis—remove the cause. If the patient is wearing too tight or too loose shoes, he should be advised regarding the proper adjustment of footwear. High heeled and pointed-toed shoes should always be condemned; also a too loosely fitting shoe.

A description of the caustic remedies, used from time to time, for the removal of corns, would occupy the space of this book. Some have been too mild, and others too strong, but after years of experience it has become an established fact that salicylic acid is the one remedy for the removal of corns. Salicylic acid is the happy medium; it is neither too strong nor too mild. Its escharotic properties are strong enough to disintegrate the corn tissue, imbedded in the epidermis, without affecting the true skin. All the multitudinous corn cures on the market contain this remedy, in various per cents., as the active ingredient of their preparations. The component compounds are generally accompanied by Cannabis Indica or some other anodyne remedy for the relief of pain and dispensed in a base of collodion or cerate, as will be found in the following formula:

​Mix until dissolved. Apply with a camel's hair brush for consecutive nights and mornings, to form a thick coating. The collodion protects the corn from irritation and rubbing, while the extract of Cannabis Indica acts as an anodyne, and the salicylic acid dissolves and disintegrates the corn.

One of the most convenient and cleverly devised treatments is known as the "Diamond Corn Plasters," which are made as follows: An adhesive plaster is made by melting equal parts of resin and balsam of fir together; while warm, spread on cambric cloth cut in diamond shape. When worn, a circular pad, with a disc in the center should be placed in the middle of the diamond and the central disc filled with the following mixture.

Melt the resin and balsam of fir together, then stir in the Cannabis Indica and salicylic acid.

​In applying these plasters the central medicated disc should be placed directly over the corn and the pointed ends of the adhesive plaster wound around the toe, to form the attachment.

The surgical treatment of corns is of great importance as instant relief can be obtained by their immediate removal with the knife. To successfully detach a corn the operator has to exercise some judgment concerning the different forms of corns. The principal object in view is to remove all the corn tissue.

In dissecting away a corn or callosity, the operator should commence at the edge of the corn, and detach from the subjacent tissue every portion of the extraneous substances there imbedded, including the so-called eye of the corn. Great caution should be exercised not to cut into the true skin, as this will produce bleeding, which can be avoided if the operator is careful. If the corn is an exceptionally sensitive growth, a few drops of cocaine solution can be injected beneath the corn, and the operation rendered painless. After the corn has been successfully removed, the denuded surface should be dusted with aristol europhen, or some other antiseptic powder, over which a thin layer of absorbent cotton is placed and held in position with adhesive plaster, which will diffuse the pressure of the foot, and assist the healing process. Some chiropodists prefer to cauterize the surface with nitrate of silver, with a view of permanently destroying the growth.

Bunions are due to a malformation of the foot, which is usually limited to a morbid condition of the internal lateral ligament of the metatarso-phalangeal articulation of the great toe, of the superimposed cellular tissue and integument and the development of a bursa produced by pressure and irritation. When the bone has become affected, it is only secondarily, and must be viewed as a complication and not as a discase. The pain arising from a bunion differs from a corn, as it is of a more aching character. Although a radical cure for bunions can seldom be promised, there are many palliative treatments, which can be applied, and relief from suffering inconvenience ​is afforded by proper treatment. The most beneficial local remedies are cold water dressings and linseed meal and boracic lint poultices. If the bursa becomes too annoying, it may be dissected away, but such operations always result in ankylosis.

Ingrown Toe Nail is of very frequent occurrence, and is usually found upon the outside surface of the great toe. This condition is due to wearing shoes which are not long enough for the feet, or the foot is thrown forward, as with high heeled shoes, impinging the great toe.

The following method of medicated treatment is the most satisfactory and will cure at least ninety per cent of all cases: The flesh should be pulled away from the nail at the irritating side, by a strip of adhesive plaster which is wrapped around the toe, to draw the cutaneous border away from the nail. The irritating surface should now be thoroughly cleansed with peroxide of hydrogen. The exposed fissure should be packed with a copious application of dried alum and thoroughly packed in with an absorbent cotton tampion, over which the second strip of adhesive plaster may be wrapped entirely around the toe. The accompanying cut illustrates the method of packing and applying the tension strip, which is now ready for the final strip around the toe.

This simple method, if properly conducted, will give most excellent results; by repeating this application for a few days the suppuration rapidly dries up, and pain and discomfort are relieved almost at once.

The surgical treatment consists of complete removal of that portion of the nail imbedded in the flesh. The operation can be made painless by the use of an injection of cocaine ​alongside the parts to be operated upon, and the Esmarch hæmostatic bandage should be applied above the operative surface, to check the flow of blood. With a pair of sharp pointed scissors the nail is cut its full length; the offending portion should then be grasped with a strong pair of dressing forceps and with a slight twist outwards, removed from the matrix, and an antiseptic dressing applied.

Sometimes appear at the outer margin of the great toe, and create great suffering; the only method of treatment is complete excision and an antiseptic dressing.

Onychis is an inflammation of the matrix of the nail, causing ulceration of the surrounding tissues and may be caused either by injury or constitutional disturbances. The simpler forms commence with the usual signs of inflammation around the nail, which becomes red, painful and swollen. Mild cases can be cured by cauterizing the parts with nitrate of silver, or other causties. Other cases will require the complete removal of the nail by the use of the knife, allowing the wound to heal by granulation.

Hypersidrosis, or excessive sweating, is a very annoying condition, which Chiropodists are requested to treat. Patients thus afflicted should wash their feet and change their stockings daily, and provide good ventilation in their shoes. The ​inside of their stockings should be dusted with boracic acid, and the application of the following formula, each night before retiring, will be found beneficial:

Bromidrasis, or obnoxious smelling feet, is not of uncommon occurrence, and many husbands and wives have been requested to sleep alone owing to the odor emanating from this condition. The following formula will always give prompt relief:

Sprinkle liberally on the feet and in the stockings and shoes. This application can also be applied to the axillæ and other parts of the body for the same condition.

Chilblain is a local non-suppurative hyperemia, or cellulo dermatitis, induced by exposure to cold and can readily be cured by the use of equal parts of Peruvian bark and castor oil.