Heloma Molle

A 54-year-old male patient with type 2 diabetes diagnosed at the age of 48 years attended the outpatient diabetic foot clinic for callus removal. He had severe diabetic neuropathy (loss of sensation of pain, light touch, temperature, vibration and 5.07 monofilaments), and he complained of mild pain on his left little toe.

On examination, a painful corn was seen at the medial aspect of his left little toe (Figure 3.13).

Corns are circular hyperkeratotic areas which may be soft or hard. They have a polished or translucent center and may become painful due to persistent pressure and friction. Soft corns develop in the interdigital

Corn Little ToeHeloma Vascular
Figure 3.13 Heloma molle

spaces; these are known as heloma molle, and they are caused by pressure and friction from the adjacent toe bones. This type of corn often has a soft consistency (in contrast to a heloma durum) due to moisture retention in the interdigital space. The commonest location of a heloma molle is the lateral side of the fourth toe, caused by pressure and friction on the adjacent head of the proximal phalanx of the fifth toe, but it may also occur in the other interdigital spaces. Osteoarthritic changes of the distal interphalangeal joints often cause heloma molle. Kissing heloma molles result when the ends of the phalanges are too wide. Tight shoes aggravate the problem. This condition is especially common in women who wear high-heel shoes, which shift the body's weight to the front of the foot, squeezing the toes into a narrow, tapering toe box.

Heloma molle, like heloma durum may cause discomfort, and it may be complicated by infection. The patient is advised to wear wide shoes or shoes with a high toe box. Surgical removal of small portions of the bones or the exostoses that are involved in the pathogenesis of the heloma molle is the permanent treatment.

Keywords: Corns; heloma molle; heloma durum

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