A heloma molle is a soft callus or corn that commonly occurs at the fourth interdigital space, between the fourth and fifth digits. The callus may be located at other sites, depending on the anatomy and biomechanics of the individual. The callus may appear in the webbing of the interdigital space or on either side of the fourth and fifth toes at one of the “knuckles.” There are three small bones in the toes known as phalanxes. If the lesion forms at the joints of the fourth and fifth toes, it is thought that the head of the proximal phalanx of the 5thdigit is compressed against the base of the 4thproximal phalanx. A callus forming at the webbing of the interspace is most often associated with a short fifth metatarsal.
With heloma molles, patients often complain about pain at the site of the lesion that is aggravated by tight shoes, pressure, and ambulation. Heloma molle may be associated with other conditions such as bunions or a fifth digit deformity. If ignored, a heloma molle may develop into something more serious such as an infection, sinus tract to the bone, even a bone infection.
The first line of treatment for a heloma molle include, padding that would separate the digits, local debdridement and possible keratolytics that would keep the callus down. Antimicrobrial topicals may be required if an infection is involved. Regular maintenance would be required to keep the callus from reforming. If the heloma molle persists and continues to cause pain, there are several surgical options aimed at relieving the pressure areas. One such procedure would be the removal of the proximal phalanx base of the fourth digit. Another surgery that would prevent reoccurrence is syndactilization of the digits after resection of the involved areas. Call your podiatrist today if you have questions or concerns about a heloma molle or calluses.
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