Skin Surgery for Scars on Toes
Hypertrophic scars are a type of scar tissue that form when the body produces an excess of collagen during the healing process (Ogunleye, 2014). They are raised, thick, and there is often a change in colour, and can occur on any part of the body (Ogunleye, 2014). One area where hypertrophic scars are commonly seen is on the tops of toes, particularly among African Caribbean women who have used corn plasters in correctly containing salicylic acid to treat lesions that were not actually corns. This can be classed as burn injury to the dorsum (top of) toes.
A corn is a small, circular patch of thick, hard skin that forms on the tops or sides of the toes or feet. A corn, also known as a "clavus," "heloma," or "focal intractable plantar hyperkeratosis," is a type of callosity however they should be distinguished from a callus, which is a more diffuse type of callosity. Thus, a corn is a well-delimited focal area of hyperkeratosis. Corns are caused by repeated friction or pressure on the skin and are often the result of poorly fitting shoes or other forms of irritation. They can be very painful when pressed or rubbed and may cause discomfort when walking or standing.
There are several reasons why women may be more likely to develop corns than men. One possible reason is that women tend to wear shoes that are more constricting or ill-fitting than men's shoes. High heels, for example, can put pressure on certain parts of the foot and cause corns to form. Another possible cause is a Morton's toe, also known as Morton's foot or Greek foot, may be more likely to develop a hypertrophic scar on the top of the second toe. Morton's toe is a condition in which the second toe is longer than the big toe, which can cause the weight-bearing part of the foot to shift slightly. This can lead to an uneven distribution of pressure on the toes, with the second toe bearing more weight than it should and the third and fourth toes clawing. Over time, this excess pressure can lead to the development of a hypertrophic scar on the top of the second toe. Wearing shoes that are too tight or have a narrow toe box can also contribute to this issue, as it can further exacerbate the uneven distribution of weight and increase the risk of developing a scar.
Hypertrophic scars are very rarely painful and can also be hyperpigmented, meaning that they are darker in colour than the surrounding skin (Ogunleye, 2014) and in some cases be hypopigmented (lighter). In the case of hyperpigmented scars this is due to an increase in the production of melanin, the pigment that gives skin its colour In (Ogunleye, 2014). Hyperpigmentation of hypertrophic scars is more common in individuals with darker skin tones (Nash, 2018), and can be a source of frustration and concern for those affected (Ogunleye, 2014).
Dyspigmentation occurs when normal melanogenesis within wounded skin is disrupted, making scars more noticeable (Tyack, Pegg et al. 1997). The effects of this can be devastating, resulting in social embarrassment and even isolation for some.
One treatment option for hypertrophic scars is surgical excision with sutures (Ogunleye, 2014). This involves the removal of the scar tissue through surgery, and the closure of the wound with sutures (Ogunleye, 2014). Surgical excision can be an effective treatment for hypertrophic scars, as it removes the excess collagen and allows for the formation of normal scar tissue (Ogunleye, 2014).
There is evidence to support the use of surgical excision with sutures for the treatment of hypertrophic scars (Ogunleye, 2014; Nash, 2018; Kim, Kim, & Kim, 2017; Seo, Lee, & Han, 2016; Wang, Li, & Zhang, 2015). A review of studies published in the Journal of the American Academy of Dermatology found that surgical excision was effective in improving the appearance of hypertrophic scars in a majority of cases (Ogunleye, 2014). Another study published in the Journal of Burn Care and Research found that surgical excision with sutures was an effective treatment for hypertrophic scars resulting from burns (Nash, 2018). Other studies have also demonstrated the effectiveness of surgical excision with sutures for the treatment of hypertrophic scars caused by various injuries and medical conditions (Kim et al., 2017; Seo et al., 2016; Wang et al., 2015).
As people generally seek cosmetic interventions to feel better about themselves, one would anticipate that cosmetically successful procedures would lead to enhanced self-esteem, mood, and social confidence. While studies spanning an extending period of time have reported that most people undergoing cosmetic interventions are satisfied with the result (Jones et al., 2018); (Lee et al., 2015).
Jones and Hunter (2018) conducted a systematic review of studies published between 1990 and 2015, and found that the overall satisfaction rate among patients who underwent cosmetic surgery was high, with most studies reporting satisfaction rates of 75% or higher. Lee, Kwon, and Kim (2015) also conducted a systematic review of studies published between 1990 and 2013, and found that the overall satisfaction rate among patients who underwent aesthetic surgery was high, with most studies reporting satisfaction rates of 80% or higher. These findings suggest that the majority of people undergoing cosmetic interventions are satisfied with the results.
Domains of functioning showing improvement included “self worth”, “self esteem”, “distress and shyness” and “quality of life” (Castle et al., 2002).
It is important to note that surgical excision is not appropriate for all cases of hypertrophic scars, and the decision to undergo surgery should be made in consultation with a qualified healthcare provider (Ogunleye, 2014). Factors that may affect the suitability of surgical excision include the size, location, and depth of the scar, as well as the overall health of the individual (Ogunleye, 2014).
In conclusion, the use of corn plasters containing salicylic acid to treat non-corn lesions on the tops of toes can lead to the development of hypertrophic scars, which may be hyperpigmented in individuals with darker skin tones (Nash, 2018). Surgical excision with sutures is an evidence-based treatment option for hypertrophic scars (Ogunleye, 2014; Nash, 2018; Kim et al., 2017; Seo et al., 2016; Wang et al., 2015), and can be effective in improving their appearance (Ogunleye, 2014). However, the suitability of this treatment should be evaluated on a case-by-case basis in consultation with a qualified healthcare provider (Ogunleye, 2014).
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