I remember during my training days, how difficult it is to inject local anesthetic for corn excision. Where the local spilt all over.
I use a posterior tibial nerve block with lidocaine 2%. It is quite simple. Find the artery and leave a depot near the artery. Take care not to puncture the artery. With this technique the whole foot sole is numb. A number 11 blade is ideal to remove the corn with an elliptical excision. Sharp spoons are also useful. I close the skin with an absorbable suture.
Used to have the same problem. Another thing was, as it was a weight bearing area , there would be recurrence in the same spot. I send these patients to my Dermatology colieagues for treatment with keratolytic agents and change the foot wear for distributing the weight evenly. Only when there is severe pain on walking I remove the corn but, again with above measures.
In our unit we tend to use propofol sedation and local or regional block depending on size. For smaller lesions, I generally fulgurate with diathermy. Larger lesions might require a number of repeat treatments to destroy the lesion and allow normal skin to heal over it.
recently i have learned that 2% lidocaine through the corn perpendicularly using 27 g needle. slowly pushed; infiltrate once the pt feels pain and when u feel free flow, around 2ml- 5ml depending on the size and required fullness around the corn usually is enough at one site,this also give the demarcation of the complete excision. than number 11 blade is ideal to remove the corn in an conical excision.
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