1276
HELOMA MOLLE
Refers to a soft corn that often affects the interdigital space between the fourth and fifth digits.
The corn may be located at several sites.
Results from pressure by an enlarged joint.
It may occur at both sides of the distal or proximal interphalangeal joints of the opposing toe surfaces.
More commonly, the lesion site is at the proximal interphalangeal joint of the fifth digit when the head of the proximal phalanx of the fifth digit is compressed against the base of the proximal phalanx of the fourth digit.
It may also occur at the distal interphalangeal joint of the fifth digit when it is compressed against the head of the proximal phalanx of the fourth digit.
A lesion may also form in the fourth web interspace, and this is most often associated with a short fifth metatarsal which causes the phalanges of the fifth digit to exist further proximal.
Less frequently, first, second, and third interspace lesions have all been observed.
Heloma molle patients often experience pain at the site of the lesion enhanced by pressure, tight footwear and ambulation.
Associated conditions include: hallux valgus, underlying fifth toe deformity, or adductus deformity of the fifth metatarsophalangeal joint.
Serious sequelae include: infection, sinus tract to the bone, intertrigo, or osteomyelitis.
Conservative management: consists of digital separation, padding, local debridement, and topical dryrng agents and antimicrobials.
Maintenance care is usually required.
Surgical treatment of the fouth interdigital space heloma molle involves resection of the proximal interphalangeal joint pressure areas, not necessarily the corn.
Preoperative resolution of any infectious process or maceration prior to surgical intervention.