Durlacher’s corn is a distinctive, often very painful type of corn that typically occurs at the side of the nail of the little toe, especially where footwear places excessive pressure on this area. It occupies an interesting place in both the medical history of chiropody and in modern podiatric practice because it sits at the borderline between a traditional “corn” of skin and an abnormality of the toenail itself.
Historical background
The term “Durlacher’s corn” is derived from Lewis Durlacher, a prominent 19th‑century British chiropodist who served as chiropodist to the royal household and wrote an influential text on corns, bunions, nail disease, and foot care, first published in 1845. In his description, he highlighted a particularly painful corn close to the nail of the little toe that was long, thin, and difficult to see, especially in young people who had just begun to wear stiff, pointed shoes. Over time, this eponym became attached specifically to corns situated near the lateral edge of the fifth toenail, and in North America, the same lesion is often called Lister’s corn, reflecting regional differences in terminology rather than in pathology.
Typical site and appearance
Classically, a Durlacher’s corn forms at the outer side of the nail of the fifth toe, close to or apparently under the nail edge, in a location where shoe pressure is greatest. Clinically, patients describe a sharply localized, “deep” pain when pressure is applied, and the lesion often appears as a small but deep‑seated area of hyperkeratosis that may be mistaken for an ingrown toenail, a split nail, or a simple hard corn. Podiatrists frequently encounter corns on the fifth toes in general, but corns immediately adjacent to the nail base or margin—especially if recurrent and exquisitely tender—raise particular suspicion for a Durlacher‑type lesion.
Skin lesion or nail anomaly?
Historically, Durlacher described the lesion as a corn of skin—essentially a focused plug of thickened keratin in the epidermis, comparable to other corns produced by localized pressure and friction from footwear. However, more recent dermatologic and podiatric work has shown that a proportion of these so‑called Durlacher corns are in fact “double nails” of the fifth toe: miniature accessory nail plates on the lateral side, often separated from the main nail by a longitudinal groove or depression. Histological examination of tissue removed during surgery has demonstrated that in some cases the painful “corn” is composed of true nail keratin rather than skin keratin, and radiographs in selected patients have even shown a Y‑shaped distal phalanx that could help explain the formation of two nail segments.
Causes and contributing factors
Like other corns, Durlacher’s corns are closely linked to mechanical pressure and friction, particularly from ill‑fitting shoes that taper to a point or are too narrow across the toes. Stiff or pointed footwear pushes the little toe against the shoe upper, concentrating pressure at the outer nail edge and predisposing both to hyperkeratosis of adjacent skin and to chronic irritation of any underlying accessory nail segment. Foot structure and biomechanics also matter: a varus fifth toe, bony prominence, or abnormal nail shape can magnify focal pressure, so that even routine walking or sport gradually produces a painful Durlacher‑type lesion.
Symptoms and impact on function
Patients usually report a sharp, localized pain at the side of the fifth toenail that is aggravated by tight shoes, prolonged standing, or walking, and relieved by removing pressure. The pain can be severe enough to alter gait, leading to limping or compensatory loading of other parts of the foot, which in turn may produce secondary problems such as callus under the metatarsal heads or strain in adjacent joints. On examination, clinicians may see a small area of thickened skin, a tiny split or duplication of the nail, or both, and gentle probing often elicits disproportionate tenderness compared with the small visible lesion.
Diagnosis and differentiation
Diagnosis is largely clinical and begins with careful inspection of the fifth toe, ideally after reducing callus to reveal the underlying structure of the nail and surrounding skin. Dermatoscopy can help distinguish between pure hyperkeratotic skin (a true corn) and a divided or duplicated nail plate where a thin accessory segment lies laterally, explaining recurrent symptoms despite repeated debridement. The lesion must also be distinguished from an ingrown toenail, simple hard corn, or wart; unlike warts, corns and accessory nails lack thrombosed capillaries and maintain normal skin lines around them, and unlike a typical ingrown nail, the pain is often more pinpoint and associated with a tiny, deeply seated core or nail spicule rather than swollen, inflamed tissue
Conservative management
Initial treatment usually focuses on reducing pressure and friction while addressing the hyperkeratosis. Key conservative measures include careful podiatric debridement or enucleation of the corn, use of protective padding or silicone toe sleeves, and modification of footwear to provide more room in the toe box and reduce lateral pressure on the fifth toe. In patients with dry skin or associated callus, regular use of emollients and keratolytic creams (such as those containing urea or salicylic acid, when appropriate) can help soften thickened skin, though strong chemical treatments should be used cautiously and under professional guidance, especially in people with diabetes or circulatory problems.
Surgical and definitive options
When an underlying double nail or persistent, deeply seated corn continues to cause pain despite optimal conservative care, minor surgical procedures can provide more definitive relief. For double‑nail variants, a partial nail avulsion targeting only the small lateral nail segment has been described, often combined with chemical or surgical destruction of the accessory nail matrix to prevent regrowth while preserving the main nail. In cases where the lesion is primarily hyperkeratotic skin but driven by a bony deformity or extreme toe position, surgical correction of the underlying toe structure may be considered to redistribute pressure and prevent recurrence, though such interventions are reserved for selected, severely symptomatic patients.
Prevention and long‑term care
Prevention of Durlacher’s corns relies on the same principles used to prevent other corns and calluses: minimizing abnormal pressure, optimizing footwear, and monitoring high‑risk feet. Choosing shoes with adequate width, soft uppers, and sufficient depth in the toe box helps avoid compression of the little toe, while regular self‑inspection and early podiatric assessment of any tender area at the toenail margin can prevent a small lesion from becoming a chronic, disabling problem. For individuals with structural deformities, orthotic devices, toe spacers, or custom footwear may be recommended as part of a broader strategy to protect the lateral toes and maintain comfortable, efficient gait.
Significance in modern practice
Durlacher’s corn illustrates how a condition first described in an era of stiff, pointed boots remains relevant in contemporary practice, where fashion footwear and sporting shoes still create similar mechanical stresses. It also highlights the evolving understanding of foot pathology, moving from a purely skin‑based concept of corns toward recognition that in some cases a structural or nail‑based anomaly is the primary cause, with the corn merely a painful symptom of deeper anatomical variation. For clinicians and patients alike, appreciating this dual nature—part corn, part nail problem—guides more accurate diagnosis and more targeted treatment, improving comfort and function in a very small but disproportionately troublesome part of the foot.