Let CbZ denote the group of knots in homology spheres that bound homology balls, modulo smooth concordance in homology cobordisms. Answering a question of Matsumoto, the second author previously showed that the natural map from the smooth knot concordance group C to CbZ is not surjective. Using tools from Heegaard Floer homology, we show that the cokernel of this map, which can be understood as the non-locally-flat piecewise-linear concordance group, is infinitely generated and contains elements of infinite order. In the appendix, we provide a careful proof that any piecewise-linear surface in a smooth 4-manifold can be isotoped to be smooth away from cone points.