athletes Foot

The Many Skin Problems of the Foot and How to Deal With Them

Allergies

Two kinds of dermatitis are caused by substances coming in contact with the skin: primary irritant dermatitis and allergic contact dermatitis. The primary irritant dermatitis is due to a non-allergic reaction of the skin resulting from exposure to an irritating substance. Allergic contact dermatitis is the allergic sensitization to various substances.

People who work in areas where their feet are exposed to repeated or prolonged contact to chemicals, oils, or wet cement can develop primary irritant dermatitis. Some solutions are safe if used properly, but ironically, their improper use can cause a significant contact dermatitis. This is particularly dangerous with diabetics.

Hot water can cause damage to the skin and result in first or second-degree burns. Soaking your feet in such solutions as bleach, vinegar, salt water and Betadine can be beneficial, taking care to not use excessive amounts.

Allergic contact dermatitis is the result of exposure to substances that sensitize the skin, so that each time one becomes exposed to it again, an inflammatory reaction occurs. Some people are allergic to the substances in the dyes of socks or the materials used to make shoes. Adhesive tapes can cause an allergic reaction with blisters or a rash developing beneath the tape. Because of the heat and the accumulation of moisture beneath the tape, an acute Athlete's foot infection may occur.

Treatments may include cool compresses, topical steroid compounds like hydrocortisone creams, and anti-fungal creams.

Athlete's Foot (tinea pedis)

Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus usually attacks the feet because shoes create a warm, dark, and humid environment that encourages fungus growth.

The warmth and dampness of areas around swimming pools, showers, and locker rooms, are also breeding grounds for fungi. Not all fungus conditions lead to Athlete's foot, however. Other conditions, such as malfunctions of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, also may mimic Athlete's foot.

Symptoms of athlete's feet include drying skin, itching scaling, inflammation, and blisters. Athlete's foot may spread to the soles of the feet and to the toenails, and can spread to other parts of the body, including the groin and underarms.

You can prevent Athlete's foot by:

  • Avoiding walking barefoot. Use shower shoes.

  • Reducing perspiration by using talcum powder.

  • Wearing light and airy shoes.

  • Wearing socks that keep your feet dry, and changing them frequently if you perspire heavily.

While fungicidal and fungistatic chemicals are usually used to treat Athlete's foot problems, they often fail to contact the fungi in the lower layers of the skin. Instead, our practice may prescribe topical or oral antifungal drugs.
Blisters

Heat, moisture and friction are generally the cause of blisters. Blisters can also form from fungal infections, allergic reactions, and burns.

Because of a condition called neuropathy, or nerve damage, diabetes often are unable to detect a burn because there is no pain.

Proper care of blisters should involve draining their fluid but leaving their "skin" intact. Protect with a non-stick bandage with mild compression. Skin sprays and adhesive gel pads, as well as special socks, help minimize friction.
Burning Feet

Burning feet is a common complaint, especially among people over 50 and those who are diabetic.

Thyroid dysfunction, gastric restriction in morbidly obese people, and heavy use of alcohol also have been linked with burning feet.

Neuroma and tarsal tunnel syndrome, which causes a pinched nerve, also can result in burning feet.
Calluses

A callus is an area of hard, thickened skin that can occur across the ball of the foot, on the heel, or on the outer side of the big toe. While many consider them a skin problem, they actually are systemic of a problem with the bone.

Calluses have painful nerves and bursal sacs (fluid-filled balloons that act as shock absorbers) beneath them, causing symptoms ranging from sharp, shooting pain to dull, aching soreness.

Calluses form from repeated friction and pressure, as the shoe (or ground) rubs against a bony prominence (bone spur) on the toe or foot. The skin thickens in response to this pressure. Small amounts of friction or pressure over long periods of time cause a corn or callus. A great deal of friction or pressure over shorter periods of time can cause blisters or open sores. Calluses typically develop under a metatarsal head (the long bone that forms the ball of the foot) that is carrying more than its fair share of the body weight, usually due to it being dropped down or due to its longer length.

Calluses can be treated with over-the-counter callus removers that have strong acids that peel this excess skin away after repeated application. You should be careful with these products as they can cause chemical burns when not used correctly. Begin by soaking your feet in warm soapy water and gently rubbing away any dead skin that loosens. A pumice stone or emery board is then used to "file" this thickened skin. Apply a good moisturizer to the hardened areas to keep them softer and relieve pain. Non-medicated corn pads or moleskin (a thin fuzzy sheet of fabric with an adhesive back) can relieve calluses, but should be removed carefully to avoid tearing the skin.

If you need assistance relieving calluses, contact our office. Calluses can be trimmed and comfortable padding applied to these painful areas. In addition to medication to relieve inflammation, cortisone may be injected into the underlying bursal sac to rapidly reduce pain and swelling.

A plantar callus forms when one metatarsal bone is longer or lower than the others, and it hits the ground first-and with more force than it is equipped to handle-at every step. As a result, the skin under this bone thickens like a rock in your shoe. Plantar calluses that are recurring are sometimes removed surgically in a procedure called an osteotomy, which relieves pressure on the bone.

A condition called Intractable Plantar Keratosis (IPK) is a deep callus directly under the ball of the foot. IPK is caused by a "dropped metatarsal," which happens when the metatarsal head drops to a lower level than the surrounding metatarsals and protrudes from the bottom of the foot. This results in more pressure being applied in this area and causes a thick callus to form.

A "dropped metatarsal" can either be a congenital abnormality, a result of a metatarsal fracture, or a structural change that may have occurred over time.

How to prevent calluses:

  • Switch to better shoes, or even an orthotic device.

  • Buy socks with double-thick toes and heels and nylon hose with a woven cotton sole on the bottom of the foot.

Corns

Corns are calluses that form on the toes because the bones push up against the shoe and put pressure on the skin. The surface layer of the skin thickens and builds up, irritating the tissues underneath. Hard corns are usually located on the top of the toe or on the side of the small toe. Soft corns resemble open sores and develop between the toes as they rub against each other.

Improperly fitting shoes are a leading cause of corns. Toe deformities, such as hammertoe or claw toe, also can lead to corns. In a visit to our office, your corns can be shaved with a scalpel. Self care includes soaking your feet regularly and using a pumice stone or callus file to soften and reduce the size of the corn. Special over-the-counter non-medicated donut-shaped foam pads also can help relieve the pressure.

Cysts

Cysts are fluid filled masses under the skin. Common cysts of the feet include synovial cysts, ganglia and cutaneous mucoid cysts.

Most foot cysts are located under the skin, although occasionally they may be found in tendon or bone. The synovial or ganglionic cysts are connected to a nearby joint or tendon, are harder to treat.

Mucoid cysts are not connected to a joint; if they are located near the nail, they may cause the nail to grow improperly.

Most cysts are mildly painful because of pressure created by your shoes. When the cyst encloses or presses on a nerve, it can cause a sharp pain.

Some cysts form as a result of repeated injury to your foot. Ganglion cysts may be treated by numbing the area and extracting the fluid inside. A steroid or hardening agent may then be injected into the cyst to try to prevent it from filling again. Loose fitting comfortable shoes are likely your best preventative measure.

Frostbite

Extreme exposure of your feet to cold over for a prolonged period can lead to a serious condition called frostbite. If the skin changes color from blue to white or you feel numbness in your toes or feet, you may have frostbite. People with a history of frostbite often get it again in the same place. New battery-powered heated ski boots and exothermic packs are effective in preventing frostbite.

If you suspect that you have frostbite, seek emergency medical care as soon as possible. Ensure that your feet are dry and warm, but do not expose the flesh to extremely warm or hot temperatures. A gradual and steady warming procedure should be followed.
Fungus

Athlete's foot and fungal nails are the most common types of foot fungus.

Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus usually attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth.

The warmth and dampness of areas around swimming pools, showers, and locker rooms, are also breeding grounds for fungi.

Not all fungus conditions lead to Athlete's foot, however. Other conditions, such as malfunctions of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, also may mimic Athlete's foot.

Symptoms of athlete's feet include drying skin, itching scaling, inflammation, and blisters. Athlete's foot may spread to the soles of the feet and to the toenails, and can spread to other parts of the body, including the groin and underarms.

You can prevent Athlete's foot by:

  • Avoiding walking barefoot. Use shower shoes.

  • Reducing perspiration by using talcum powder.

  • Wearing light and airy shoes.

  • Wearing socks that keep your feet dry, and changing them frequently if you perspire heavily.

While fungicidal and fungistatic chemicals are usually used to treat Athlete's foot problems, they often fail to contact the fungi in the horny layers of the skin. Instead, topical or oral antifungal drugs may need to be prescribed.

Fungal toenail infections are a common foot health problem and can persist for years without ever causing pain. The disease, characterized by a change in a toenail's color, is often considered nothing more than a mere blemish, but it can present serious problems if left untreated.

Also referred to as onychomycosis, fungal nail infections are an infection underneath the surface of the nail, which can also penetrate the nail. In addition to causing difficulty and pain when walking or running, fungal nail infections are often accompanied by a secondary bacterial and/or yeast infection in or about the nail plate.

A group of fungi called dermophytes easily attack the nail, thriving off keratin, the nail's protein substance. When the tiny organisms take hold, the nail may become thicker, yellowish-brown or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.

Nail bed injury may make the nail more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of Athlete's foot and excessive perspiration.

You can prevent fungal nail infections by taking these simple precautions:

  • Exercise proper hygiene and regularly inspect your feet and toes.

  • Keep your feet clean and dry.

  • Wear shower shoes in public facilities whenever possible.

  • Clip your nails straight across so that the nail does not extend beyond the tip of the toe.

  • Use a quality foot powder - talcum, not cornstarch - in conjunction with shoes that fit well and are made of materials that breathe.

  • Avoid wearing excessively tight hosiery, which promotes moisture. Acrylic socks tend to "wick" away moisture faster than cotton or wool socks, especially for those with more active life styles.

  • Disinfect home pedicure tools and don't apply polish to nails suspected of infection.

Over-the-counter liquid antifungal agents, while sometimes effective, may not prevent a fungal infection from recurring. I may prescribe a topical or oral medication, and removal of diseased nail matter and debris (debridement).

In some cases, surgical treatment is prescribed, during which the infected nail is removed. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail.

Gangrene

Gangrene usually occurs after the blood supply to your foot is lost. Bacterial infections of open sores or ulcers also can lead to gangrene.

Diabetics are most prone to foot gangrene because they typically have poor circulation or nerve damage, which can lead to loss of blood supply. Diabetic neuropathy, or nerve loss, affects the nerves of the feet and legs causing a diminished ability to perceive pain, excessive heat, cold, vibration, or excessive pressure.

Any sudden onset of foot or leg pain accompanied by lower skin temperature and skin color changes may indicate a sudden blockage of blood flow to the legs.

Gangrene must be surgically removed, followed by oxygen treatment and intravenous antibiotics.

Some flesh-eating bacteria called Hemolytic Streptococcus can cause intense local heat, redness, swelling, fever, and weakness. The infection can start with a small abrasion or injury. This condition requires immediate medical treatment and can result in amputation and/or death.
Lesions

While most pigmented areas are nothing but freckles and moles, one kind of deadly pigmented lesion that can occur on the foot and lower extremity is malignant melanoma. Be watchful of any pigmented lesion that suddenly occurs or starts to change its appearance.

Malignant melanoma may also form under the nails of the feet. The thumb and big toe are more commonly affected than the other nails. Often the adjacent skin to the nail is ulcerated.

A condition called Actinic Keratosis is another cancer-causing lesion that can occur on the feet. It is most commonly found in sun-exposed areas of the body such as the foot. On the foot they are frequently mistaken for plantar warts. Treatment consists of freezing the lesions with liquid nitrogen or sharp excision.

Kaposi's Sarcoma is another cancerous lesion that can occur on the soles of the feet. They are irregular in shape and have a purplish, reddish or bluish black appearance. They tend to spread and form large plaques or become nodular. The nodular lesions have a firm rubbery appearance. The disease is usually associated with AIDS infection. It can occur without an AIDS infection, but this is very rare.

Psoriasis

Psoriasis is a common, chronic, and recurrent inflammatory disease of the skin characterized by round, reddish, dry scaling patches covered by grayish white or silvery white scales. The lesions are most commonly found on the nails, scalp, elbows, shins and feet. Psoriasis can be difficult to distinguish from Athlete's foot, and the nail appearance may be confused with fungal infections of the toenails.

Psoriasis can cause a characteristic pitting appearance on the nails. Pustular psoriasis is a form of the disease characterized by small pustules or blisters filled with clear or cloudy fluid, and can mimic acute Athlete's foot.

Psoriasis can also affect the joints of the feet and lower extremities, leading to painful arthritis. Anti-inflammatory medications, steroids, and other medications are common treatment for psoriasis. Please consult us before taking any medications.
Smelly Feet and Foot Odor

The feet and hands contain more sweat glands than any other part of the body (about 3,000 glands per square inch). Smelly feet can be not only embarrassing but uncomfortable as well.

Feet smell for two reasons: you wear shoes and your feet sweat. The interaction between your perspiration and the bacteria that thrive in your shoes and socks generates the odor. Therefore, any attempt to reduce foot odor has to address both your sweating and your footwear.

Smelly feet can also be caused by an inherited condition called hyperhidrosis, or excessive sweating, which primarily affects men. Stress, some medications, fluid intake and hormonal changes also can increase the amount of perspiration your body produces.

Prevention
Smelly feet generally can be controlled with a few preventive measures:

  • Always wear socks with closed shoes.

  • Avoid wearing nylon socks or plastic shoes. Instead, wear shoes made of leather, canvas, mesh or other materials that let your feet breathe.

  • Bathe your feet daily in lukewarm water, using a mild soap. Dry thoroughly.

  • Change your socks and shoes at least once a day.

  • Check for fungal infections between your toes and on the bottoms of your feet. If you spot redness or dry, patchy skin, get treatment right away.

  • Don't wear the same pair of shoes two days in a row. If you frequently wear athletic shoes, alternate pairs so that the shoes can dry out. Give your shoes at least 24 hours to air out between wearings; if the odor doesn't go away, discard the shoes.

  • Dust your feet frequently with a non-medicated baby powder or foot powder. Applying antibacterial ointment also may help.

  • Practice good foot hygiene to keep bacteria levels at a minimum.

  • Wear thick, soft socks to help draw moisture away from the feet. Cotton and other absorbent materials are best.

These preventive measures also can help prevent Athlete's foot, which can flourish in the same environment as sweaty feet. However, Athlete's foot won't respond to an antibacterial agent because it's caused by a fungus infection. Use an anti-fungal powder and good foot hygiene to treat Athlete's foot.

Treating foot odor
Persistent foot odor can indicate a low-grade infection or a severe case of hereditary sweating. In these cases, I may prescribe a special ointment. You apply it to the feet at bedtime and then wrap your feet with an impermeable covering such as kitchen plastic wrap.

Soaking your feet in strong black tea for 30 minutes a day for a week can also help. The acid in the tea kills the bacteria and closes the pores, keeping your feet dry longer. Use two tea bags per pint of water. Boil for 15 minutes, then add two quarts of cool water. Soak your feet in the cool solution. Alternately, you can soak your feet in a solution of one part vinegar and two parts water.

A form of electrolysis called iontophoresis also can reduce excessive sweating of the feet, but is more difficult to administer. In the most severe cases of hyperhidrosis, a surgeon can cut the nerve that controls sweating. Recent advances in technology have made this surgery much safer, but you may notice sweating in other areas of the body afterwards.
Swelling

Swelling of the feet, ankles and legs, also called edema, is often caused by an abnormal build-up of fluids in ankle and leg tissues.

Painless swelling of the feet and ankles is a common problem, particularly in older people. It may affect both legs and may include the calves or even the thighs. Because of the effect of gravity, swelling is particularly noticeable in the lower legs.

When squeezed, the fluid will move out of the affected area and may leave a deep impression for a few moments. Swelling of the legs is many times related to other, more serious causes (for example, heart failure, renal failure, or liver failure).

Common causes of foot, ankle, and leg edema include:

  • Blood pressure-lowering drugs.

  • Body fluid overload.

  • Burns.

  • Certain antidepressants.

  • Congestive heart failure.

  • Diagnostic tests.

  • Environment.

  • Estrogens and progestin oral contraceptives.

  • Extremity surgery.

  • Generalized allergy.

  • Glomerulonephritis or other kinds of kidney disorders.

  • Infiltration of an intravenous site.

  • Injury or trauma to the ankle or foot.

  • Insect bite or sting.

  • Long airplane flights or automobile rides.

  • Long-term corticosteroid therapy.

  • Medical treatments.

  • Medications.

  • Menstrual periods (for some women).

  • Pregnancy (mild to severe swelling).

  • Prolonged standing.

  • Starvation or malnutrition.

  • Sunburn.

  • Testosterone.

  • Venogram.

  • Venous insufficiency (varicose veins).

You can mitigate swelling by elevating your legs above the heart while lying down. Avoid sitting or standing without moving for prolonged periods of time. Avoid putting anything directly under the knees when lying down, and don't wear constricting clothing or garters on the upper legs.

Exercising the legs causes the fluid to work back into the veins and lymphatic channels so that the swelling goes down. The pressure applied by elastic bandages or support stockings can help reduce ankle swelling. A low-salt diet may help reduce fluid retention and decrease the ankle swelling.
Ulcers

Ulcers are skin wounds that are slow to heal and are classified in four stages, according to which layers of skin are broken through.

Those stages and their characteristics are:

  • Stage 1 - characterized by a reddening over bony areas. The redness on the skin does not go away when pressure is relieved.

  • Stage 2 - characterized by blisters, peeling or cracked skin. There is a partial thickness skin loss involving the top two layers of the skin.

  • Stage 3 - characterized by broken skin and sometimes bloody drainage. There is a full thickness skin loss involving subcutaneous tissue (the tissue between the skin and the muscle.)

  • Stage 4 - characterized by breaks in the skin involving skin, muscle, tendon and bone and are often associated with a bone infection called osteomyelitis.

People get foot ulcers for four major reasons:

  • Neuropathic - loss of sensation in the feet.

  • Arterial - due to poor blood flow to the lower extremity. This type of ulcer can be very painful and is usually found on the tips of toes, lower legs, ankle, heel and top of the foot. It can very easily become infected.

  • Venous - This type of ulcer is due to compromised veins. It is commonly seen around the inside of the ankle and are slow to heal.

  • Decubitus - This type of ulcer is caused by excessive prolonged pressure on one area of the foot. The most common place to see this type of ulcer is in a person confined to bed and they occur on the backs of the heels.

Foot ulcers are typically found in diabetics.

As prominent metatarsal heads on the plantar or bottom of the foot are subjected to increased pressure, the skin begins to become callused. The callused skin can be subjected to shear forces that cause a separation between the layers of the skin, which fill with fluid and become contaminated and infected. The result is a foot ulcer.

"Contact casts" are sometimes applied to the diabetic foot to relieve the bony prominent areas of pressure, allowing ulcers are to heal.
Warts

Most foot warts are harmless, even though they may be painful. They are often mistaken for other conditions such as corns or calluses -[which are layers of dead skin that build up to protect an area which is being continuously irritated]. A wart, however, is a viral infection. Over 42 types of viruses are known to cause a wart.

More serious foot lesions such as malignant (cancer) lesions can sometimes be mistaken as a wart. Children, especially teenagers, tend to be more susceptible to warts than adults while some people seem to be immune. The most common times for warts to occur are, puberty, emotional & physical stress, pregnancy and menopause.

Warts can appear anywhere on the skin and those which are located on the sole of the foot are called plantar warts. The virus generally invades the skin through small or invisible cuts and abrasions. When they get large enough they can be quite painful.

Plantar warts appear to be hard and flat, with a rough surface and well-defined boundaries but their true size is hidden because they are pushed into the skin. Warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.

The plantar wart is often contracted by walking barefoot on contaminated surfaces. The virus that causes plantar warts thrives in warm, moist environments, making infection a common occurrence in public bathing facilities, locker rooms and even can be transmitted when trying on a pair of shoes.

If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading.

Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.

Plantar warts that develop on the weight-bearing areas of the foot - the ball of the foot, or the heel, can cause sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

Prevention:

  • Avoid direct contact with warts - from other persons or from other parts of the

  • body. Avoid walking barefoot, except on sandy beaches.

  • Change your shoes and socks daily.

  • Check yours & your children's feet periodically.

  • Keep your feet clean and dry.

  • When trying on new shoes always wear socks.

Treatment:

Over-the-counter foot wart treatments are usually the first course of treatment that a person will try. The acid used can kill some warts but usually by the time the wart is discovered it is larger and the Over-the-counter medication will be ineffective.

My practice can treat warts a variety of ways, including medication and surgical removal.