foot odorFoot odor, medically known as bromhidrosis is foul smelling perspiration that occurs when normally odorless foot perspiration becomes overgrown with bacterial decomposing surface debris, thus producing a pungent biochemical waste. No one bacterial species is responsible with many of the resident (normally occurring on the skin) bacteria capable of producing volatile acids. Isobutyric acid produces a “dirty sock” odor while isovaleric acid produces the “smelly feet” odor. It has been found that athletes foot actually increases the bacteria count and thus worsen the odor. It is estimated that each foot contains over 250,000 sweat glands making the feet the highest concentration of this type of gland. It is this excessive perspiration that leads to foot odor. Excessive perspiration is known as hyperhidrosis. Excessive perspiration of the soles and usually the palms as well affects about ¼ of one percent of the population. The more common type of hyperhidrosis is idiopathic (unknown origin) which is usually from excessive stimulation of the eccrine or sweat glands. This is a sympathetic nerve response along the lines of “fight or flight”, seen in nervous individuals. The other type of hyperhidrosis is the pathologic form, which may be the result of diabetes, hyperthyroidism, or even a lesion of the central or peripheral nervous system. Hyperhidrosis clinically appears as pink moist skin that is cool to touch. The foot is also clammy. Excessive perspiration between the toes results in maceration. Sometimes the hyperhidrosis can be so severe that drops of sweat actually run off the foot; I have seen this a number of times over the years. Along with this the shoes are usually damp, and moldy. It is this type of environment that leads to foot odor. Management of both foot odor and perspiration go hand in hand. One method to reduce odor is to boil a few tea bags in a pint of water for 15 minutes, then pour the water into a foot bath of two quarts of cool water. Soak your feet in this solution for 10-15 minutes. It is thought the tannic acid in tea is the odor neutralizer. The next thing is to reduce the amount of perspiration. In patients where there is a nervous component, if the condition is bad enough, oral anti-anxiety medication may be indicated. You might be wondering why someone would take that kind of medication for sweaty feet; the answer is simple. This type of foot condition many times will lead to a secondary fungal infection, which may then lead to a bacterial infection of the foot. Depending on the overall health of the patient, bacterial infections of the foot can be very dangerous. Warts also have a tendency to spread more rapidly in excessively moist skin. Simpler measures include commonsense initiatives. Changing the shoes you wear each day so that they have a chance to dry out. A mistake many people make is that they come home, take off their sweaty shoes and throw them into the dark, cool closet. Bacteria and fungus thrive in dark moist environments. The inside of the shoe never has a chance to dry out and the following morning is put back on the foot. A better idea is to leave the shoe by an open window or on a door stoop in order for the inside of the shoe to fully dry out. Cotton socks which are absorbent, fungistatic and bacteriostatic are a better choice than wool or synthetic socks which retain moisture. If it is possible, changing your socks midday is also recommended. Click on the picture below to take a look at socks which are designed to absorb moisture and are lined with silver which is a known bacteria killing agent. Substituting shoes and sandals for boots, if possible, is also a good idea. Absorbent powder like Zeasorb are useful during the day. Baby powder is not as good. Believe it or not but there are topical antiperspirants for the feet. Drysol is 20% solution of aluminum chloride and anhydrous ethyl alcohol. This product is applied nightly for one week, then tapered to twice a week for control. Lazerformalyde is another popular foot antiperspirant, which actually comes in a roll on jar. Overuse of these products will result in over drying of the feet and the bottom of the feet will become very leathery in appearance and prone to cracking open. In recent years Botox (botulinum toxin type A) injections have become popular in diminishing perspiration in the feet and hands. The success rate is extremely high but there are a few potential adverse reactions including pain on injection, bruising, with muscle weakness being the main adverse reaction as a reaction to nerve blocks. Since the treatment involves multiple injections with each injection occurring less than an inch apart, the total amount of injections will ultimately be determined by the size of the foot, thus it is best to have these injections done under anesthesia either intravenous sedation or via local anesthesia around the ankle which will completely numb the bottom of the foot. Each injection is limited to just underneath the skin. If the injections are done too deeply it can cause muscle weakness on the bottom of the foot. There are contraindications for this type of treatment which include people with peripheral neuro-muscular disease, those with a hypersentivity to Botox and women who are pregnant. Once the perspiration is under control the next step is to reduce the bacterial and fungal population of the feet. This is accomplished by using a strong antibacterial soap such as povidone-iodine soap on the feet when bathing. After the feet have been thoroughly dried, application of a topical antifungal cream such as Lotrimin or Lamisil can be very effective in eliminating any fungus growth. Other outside factors tend to promote foot perspiration. Caffeine in coffee, tea and soda stimulates the sympathetic nervous system and thus produces more perspiration. Additionally, many patients are just anxious, nervous individuals causing excessivel perspiration. Along with oral medication as mentioned earlier, stress reduction and relaxation techniques may be helpful.
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