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Bacterial Infections

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 Bacterial Infections


Signs of bacterial infection of the skin include pain, redness, draining, swelling, and pitting and sloughing of the skin. In severe infections, malaise, loss of appetite, fever, chills, nausea, and vomiting can occur. It is always safest to have a suspected infection evaluated by a medical professional. Any one experiencing symptoms of infection should seek immediate medical attention.

There are several common bacterial infections of the foot. Pitted keratolysis is a minor bacterial infection  where small, dark pits typically form on the heels, though some people may have other symptoms. In some cases, these pitted lesions cause itching and discomfort. A doctor may prescribe an antibiotic medication if there is itching and discomfort. 



An ingrown toenail can puncture the skin and cause a painful bacterial infection, commonly on the big toe. In minor cases, soaking the infected toe in warm soapy water twice daily and covering the site with iodine or a topical antibiotic and a bandage can help heal the infection. Check the nail and remove any sharo edges that may be the cause of the infection. For recurrent in fections, a podiatrist may need to care for the nail. See the chapter on nails for more information.

Feet that sweat excessively are especially vulnerable to an infection that may mimic a bacterial infection but is caused by a type of fungus known as yeast. Candida albicans is a common yeast that thrives in warm, moist environments, which makes the skin between the toes an ideal location for infection. White, sloughing skin with surrounding redness is a sign of Candida albicans infection.

This yeast infection is often mistaken for athlete's foot, but is not treatable with some of the more common over the-counter athlete's foot medications. If a suspected case of athlete's foot does not improve after two to three days of using topical antifugal medications, then a b acterial or candida infection may be present. Seek care from a medical professional.

Reference: Great Feet for Life: Paul Langer, DPM

Itching Skin on the Feet

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Itching Skin on the Feet

Itching skin is very common. It can be caused by a numb er of things, including certain medications, changes in the blood flow, infections, parasites, allergic reactions, and skin conditions (such as eczema and psoriasis). Most commonly, itching skin of the feet is caused by athlete's foot or, simply, dryness.

Itching feet can be treated by moisturizing the skin with lotion. For stubborn cases, you can apply a nonprescription antihistamine oor cortisone cream in addtion to the moisturizer. Be careful, however, not to treat athlete's foot with cortisone cream because this could make the condition worse. Conctact your doctor if itching persists.
Some skin changes are more difficult to diagnose and treat. The conditions listed below should be evaluated by a medical professional so that appropriate treatment can be initiated.


Eczema is a condition where dry, itchy patches of skin form on the lower legs or feet. Outbreaks are sometimes also found on the trunk or arms as well. There are a few different forms of eczema, each with its own unique characteristics. The skin lesions may be caused by allergic reactions, nutritional deficiencies, hereditary factors, or circulation changes.

The dry, itching skin can crack, bleed, or break open if it is scratched. Emoliants, topical cortisone cream,and petroleum jelly are often  used to treat eczema. Occasionally, however, topical or oral antibiotics are needed  if a secondary infection develops.


Treatment is dependent on which type of eczema is present. For this reason, you should see a doctor if you think you have eczema


Psoriasis is a hereditary skin disorder that causes skin  lesions, swelling, and arthritis. It appears as itchy patches of silvery scales on the elbows, scalp, forearms, back, hands, or feet. It can make wearing shoes and socks uncomfortable and even painful. While 75 percent of those with psoriasis are affected at an early age, 25 percent do not see symptoms until age fifty or later.

Psoriasis of the feet is best evaluated and treated by a rhumatologist or a dermatologist working with a podiatrist. Without proper treatment, psoriasis is persistent and can even become infected.
And,although it is not contagious, it can spread to affect larger patches of skin. To the untrained eye, psoriasis can be confused with calluses or athlete's foot and, therefore, may not be treated properly. Contact your doctor if you think you may have psoriasis.



Allergic Reactions

Allergic reactions can cause itching, redness, hives, bumps, and blisters. The most common cause of allergic reactions on the skin of the feet are new shoes, new socks, new laundry detergent, or a bandage. In fact, a good indication of an allergic reaction is that often the irritated area has the shape of whatever caused the reaction, such as straps from a sandal. Leather is not usually an allergen, but shoe leather may contain other materials, such as synthetics, dyes, or adhesives, that do cause allergic reactions.

Many socks contain synthetic elastic fibres that can cause or contribute to rashes. Latex and other synthetic rubbers are highly allergenic for some people. In addition to what people put over their feet, what they put on their feet can also trigger or contribute to allergic reactions. Adhesives found in tapes or bandages are allergens for some. And some people are allergic to creams, lotions, powders, and even topical antibiotics. Of special concern are over-the-counter corn and callus treatments. In people with poor circulation, diabetes, or numbness, these treatments can cause severe skin reactions.


Sometimes allergens get on the skin unintentionally. People who are allergic to plants such as poison ivy and poison oak should wash off any oily residue with soap and water as quickly as possible in order to minimize the severity of the skin reaction.

Some allergic reactions are caused by what people put in to the body. People who take multiple medications may be vulnerable to generalized skin rashes. If a change in or an addition of medications has preceded a rash outbreak, inform the prescribing physician immediately. Such a rash is a sign of a serious side effect and should be evaluated by a medical professsional. Foods and drinks can also cause allergic reactions. As with medications, suspected food and drink allergies should be immediately evaluated by a physician .
Basic treatment of an allergic reaction on the feet consists of washing the skin, applying a powder to absorb moisture and residual allergens, and using a topical cortisone cream to decrease the itching, inflammation, and redness. Of course, you should also remove the suspected triggering agent (s). If the itching and rash do not respond to treatment, consult a physician.
Parasitic Infestations

Parasite infestations can be intensly itchy, especially at night. The parasite burrows under the skin leaving a curved track that can be seen in the itching area. Sometimes ther are small blisters present as well. Norwegian or keratotic scabies can produce white scales under and around the toenails and then spread to the surrounding skin. Suspected parasite infestations should be diagnosed and treated by a physician.

Reference: Great Feet For Life: Paul Langer, DPM 

Athlete's Foot

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 Athletes's Foot


Athlete's Foot is an infection of the skin caused by a fungus. Fungus is always living on our skin. Most of the time, this fungus is held in check by our immune system. Occasionally, however, when con ditions are right, the fungus can overwhelm our natural defenses and flare up, by either rapidly reproducing on the surface of the skin or by infecting tiny scapes or tears in the skin.

Fungus thrives on warm, moist surfaces, such as the inside of shoes and shower floors. Everyone is susceptible to athlete's foot, but outbreaks are most common in people whose feet sweat profusely, especially during warm months. Just as some of us are more susceptible than others to colds or allergies, some of us are more susceptible to fungal infections. Often susceptibility is a family trait.
Free your feet from your shoes whenever possible to let them "breathe". The dark, moist, warm environment created by shoes is a breeding ground for bacteria and fungus. Sandals are great for warm climates and seasons, and for those whose feet sweat heavily or are prone to odor. In colder climates and during colder seasons, changing socks frequently helps keep the feet dry.


The most common symptoms of Athlete's Foot are redness with itching. Flaking skin on the bottom of the foot. Some forms of athlete's foot cause moist, white, peeling skin between the toes or small fluid-filled blisters on the arch. Other symptoms including burning and odor. if untreated, athlete's foot can contribute to fungal infection of the toenails and secondary bacterial skin infections. Even with diligent treatment some people are vulnerable to recurrences.  


Treatments of athlete's foot involves good foot hygiene, topical medications, and frequent shoe and sock changes, Foot hygiene requires bathing the feet daily in soap and water and drying them thoroughly, especially inbetween the toes.
Keeping the skin dry by using foot powders and wearing ventilated shoes is also important. Old, smelly shoes should be thrown away to prevent reinfection. Suffers should wear clean socks every day. Clean socks help keep the feet dry, and most importent, minimize the amount of fungus on the skin. For those whose feet tend to sweat profusely, changing socks two or three times a day is beneficial.
Do not treat a suspected case of athlete's foot with anything other than an antifugal medication unless directed to do so by a doctor. Topical cortisone creams can actually make the infection worse, and topical antibiotics can promote growth of resistant forms of bacteria. 


In addition to good foot hygiene, treatment of athlete's foot requires medication. Seventy to 80 percent of athlete's foot infections respond to topical , over-the-counter treatments. A doctor's care may be needed for stubborn cases of athlete's foot(those that do not respond to treatment within one or two weeks). He or she may run diagnostic lab tests to confirm the diagnosis and to decide if treatment with prescription medication is necessary.


Sloughing, or peeling skin between the toes can be a sign of a particularly stubborn form of athlete's foot that involves a bacterial infection as well as a fungal infection. This form is most commonly seen between the fourth and fifth toes. Treatment is the same as that for opther athlete's foot outbreaks: wash and thoroughly dry the feet and apply an antifugal powder on a daily basis.In some cases, placing swatches of cotton or lamb's wool between the toes is also helpful. Keeping the areas between the toes as dry as possible will promote healing.Sufferers should see a doctor if an outbreak does not respond within two weeks. A priscription medication may be required.

Treat athlete's foot for one to two weeks after the symptoms have disappeared and use an antifugal powder daily thereafter to minimize the risk of recurrence.
Reference: Great Feet for Life: Paul Langer, DPM

Blisters on the Feet

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Blisters on the Feet

Blisters on the feet can be caused by drug reactions, allergic reactions, or friction (rubbing)-most commonly, the friction created by wearing new shoes. In severe cases, blood will fill the blisters and cause them to appear purple or black. Shoes that are too wide usually cause blisters in the arch or the bottom of the forefoot.Shoes that do not have enough toe length or toe depth will cause blisters on the tops or sides of the toes. Shoes that are too stiff or too loose in the heel will cause blisters on the back of the heels.

Always break in new shoes gradually, making sure to remove them at the first sign of pain. The safest way to treat a friction blister is to remove the shoe, cover the blister with a bandage( bandages especially made for blisters are now available at most pharmacies), and monitor the site for signs of infection. If you have a circulation disorder, thin skin, or diabetes, you should be especially cautious with blisters. Do not stick any adhesive bandages directly to the blister itself, as this could tear the skin on removal. Adhesive bandages should only stick to the healthy skin around the blister.


Once a blister has broken open or drained, it should be treated as any open sore and monitored for signs of infection. Treat the site with a topical antibiotic and cover with a bandage. If the blister is painful and does not drain or break open, it should be seen by a doctor. Likewise, see a doctor if a blister shows signs of infection (growing redness around the site, presence of pus). To avoid infection, it is best to have a medical professional drain the fluid from the blister. A doctor can also best diagnose and treat a blister that is infected. 



If a medical professional is not readily available and the blister is in a place that limits walking ability, you may drain it carefully yourself. keep in mind that a blister that is punctured or breaks open is much more likely to become infected than a blister that remains intact. Blisters that are red or purple in color likely contain blood and should not be punctured. Ideally, you should clean the skin around the blister with iodine or similar antiseptic before attempting to drain it.

At the very least scrub the area vigorously with soap and water. You can sterilize a sewing needle or safety pin by either boiling it in water for fifteen minutes or holding it to a flame and then cleansing it with isopropyl alcohol. The blister can then be pierced at its lowest point so that gravity will help it drain. Rolling a finger over the blister towards the hole where you pierced it  will help to squeeze out the fluid.

Occasionally the blister will require two to three punctures to drain. Drain all of the fluid to alleviate the discomfort the blister is causing you, but do not remove the skin of the blister. Protect, cover, and monitor the site of the blister for signs of infection. Eventually, the blistered skin will dry up and slough off as it heals.

Blisters that are the result of a drug reaction, infection, or allergic reaction usually appear as clusters of blisters with red skin surrounding them. These should be covered with a bandage and seen by a medical professional as soon as possible, as they could be a sign of a serious medical condition.
Reference: Great Feet For Life:Paul Langer, DPM

Sweaty or Smelly Feet

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Sweaty or Smelly Feet

Hyperhidrosis is a condition where the sweat glands of the feet and hands are overactive, resulting in excessive sweating. Many thigs, including stress, changes in the weather, illness, and medications, can trigger an episode of excessive sweating. Most often, we don't know what the trigger is.

Excessive moisture on the skin can lead to such problems as foot odor, athlete's foot, blisters, and warts. The bad odor we associate with sweaty feet is usually caused by bacteria or fungi that thrive in the warm, moist confines of shoes. And while moisture does not itself cause blisters or warts, it can weaken the skin  making it more susceptible to blisters and warts.
Unfortunately, there is no cure for hyperhidrosis. Most treatments are aimed at keeping the feet dry. First and foremost, it is important that sufferers wear shoes made from "breathable" materials (materials that allow air to move into and out of the shoe). For casual or dress shoes, leather uppers tend to be more breathable than synthetic leather. Nylon mesh uppers are ideal, especially for sporting activities. 

Socks are important for preventing and treating hyperhidrosis because they can either trap moisture next to the skin or help to evaporate. Contrary to popular belief, cotton is not the ideal fabric for socks, because when cotton gets wet it stays wet. Though soft and absorbent, cotton is not as effective  as newer fabrics at protecting the skin of the feet.


Nylon and other synthetic materials can wick, or pull, moisture away from the skin and help it to evaporate. All shoe stores and sporting good stores carry socks that wick moisture from the skin. But wicking socks have their limitations, so even these socks should be changed two or more times a day if the feet are particularly sweaty,
topical skin treatments can also help control excessive moisture. Powders are very effective at keeping the feet cool and dry. Most powders are made from talc or cornstarch, or combination of the two. For those with sensitive skin, corn starch-based powders may be less irritating.


Foot powders that include antifugal ingredients are especially useful for those with sthlete's foot. It is best to apply the powder directly to the feet instead of sprinkling it into socks or shoes. 



Some roll-on and powder products contain the antiperspirant aluminum chloride and can decrease sweating when applied daily. They also work well in combination with other treatments described in these chapters. Aluminum chloride products are available without prescription at many stores and pharmacies.

Soaking the feet in a solution of one part aluminum acetate diluted in twenty parts of water (called Burrow's solution), followed by an application of an exfoliating lotion, can help in some cases. The addition of foot soaking to a regimen of daily use of powders can work well for stubborn cases of foot odor and sweating feet.
Powdering the skin directly is more effective than putting powder in the shoes and socks. A simple way to powder the feet is to cover the bottom of a small pan  or shoe box with powder and dip the feet in before putting socks and shoes on.


Reference:Great Feet For Life: Paul Langer, DPM 


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