Skin Problems on the Foot
Mid-September is a pivotal time of year. Summer is all but over. Beaches are closing, the kids are back to school, and fall sports are in full effect. It's also a pivotal time of year for peoples' feet, as they're now being exposed to new school shoes, locker rooms, and well-used sandals. Along with these trends, I see a lot of the typical foot skin maladies during the late summer and early fall.
Corns vs. Warts
I'm often asked to examine a lump of skin at the bottom of the foot under the assumption that it is a plantar wart. While these lumps are, in fact, often warts, they can also be corns. Because the treatment is drastically different, it is important to make the distinction.
Plantar warts get their name because they are located on the plantar surface (bottom) of the foot. The viruses that cause warts in this area aren't particularly different from those that cause warts on other areas of the skin. The warm, often moist, thick skin of the sole is a prime breeding ground for warts. These viruses are commonly found in shoes, shower stalls, and on the feet of others. The added nuisance of plantar warts is that the heaped, warty skin often gets stepped on, pounding it deeper into the tissue of the foot and causing pain. Plantar warts can further cluster and spread across the foot. These clusters, along with the black dots that indicate a blood supply, are a dead giveaway that it is a wart.
Corns, on the other hand, are simply heaped skin caused by excess friction. With this friction, the body's response is to callus or form thicker skin. With corns, the callus gets jammed deeper with pressure on the foot. Like warts, corns can be painful, but they are often singular, overly high-friction areas and lack those telltale black dots.
The mainstay of wart treatment is cryo therapy with liquid nitrogen or acid treatment. Corns are treated by cutting away the excess dead skin and addressing the foot issue (such as shoe wear or flat arches) that is causing the excessive friction.
Dyshidrosis (or dyshidrotic eczema) is a rashy condition most often present on the soles of the feet. The condition is caused by excessive wetting and drying of the skin in cycles, which causes thickening, peeling, redness, and often fluid-filled bubbles on the skin. Dyshydrosis is often itchy but can also be painful and lead to cracking of the skin.
Treating this condition involves addressing the primary cause, which is the constant sweating-drying cycles. Wearing wicking socks that remove moisture from atop the skin is quite helpful. Running stores offer an excellent selection of wicking socks. Shoes that breathe (circulate air) can help, but avoiding skin on plastic or rubber surfaces is paramount. (For instance, I've noticed a jump in dyshidrosis since Crocks came on the scene roughly a decade ago.)
If none of these preventative measures work, a lotion that contains lactic acid can help. There's a prescription form called Lac-hydrin and an over-the-counter form called Am-lactam. Both work about the same, with the active lactic acid ingredient causing a faster turn over of the thickened, hydrated skin. My patients put the lotion on at night and then wash their feet in the morning.
Athlete's foot is a common sight around the locker room. The warm, moist setting is the perfect breeding ground for fungus. Likewise, athletic shoes (dark, warm, and moist) are welcome fungal harbors.
Fungal skin infections often start between the toes with itching, redness, and peeling. The infection often spreads from there to other toes and up the length of the foot. Preventative measures include frequent foot washing, regular sock changing, and flip flops for the locker room shower. Despite these measures, athlete's foot can still affect even the most cautious. Treatments available include over-the-counter and prescription anti-fungal medications. In my opinion, the prescription medications offer better efficacy, shorter course, and less expense.
Fissures are painful cracks on the heel. These often come from thickened, dried heel skin, which occurs as a response to excessive wear and friction. Sandals or open-back shoes are the most common cause, but again, cycles of sweating and drying can cause the skin to crack. Each step can open the crack, preventing healing and causing significant pain.
Prevention can be accomplished by wearing wicking socks and keeping the skin of the heel from heaping. This can be accomplished with a pumice stone, which removes layers of the skin in the shower or bath.
If the fissures are especially bad and need to be treated, I recommend super glue gel. Put a small amount of the glue in the fissure and pinch it shut. It will sting, but the glue will work to bind the fissured skin together as it heals.
Skin conditions on the feet are common. While preventative measures can often divert the problems, most are readily treatable.
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