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Common Foot Problems During Summer and Their Management

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With the arrival of summer months, there arise several problems for your feet too. When environment is very warm and hot and your feet are enclosed with tight fitting shoes, your feet are prone to several skin issues including fungal infection, eczema, pressure blisters, and the most embarrassing problem “smelly feet”. But the good news is that with proper precautions and managements, you can have healthy and odorless feet throughout the summer months. We’ll discuss common foot problems during summer and try to advice some tips for better management.

Fungal Infection

Fungal infection of the leg or commonly called athlete’s foot is the most common foot problem during summer months. Fungus loves warm and sweaty environment, that’s why summer season is perfect for fungus to grow. You may experience severe itching and sometimes pain, red and dryness of the feet. You may also experience burning sensation in feet. One of the measure problems is smelly feet. For symptomatic management you may take oral antihistamines which will relieve the itching. Although topical antifungal might be sufficient for mild cases of foot fungal infection, oral anti-fungal medications may be needed in order to totally eradicate them. Long course treatment of antifungal (6-12 weeks) may be needed if nails are also involved (toe nail fungus).

Friction Blisters

Many people love to travel during summer, you may have already planned for many things to see and do during summer. Friction blisters on foot is another common encountered problem during summer. The more you walk, the more likely you are to blister on foot. Friction blisters are fluid filled blisters and are usually very painful. They are caused by friction of your foot against your shoes. Wearing poorly fitted shoes during walking or exercise can cause such blisters. To avoid such issues wear comfortable and well-fitted shoes.

Minor Cuts and Injuries

As most of the people love to go bare foot on sands and grass during summer, possibility of minor cuts and injuries are increased. Although minor cuts and injuries are not of much concern, individuals with diabetes must strictly avoid walking barefoot.

Corns and Calluses

Corn and calluses are also commonly seen during summer months. They are often caused by prolonged friction and pressure against the shoes. Moreover, in summer there is a chance of infection if you already have corn and calluses. Visit your doctor for better management. Usually wearing loose fitting shoes with special soft pads on pressure areas will also solve the problem.

Plantar Warts

Planter warts are also common during summer months. They are caused by human papilloma virus. They are sometime very painful and can spread if untreated. There is not much success with over the counter warts medications. Visiting the doctor for proper management is a good option. Your doctor will freeze, burn or cut-off the wart with topical and oral antibiotics so it won’t get infected.

How to avoid common foot problems during summer?

Wash your feet frequently
Foot sweating can be major problem in summer and chances of fungal breeding are more in hot and moist environment. Kick away the fungus by regularly washing your feet.

Let your feet breathe
Wear loose fitting air shoes or sandals that will help keep your feet dry and avoid sweating. Put away boots and other warm shoes for winter. Sometimes wearing sandals for long period might cause friction blisters, so take break in between if you walk with the sandals for long period.

Change your socks and shoes regularly
If you sweat more, it is very important to change socks several times a day and shoes every 2-3 days. Wash your shoes often and dry it so the chance of moisture and fungus accumulation in your shoe is reduced.

Keep your Feet Dry
If you have tendency to sweat more, you may apply foot powder that can soak up excessive moisture and keep your feet dry. There are several brands of powder in the market; you better buy the powder with antifungal and antibacterial properties.

Avoid barefoot walking
Avoid walking barefoot in the public places in the summer; they can be a source of fungal infection. Always wear sandals or other foot wear when you walk around sand, baths, locker rooms and other public places.

Don’t ignore the sunscreen
Just like the rest of your body foot also need to be protected from sun. Use sunscreen of spf 30+ if your feet are to be exposed to sun for longer period.

Burning Feet Syndrome

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Burning feet syndrome (BFS) is a disorder commonly seen in elderly individuals. Although no specific caused is identified, it can occur as solely just a symptom or the manifestation of internal disease. Individual with burning feet syndrome may experience burning or stinging sensation and numbness and sometimes heaviness in the feet that may sometime accompanied by swelling and redness of the skin.

Although burning sensation is often limited to the soles of the feet, it may sometime involve the ankles and lower legs. Palms and arms are usually not affected. Symptoms usually worsen at night with slight relief during day time. Individual may also experience tingling or pricking sensation with pins and needle in the lower legs. In some cases, the eyes may also be affected.

What causes burning feet syndrome

Although in most of the cases the actual cause is unknown, burning feet syndrom may sometimes be due to nerve damage, chronic alcohol abuse, fungal infection, thyroid problems, kidney failure, liver damage, blood disorders, and ill-fitting shoes.

Burning Feet Syndrome Treatment

First measures in management are to find out the underlying cause and avoid or treat it. Check for diabetes, hypothyroidism etc. and manage them accordingly. Besides that, there are several home measures you may follow for symptomatic management of burning feet syndrome.

  • Wear loose fitting and comfortable shoes
  • Soak your feet in cold water for 10-15 minutes (don’t use ice)
  • Avoid excess exposure to heat.
  • Massage your feet every day that will help promote circulation.
  • Go for regular walks every day. This can improve peripheral circulation of the feet
  • Take adequate rest.

For symptomatic relief in a patient with burning feet syndrom following medications may be used or prescribed by your doctor.

  • Ibuprofen
  • Gabapentin (Neurotin)
  • Pregabalin (Lyrica)
  • Amitriptyline
  • Carbamazepine
  • Duloxetine

Burning Sensation in Feet: Its Causes and Remedies

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Burning sensation in feet can be simply because you are tired and may go away after a good rest. However, burning feet can also be due to nerve damage (peripheral neuropathy), perhaps as a result of underlying chronic diseases like diabetes, HIV, hypothyroidism, vitamin B12 deficiency or exposure to certain toxins or chronic alcohol intake. There are several other causes of burning feet ranging from harmless temporary conditions to chronic diseases. In this article we’ll try to review few of the causes of burning sensation in feet and its management.

What Causes Burning Feet

The sensation of burning can be mild or severe with associated painful needle prick sensation. Some may also experience tingling sensation or sensation loss on affected area. When burning feet is so intense and painful that can interfere on your day to day activities and sleep, it can be as hell. Several conditions can cause such sensation on legs, some of which are listed below:

  • Diabetes neuropathy
  • Athlete’s foot (fungal infection)
  • Vitamin B12 deficiency, Vitamin B5 and sometimes B6
  • Chronic alcohol abuse
  • Chronic smoking
  • Heavy metal poisoining like mercury, lead and arsenic
  • Hypertention
  • Vasculitis (inflammation of blood vessels)
  • Chronic kidney disease
  • Thyroid disorders (especially hypothyroidism)
  • HIV/AIDS
  • Lyme disease
  • Sarcoidosis
  • Several drugs like amiodarone, metformin, isoniazid and other chemotherapy drugs
  • Guillain-Barre syndrome
  • Amyloid polyneuropathy
  • Edema or fluid retention
  • Peripheral artery disease
  • Tarsal tunnel syndrome
  • Charcot-Marie-Tooth disease
  • Complex regional pain syndrome
burning foot
Burning Sensation in Feet
Proper Diagnosis of Burning Feet

Correct diagnosis of burning feet is very important in order to manage it effectively. In most of the cases when the cause is known (like diabetes) your doctor will diagnose it immediately. But when the burning sensation in feet is sudden, severe and worsening and the exact cause can’t be identified, additional lab tests may be needed in order to proper diagnose. These tests may include blood test, urine test, spinal fluid tests, nerve conduction studies, nerve biopsy and electromyography.

Treatment of Burning Feet

Treatment options are targeted towards avoiding the causative factors. If it was due to nerve damage it should be managed accordingly and prevent further damage. If you have diabetes, keeping your blood sugar level under control by any means (exercise, diet and drugs) is very important. For other specific causes it may be managed accordingly as below:

When it is due to vitamin B12 deficiency, taking an oral or intravenous vitamin B12 will resolve the issue.
If you consume alcohol, stopping alcohol intake will prevents further nerve damage and allows nerves to heal.
If it was due to low thyroid level, taking oral thyroid hormone will balance the thyroid level and resolve neuropathy and burning feet.
If it was due to chronic kidney disease, dialysis might be needed to resolve the associated pain and burning feet.

For symptomatic treatment of burning feet several treatments may be prescribed by your health care provider. Some of which are listed below

  • Pregabalin (Lyrica)
  • Gabapentin (Neurotin)
  • Amitriptyline
  • Carbamazepine
  • Duloxetine
Home Remedies for Burning Feet
  • Take rest; when you rest or sleeps raise your feet.
  • Wear confortable fitting shoes
  • Wash or soak your feet with cold water, don’t use ice.
  • Exercise regularly, especially regular walks can help improve peripheral circulation of the feet that can help improve the symptoms.
  • Change your shoes and socks after exercise and allow it to dry.
  • Massage your feet 1-2 times a day; this will also help in circulation.
  • You may take pain relievers for temporary relief.
Contact Your Health Care Provider if:
  • You continue to experience burning sensation of the feet, despite all home self-care measures.
  • If you develop an open would in the foot.
  • Feel that the sensation has spread upward toward legs and thighs.
  • You feel sensation loss in any affected areas.

Frostbite

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Frostbite occurs when skin and subcutaneous tissue freezes after exposure to extreme and prolonged freezing condition. Frostbite usually affects ears, nose, cheeks, fingers and toes.

This is an emergency condition and requires immediate medical attention and prompt treatment. It may usually be associated with hypothermia, a life-threatening condition. So knowing the symptoms of hypothermia is very important. This is most commonly seen in winter sports enthusiasts, climbers, homeless people and also common in people who are frequently exposed to cold weather for long time.

Frostbite symptoms:

Several degrees of frostbite are recognized and symptoms may vary accordingly. The degree of injury is directly related to the temperature and duration of freezing.

Frostnip: It is first degree frostbite and involves skin only and doesn’t cause any irreversible damage. It can be managed effectively with complete recovery by rewarming the skin. It is characterized by severe cold sensation progressing to numbness and followed by painful Erythema. It is commonly present on toes, fingers, cheeks, ear and nose.

Superficial frostbite: It’s second degree frostbite and involves the skin and subcutaneous tissues. It is associated with initial pain which gradually subsides to a feeling of warmth sensation. The affected skin is usually painless, pale and waxy. This is a sign of severe involvement. It may be associated with swelling and erythema within 24 to 36 hours after rewarming, lesions may become eroded.

Deep frostbite: It’s a third degree and fourth degree frostbite where the injury extends to deep subcutaneous tissue and may involve muscles, nerves, large blood vessels and sometimes even bone. The affected area becomes white or bluish, painless and totally numb which may result in immobility of joints and limbs and even paralysis.

One or two days after rewarming, large blisters may form. After 5-10 days of blister formation, the fluid inside the blisters is reabsorbed and this leads to formation of hard, black gangrene. A week later, a line of demarcation occurs, and the tissues distal to the line undergo auto-amputation.

Frostbite Treatment and Prevention

Prevention is the key to protecting individuals from the effects of cold weather. Here are the things you need to do.

Remove the person from the cold and take him to a warmer place. Remove wet clothes and any constricting jewelry and cover the person with warm blanket or warm hands so adequate circulation can be maintained. Seek an immediate medical help. Look for the sign of hypothermia and manage accordingly.

If immediate medical help is not available, start with rewarming first aids.

Start with a warm drink. As slow re-warming causes extensive tissue damage so rapid re-warming in a water bath between 400C to 420C degree is the treatment of choice. Re-warming should be done only after the patient has been removed from the area where there is no risk of refreezing. Never expose the patients to more than 42 degree of water bath or any higher temperature to gain rapid re-warming.

Complete bed rest is advised and the damaged part should be elevated, and blisters should be left intact. Don’t rub, massage or shake the affected area, this can be harmful.

The affected area may exposed to air at room temperature which will help relief pain and prevent further tissue damage. If pain is severe analgesics may be given.

Protection from further refreezing is a must. If you cannot guarantee the protection from refreezing, it is better to delay the re-warming process until you are sure there won’t be any exposure to cold.

First degree frostbite can be effectively managed at home following the first aids. If the skin color and feeling sensation doesn’t return to the normal state after immediate re-warming, than it may be the sign of severe frostbite. For more severe degree frostbite you should always seek medical attention. Even with the first degree frostbite you should consult the doctor. It may still be hard to identify the extent of injury and tissue damage at home. Your doctor will identify the degree of tissue damage and treat accordingly.

Other Similar condition due to cold injury are Chilblains and Trench Foot

Trench Foot

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Trench foot occurs when feet are exposed to cold and wet condition for a long period of time without immersion or actual freezing. The term “trench foot” was derived from trench warfare in world war-I, when soldiers stood for hours in trenches with few inches of cold water in them. Currently, trench foot and immersion foot are most widely encountered by homeless peoples.

Individual may develop numbness of the feet and distal legs accompanied by skin changes caused by cold injury. Trenchfoot is aggravated by dampness, constrictive foot-wears and immobility. Smoking and peripheral vascular disease contributes to the severity of tissue damage.

Trench Foot Symptoms:

Affected legs are usually cold and anaesthetic. Initially Erythema, swelling and tenderness occurs followed by numbness or tingling sensation, marked swelling and tenderness and sometimes blister formation. If left untreated it may progress to superficial gangrene. Initial ability to sweat may be lost but later there may be excessive sweating (hyperhidrosis), cold sensitivity . These changes may persist for months or even years.

Trench Foot Treatment

The most important approach for the treatment is prevention. Once the trench feet has occurred, individual should be removed from the causative environment and the affected limb should be covered with warm cloth or warm hands to maintain the temperature so adequate temperature can be maintained. Complete bed rest and restoration of the circulation are very necessary. Re-warming in water bath between 370 to 430C  is advised, but should be applied only after the patient has been removed from the causative environment. Pain management is also necessary for those suffering from pain. If some tissue is necrosed, excision of necrotic tissue is necessary and if infection occur antibiotics are required.

Similar condition due to cold injury are Frostbite and Chilblains

Chilblains – How To Prevent Yourself In Winter

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Chilblains are localised itchy, tender erythema and swelling caused by exposure to cold. The condition is also known as pernio or perniosis. If its severe, blistering and ulceration may also occur. In People with poor pheripheral circulation, moderate cold exposure may cause chilblains.

Chilblains Symptoms: Chilblain usually occurs on hand, feet, ear and face, especially in children but also occurs in adults. Initially you may be unaware of cold injury, but later burning, itching and redness grasps your attention. Affected areas are usually bluish-red,color partially or completely disappering on pressure and cool to touch.

Treatment and Prevention of Chilblains:

  • Treatment is usually not required as they usually resolve by themselves.
  • The area should be protected against further exposure to cold.
  • Heating pads may be used to warm the area.
  • For itchy cases local soothing creams like calamine lotions can be bought from a pharmacy.
  • If condition is severe some steroids cream can be applied locally.
  • If the condition is not under control, you should visit the doctor.
  • Your doctor may prescribe some vasodilator like nicotinamide 500mg 8 hourly or nifedipine 20mg 8 hourly,depending on your condition.
  • Smoking is strictly discourage.
  • Woolen socks and gloves should be worn throughout the winter if feet and hand are affected.
  • As central cooling triggers peripheral vaso-constriction, thus resulting in vascular injury with further tissue injury leading to chilblains. So warm clothes should be worn even if you doesn’t sense any cold.

More Discussion about Chilblains see here: Red, swollen, itchy and painful finger

If you have any problems concerning chilblains you can ask the Experts here: DermaTalk Skin Care Advice

Other similar condition due to cold injury are Trench Foot and Frostbite

How To Treat Foot Corn Yourself

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Corn are acquired area of thickened skin that appear over sites of repeated or prolonged trauma of the skin.The lesion arises due to prolonged repeated friction pressure over a time and are associated with poorly fitting footwear or any other anatomic deformities. Poorly fitting shoes are thought to be the most common cause. They usually cause a constant dull discomfort or a severe knife like pain on downward pressure.

They can be easily removed with debridement of the lesion with a curette.You may also remove yourself  at home. For this you need to understand few point before you start treatment, which will be discussed here.

  • Get a 40% salicylic plaster and cut it in a way slightly larger then the corn lesion.
  • Apply the felt pad to fit around the lesion and leave it overnight or as long as 5-7 days if you have thick lesion.
  • After considerable amount of days remove the dressing and soak the foot in water.
  • Get a rough towel or pumice stone and remove the whitened, softer and macerated skin.
  • You can re-apply the plaster as often needed to keep the lesion flat.

If you have any underlying disease like diabetes, caution should be taken for any infection,ulceration or sepsis.Removal of corn only treats the problem but doesn’t treat the cause. So poorly fitting shoes or any anatomical deformation should also be corrected.

If you have any questions regarding corn ask us at DermaTalk SkinCare Forum

Activated protein C can stimulate wound healing in patients with skin ulcers

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Current research suggest that Activated protein C can stimulate wound healing in patients with skin ulcers that are refractory to conventional wound-healing therapies,according to the article published in november issue of Archives of Dermatology.

The treatment of skin ulcers frequently presents a management challenge. Nonhealing wounds with poor response to conventional wound management therapy represent a significant cause of disability, affecting approximately 1% of the global population. Activated protein C is a serine protease with anticoagulant, angiogenic, and anti-inflammatory properties that has shown efficacy in patients for the treatment of severe sepsis. We report 4 cases of nonhealing lower limb skin ulcers that were treated with activated protein C.

The study included 4 patients whose wounds were not improving despite standard wound treatment for 4 months or more. Activated protein C was applied topically to their wounds once weekly for 4 weeks. All 4 patients showed a rapid positive response to treatment that was maintained during a 4-month follow-up period. The treatment was well tolerated, with no remarkable adverse effects or complications.

The likely mechanism of action is its recognized ability to stimulate angiogenesis and reepithelialization and to inhibit inflammation. Activated protein C has potential as a therapeutic option for patients with chronic skin ulcers.

Adapted from materials provided by Archives of Dermatology

How To Prevent Your Dry Skin Problem

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Dry skin is a common condition of all ages and gender but is espically present among the elderly.Dry skin is due to dehydration of strantum corneum of skin which is more commonly found in lower legs but might affect any area of the skin.When it is severe that might be associated with inflammation and pruritus it is called as aesteatotic eczema or winter itch.

Environment factors play major role in dryness of skin.Repeat exposure to solvent,soaps and disinfectants removes the lipids from the skin and decrease the natural moisturizing factor (NMF),as a result cutaneous barrier of skin is damaged which fasciliates increase in water loss upto 75 times normal.Other factors to dryness includes decrease relative humidity,exposure to dry air or seasonal cold.

Dryness of skin is not due to lack of grease or oils but it is due to lack of water.So prevention of dryness must be aimed at maintaining water in the skin and environment factors that causes.For prevention use of humudifiers,avoiding excessive exposure to soaps,solvent or other drying compound and frequest use of emmollients are encourage.Bathing frequently without moisture might contribute to dryness, so use of bath oils with warm water ( not hot water ) bath is encouraged.

Primary therapy of dryness is to add water and frequent use of emollients.For severe cases topical corticosteroids are most effective and rapid therapy.

Foot Care Tips For Winter Season

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As we store our sandles and other airy summber shoes for winter, so many of us probably not thinking about how we can adjust to boots in winter. Many might not care about their feet but its of great important to know about it as feet tends to sweat more when they are enclosed in warm socks and boots,thus they smell more and there are more fungal infections and feet also dries out more in winter.So here are few tips you should know about your foot care.

  • Mousturise the foot atleast once or twice daily.
  • Don’t use hot water to clean, as hot water dries your foot. Always use warm water, pat it dry and apply moisturise.
  • Don’t moisturise the area between toes or nails too heavily as it may lead to further infection, as fungus loves moist and dump enviroment.
  • Add some moisturising lotion or baby lotion to warm water and wash your feet.
  • Make sure all dead skin is removed from foot. You can also pumice your feet weekly.
  • If your foot cracks, apply vaseline or cocoa butter and wear socks before bed.
  • If the cracks does bleed, apply antibiotics and cover with bandage to prevent infection.
  • Always wear loose shoes or well fitting shoes as tight shoes might further contribute cracks.