Athlete’s foot is caused by a fungal infection of the skin. Athlete’s foot is by far the most common fungal infection of the skin. The infection can be either acute or chronic. The recurrent form of the disease is often associated with fungal-infected toenails. The acute form of the infection most often presents with moist, scaling between the toes with occasional small blisters and/or fissures. As the blistering breaks, the infection spreads and can involve large areas of the skin on the foot. Burning and itching accompany the blisters and may cause great discomfort. As the skin breaks down from the fungal infection, a secondary bacterial infection can ensue.
The chronic form of athletes foot is a relatively noninflammatory type of infection. It is characterized by a dull redness to the skin and pronounced scaling. It generally does not itch or result in the formation of blisters. This form of the disease frequently has an associated fungal infection of the toenails. There are good topical and oral medications available for the treatment of this condition. A definitive diagnosis is made by taking a scraping of the skin and culturing it. Treatment should be directed at controlling the fungal infection and treating any secondary bacterial infection with oral antibiotics. Soaking the feet in Epsom salts and warm water is helpful as is wearing sandals to reduce moisture accumulation and heat generated by closed shoes.
Corns & Calluses
Corns and calluses are areas of thick skin that result from excessive pressure or friction over a bone in the foot. When these areas develop on the bottom of the foot they are called calluses. When they occur on the top of the toes they are called corns. They can also occur between the toes, the back of the heels and the top of the foot. The thickening of the skin is a normal body response to pressure or friction. The most common area for the formation of calluses on the bottom of the foot is in the area of the ball of the foot. These areas can become quite painful as the skin thickens. People who have diabetes are at risk of these areas breaking down producing sores or ulcerations that can become infected. People with diabetes should not try home remedies and should see a doctor for the treatment.
Corns are areas of thick skin that most commonly occur on the top of the toes. Generally there is an associated hammertoe deformity, which causes the toes to rub on the top of the shoes. Professional treatment is directed at correcting the hammertoe deformity. Small corns can also occur on the side of the little toe next to the toenail. A small bone spur causes this problem. Professional treatment consists of removing the bone spur. Bone spurs also cause corns between the toes.
There are numerous over the counter treatments for corns and calluses. These remedies are only temporary because the source of the pressure has not been alleviated. Professional treatment consists of using a special shoe insert called a functional orthotic that corrects foot function. In certain instances, surgery may be recommended to correct the alignment of the offending bone. Cutting out the callous will only make the condition worse if the underling boney problem is not corrected.
A plantar wart is a wart that occurs on the toes or the sole of the foot. Plantar warts are caused by the verruca vulgaris virus, a common viral infection of the skin. You can get warts anywhere on your body, but when they are on the bottom of your feet, they’re called plantar warts because the bottom of your foot is known as the plantar section. This condition is more common in children than in adults. A plantar wart occurs from direct contact with the verruca vulgaris. Moist, sweaty feet are at higher risk for picking up the virus, especially in public showers and around swimming pools. The virus is not highly contagious but can thrive long enough in these ideal conditions to attach to a vulnerable foot.
Over-the-counter methods of treating plantar warts are typically ineffective because it’s too difficult for them to penetrate the thick skin on the bottom of the foot. Depending on the severity of your plantar warts, your podiatrist may recommend burning the wart with a topical acid, freezing the wart with liquid nitrogen, removing the wart with a laser, or surgically removing the wart.
Psoriasis is a common, chronic, and recurrent inflammatory disease of the skin. It is characterized by round, reddish, dry scaling patches covered by grayish-white or silvery-white scales. The lesions are commonly found on the nails, scalp, elbows, shins, and feet. On the feet, it can be difficult to distinguish it from athlete’s foot, and the nail appearance may be confused with fungal infections of the toenails. A characteristic feature of the condition is pinpoint bleeding when the scaled areas are brushed off.
A variant of psoriasis is called pustular psoriasis. This form of the disease is characterized by small pustules or blisters filled with clear or cloudy fluid. This can mimic acute athlete’s foot. It characteristically does not itch or burn. It is distinguished from athlete’s foot by negative fungal cultures. Psoriasis can also affect the joints of the feet and lower extremities causing a painful arthritis. X-rays will show characteristic erosions of the bones in the toes. Treatment consists of anti-inflammatory medications, steroids, and other medications specific for the treatment of psoriasis.
Skin Cancer & Other Lesions
Pigmented lesions should always be inspected and observed. Most pigmented areas are nothing but freckles and moles. However, a potentially deadly pigmented lesion that can occur on the foot and lower extremity is Malignant Melanoma. A physician should evaluate any pigmented lesion that suddenly occurs or a pigmented lesion that starts to change its appearance. These changes are usually subtle and may consist of increased size and depth of color, onset of bleeding, seepage of clear fluid, tumor formation, ulceration and formation of satellite pigmented lesions. The color is usually not uniform but is likely to be scattered irregularity, being brown, bluish black or black. An increase in pigmentation may precede enlargement of the lesion by several months. Although any part of the body may be affected, the most frequent site is the foot. Overall, the incidence of malignant melanoma is quite low.
Another cancer-causing lesion that can occur on the feet are called Actinic Keratosis. Although most commonly found in sun-exposed areas of the body such as the face, ears, and back of the hands, these lesions can also occur on the foot. They are characterized as either flat or elevated with a scaly surface. They can either be reddish or skin-colored. On the foot, they are frequently mistaken for planters warts. These lesions are the precursor of epidermoid carcinoma. Treatment for these lesions should be thorough as they are definitely precancerous. Treatment consists of freezing the lesions with liquid nitrogen or sharp excision.
Yet another cancerous lesion that can occur on the foot is called Kaposi’s Sarcoma. These lesions occur most commonly 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 appearance of these lesions are usually associated with AIDS infection. It can occur without the concurrent AIDS infection but this is very rare.
Increased pigmentation occurs for a variety of other reasons. Dark patches of skin occur about the ankles and lower legs in persons who suffer from Venous Stasis. Venous stasis is caused by an accumulation of fluid in the lower extremities due to poor venous return of blood to the heart. As the fluid accumulates, veins break or leak fluid into the tissues. As blood cells break up in the tissue, they deposit the iron that is part of hemoglobin in the blood cell, which stains the skin causing a light to dark brownish appearance. With time, the skin becomes thinned and weeping venous stasis ulcerations can occur. This condition requires professional attention by a physician.
Another cause of generalized increased pigmentation is diabetes. The condition termed Diabetic Dermopathy occurs most frequently on the shins and lower legs. They may have the appearance of small scars. Their appearance may precede the diagnosis of diabetes by several years. The actual cause of diabetic dermopathy is not well understood, but it does not cause any particular problem or pose any particular health threat.
Small, spider-like areas of increased pigmentation on the ankles are caused by the break down of small veins in the area and are called Spider Veins; they also pose no health risks.
Hyperhidrosis, or excessive sweating, can be localized to one area or it may be generalized. In the localized type, the most common sites are the palms and soles of the feet. The cause of this excessive sweating is not well understood. There is an emotional component to it in some, but not all, cases. The excessive moisture contributes to athlete’s foot and plantar wart infections.
There are no good oral medications for the control of hyperhidrosis. Topical antiperspirants are of little value. A prescription topical medication called “Dry sol” works for some people. This medication works best if applied to the feet before going bed, then wrapping the feet in plastic wrap and wearing socks. This should be done three to four nights in a row. Although this is not a cure for the problem, it does provide temporary relief and is useful as part of the treatment plan for athlete’s foot