Skin Disorders

  • Athlete′s Foot
  • Corns and Calluses
  • Psoriasis
  • Skin Cancers of the Feet
  • Sweaty Feet
  • Warts
What is Athlete’s Foot?

Athlete’s foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth. Not all fungus conditions are athlete’s foot. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete’s foot.

Causes

The warmth and dampness of areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi. Because the infection was common among athletes who used these facilities frequently, the term “athlete’s foot” became popular.

Symptoms

The signs of athlete’s foot, singly or combined, include the following:

  • Dry skin
  • Itching and burning, which may increase as the infection spreads
  • Scaling
  • Inflammation
  • Blisters, which often lead to cracking of the skin. When blisters break, small raw areas of tissue are exposed, causing pain and swelling.

Athlete’s foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere. The organisms causing athlete’s foot may persist for long periods. Consequently, the infection may be spread by contaminated bed sheets or clothing to other parts of the body.

When to Visit a Podiatrist

If an apparent fungus condition does not respond to proper foot hygiene and there is no improvement within two weeks, give us a call to schedule an appointment.

Diagnosis and Treatment

Your podiatrist will determine if a fungus is the cause of the problem. If it is, a specific treatment plan, including the prescription of antifungal medication, applied topically or taken by mouth, will usually be suggested. Such a treatment appears to provide better resolution of the problem when the patient observes the course of treatment prescribed by the podiatrist; if it’s shortened, failure of the treatment is common.

Fungicidal and fungistatic chemicals, used for athlete’s foot treatment, frequently fail to contact the fungi in the horny layers of the skin. Topical or oral antifungal drugs are prescribed with growing frequency. If the infection is caused by bacteria, antibiotics that are effective against a broad spectrum of bacteria, such as penicillin, may be prescribed.

It is important to keep the feet dry by dusting foot powder in shoes and hose. The feet should be bathed frequently and all areas around the toes dried thoroughly.

Prevention

It is not easy to prevent athlete’s foot because it is usually contracted in dressing rooms, showers, and swimming pool locker rooms where bare feet come in contact with the fungus. However, you can do much to prevent infection by practicing good foot hygiene:

  • Wash feet daily with soap and water; dry carefully, especially between the toes
  • Avoid walking barefoot; use shower shoes
  • Reduce perspiration by using talcum powder
  • Wear light and airy shoes
  • Change shoes and hose regularly to decrease moisture
  • Wear socks that keep your feet dry, and change them frequently if you perspire heavily
What is a Corn? What is a Callus?

Corns and calluses are areas of thickened skin that develop to protect that area from irritation. They occur when something rubs against the foot repeatedly or causes excess pressure against part of the foot. If the thickening of skin occurs on the bottom of the foot, it’s called a callus. If it occurs on the top of the foot (or toe), it’s called a corn.

Corns and calluses are not contagious but may become painful if they get too thick. In people with diabetes or decreased circulation, they can lead to more serious foot problems.

Causes

Corns often occur where a toe rubs against the interior of a shoe. Excessive pressure at the balls of the feet—common in women who regularly wear high heels—may cause calluses to develop on the balls of the feet.

People with certain deformities of the foot, such as hammer toes, are prone to corns and calluses.

Symptoms

Corns and calluses typically have a rough, dull appearance. They may be raised or rounded, and they can be hard to differentiate from warts. Corns or calluses sometimes cause pain.

Home Care

Mild corns and calluses may not require treatment. If the corn or callus isn’t bothering you, it can probably be left alone. It’s a good idea, though, to investigate possible causes of the corn or callus. If your footwear is contributing to the development of a corn or callus, it’s time to look for other shoes.

When to Visit a Podiatrist

If corns or calluses are causing pain and discomfort or inhibiting your daily life in any way, see a podiatrist.   Also, people with diabetes, poor circulation, or other serious illnesses should have their feet checked.

Diagnosis and Treatment

The podiatrist will conduct a complete examination of your feet. X-rays may be taken; your podiatrist may also want to inspect your shoes and watch you walk. He or she will also take a complete medical history. Corns and calluses are diagnosed based on appearance and history.

If you have mild corns or calluses, your podiatrist may suggest changing your shoes and/or adding padding to your shoes. Larger corns and calluses are most effectively reduced (made smaller) with a surgical blade. A podiatrist can use the blade to carefully shave away the thickened, dead skin—right in the office. The procedure is painless because the skin is already dead. Additional treatments may be needed if the corn or callus recurs.

Cortisone injections into the foot or toe may be given if the corn or callus is causing significant pain. Surgery may be necessary in cases that do not respond to conservative treatment.

Prevention
  • Wear properly fitted shoes. If you have any deformities of the toe or foot, talk to your podiatrist to find out what shoes are best for you.
  • Gel pad inserts may decrease friction points and pressure. Your podiatrist can help you determine where pads might be useful.
What is Psoriasis?

Psoriasis is a skin condition caused by faster-than-normal turnover of skin cells. Normally, new skin cells rise to the surface of the skin once a month; the old surface skin cells die and slough off while the new cells are moving to the surface. In people who have psoriasis, the new cells move to the surface so rapidly that the dead cells build up on the surface in dry, whitish-silver patches.

Some people have mild cases of psoriasis. Others have extensive cases that affect multiple parts of the body.

Causes

Psoriasis is an autoimmune disease and seems to run in families. Psoriasis tends to be more severe in people with weakened immune systems, including those with AIDS and those undergoing treatment for cancer. Stress also seems to make psoriasis worse.

Symptoms

People with psoriasis typically have areas of thick, reddened skin with dry, whitish-silver patches. The dry patches are called psoriatic plaques. The skin may feel itchy.

Psoriasis is most commonly found on the elbows, knees, and bottoms of the feet. It can also affect the fingernails, toenails, and joints of the body.

Home Care

Keep the skin well-moisturized to maintain skin health and ease the discomfort of psoriasis. Oatmeal baths can soothe the skin. Hypoallergenic moisturizer, applied on a regular basis, also helps.

Phototherapy, or light therapy—which involves exposing the skin to UV-B light—may be helpful as well. Some people use UV-B lights at home under a doctor’s direction. Other patients carefully time their exposure to sunlight. Talk to your doctor to see if phototherapy may be helpful for you.

When to Visit a Podiatrist

If you have psoriasis on your feet, see a podiatrist. A podiatrist can also help determine the cause of reddened, itchy feet. (Psoriasis can mimic severe athlete’s foot or contact dermatitis.) If you have red, irritated feet that haven’t responded to home or medical treatment, see a podiatrist.

Diagnosis and Treatment

A podiatrist will carefully examine your feet and take a thorough medical history. He or she may also take a tiny sample (biopsy) of the affected area to confirm a diagnosis of psoriasis.

Treatment depends on the severity of the disease. Mild cases of psoriasis can be treated with topical steroid creams, applied directly to the area. More severe cases of psoriasis may need systemic (whole body) treatment. Drugs that depress the immune system, including methotrexate and cyclosporine, help some people with psoriasis. Certain biologic drugs, including Humera® and Enbrel®, are also useful for psoriasis. If you have severe psoriasis, you may work with a variety of medical specialists to get your psoriasis under control.

Prevention

You can’t prevent the development of psoriasis, but you can avoid things that make your psoriasis worse. Stress management techniques may help some people with psoriasis. Alcohol, dry air, and too much or too little sunlight seems to trigger psoriasis for some people, so controlling your exposure to things that irritate your psoriasis may help. Talk to your doctor to find out what you can do to control your psoriasis at home.

What Are Skin Cancers of the Feet?

Skin cancer can develop anywhere on the body, including in the lower extremities. Skin cancers of the feet have several features in common. Most are painless, and often there is a history of recurrent cracking, bleeding, or ulceration. Frequently, individuals discover their skin cancer after unrelated ailments near the affected site.

Causes

We often view the sun’s harmful rays as the primary cause of skin cancer; the condition is often found on parts of the body that receive the most sun exposure. Skin cancers of the feet, however, are more often related to viruses, exposure to chemicals, chronic inflammation or irritation, or inherited traits. Unfortunately, the skin of the feet is often overlooked during routine medical examinations, and for this reason, it important that the feet are checked regularly for abnormalities that might indicate evolving skin cancer.

Types and Symptoms

Some of the most common cancers of the feet are:

Basal Cell Carcinoma: Basal cell carcinoma frequently is seen on sun-exposed skin surfaces. With feet being significantly less exposed to the sun, it occurs there less often. This form of skin cancer is one of the least aggressive cancers in the body. It will cause local damage but only rarely spreads beyond the skin. Basal cell cancers may appear as pearly white bumps or patches that may ooze or crust and look like an open sore. On the skin of the lower legs and feet, basal cell cancers often resemble non-cancerous skin tumors or benign ulcers.

Squamous Cell Carcinoma: Squamous cell carcinoma is the most common form of cancer on the skin of the feet. Most types of early squamous cell carcinoma are confined to the skin and do not spread. However, when advanced, some can become more aggressive and spread throughout the body. This form of cancer often begins as a small scaly bump or plaque, which may appear inflamed. Sometimes there is a history of recurrent cracking or bleeding. Occasionally it begins as a hard projecting callus-like lesion. Though squamous cell cancer is painless, it may be itchy. Squamous cell cancer may resemble a plantar wart, a fungal infection, eczema, an ulcer, or other common skin conditions of the foot.

Malignant Melanoma: Malignant melanoma is one of the deadliest skin cancers known. Non-surgical treatments are rarely effective, and many remain experimental. This type of skin cancer must be detected very early to ensure patient survival. Melanomas may occur on the skin of the feet and on occasion beneath a toenail. They are found both on the soles and on the top of the feet. As a melanoma grows and extends deeper into the skin, it becomes more serious and may spread through the body through the lymphatics and blood vessels.

Malignant melanoma has many potential appearances, leading to its nickname, “The Great Masquerader.” This skin cancer commonly begins as a small brown-black spot or bump; however, roughly one third of cases lack brown pigment and thus appear pink or red. These tumors may resemble common moles; however, close inspection will usually demonstrate asymmetry, irregular borders, alterations in color, and/or a diameter greater than 6 mm.  Melanomas may resemble benign moles, blood blisters, ingrown nails, plantar warts, ulcers caused by poor circulation, foreign bodies, or bruises.

When to Visit a Podiatrist

Podiatrists are uniquely trained as lower extremity specialists to recognize and treat abnormal conditions on the skin of the lower legs and feet. Skin cancers affecting the feet may have a very different appearance from those arising on the rest of the body. For this reason, a podiatrist’s knowledge and clinical training is of extreme importance for patients for the early detection of both benign and malignant skin tumors.

Learn the ABCDs of melanoma. If you notice a mole, bump, or patch on the skin that meets any of the following criteria, see a podiatrist immediately:

  • Asymmetry – If the lesion is divided in half, the sides don’t match.
  • Borders – Borders look scalloped, uneven, or ragged.
  • Color – There may be more than one color. These colors may have an uneven distribution.
  • Diameter – The lesion is wider than a pencil eraser (greater than 6 mm).

To detect other types of skin cancer, look for spontaneous ulcers and non-healing sores, bumps that crack or bleed, nodules with rolled or “donut-shaped” edges, or scaly areas.

Diagnosis and Treatment

Your podiatrist will investigate the possibility of skin cancer both through a clinical examination and with the use of a skin biopsy. A skin biopsy is a simple procedure in which a small sample of the skin lesion is obtained and sent to a specialized laboratory where a skin pathologist will examine the tissue in greater detail. If a lesion is determined to be cancerous, your podiatrist will recommend the best course of treatment for your condition.

Prevention

Prevention of skin cancer on the feet and ankles is similar to any other body part. Limit sun exposure, and make sure to apply appropriate sunscreen when you are outdoors and your feet and ankles are exposed.

What are Sweaty Feet?

Excessive sweating of the feet is called hyperhidrosis. It’s more common in men than in women, and more common in young adults than older adults.

People whose feet sweat excessively often also have problems with excessive sweating of the palms. According to the International Hyperhidrosis Society, 3 percent of the population suffers from hyperhidrosis.

Causes

Excessive sweating of the feet seems to be an inherited problem. No one knows exactly why it occurs, but people who sweat excessively seem to have a different “set point” than other people. Most people sweat when it’s hot out, or when they become warm. People with hyperhidrosis sweat excessively almost all the time.

Symptoms

The most obvious symptom of hyperhidrosis is feet that sweat excessively. Some people sweat so much that their feet may slip around inside their shoes.

The feet may also have a whitish, wet appearance; sometimes, foot infections are present as well. (Constant wetness breaks down the skin, allowing infection to set in.) Foot odor is common.

Those suffering from hyperhidrosis may also experience emotional stress and worry regarding foot odor. Sweat-related anxiety and isolation can be particularly severe among teens with plantar hyperhidrosis.

Home Care

Good foot hygiene is essential. Wash your feet daily with an antibacterial soap; be sure to wash between the toes. Dry the feet thoroughly, then apply cornstarch, foot powder, or an antifungal powder to your feet. Wear wicking socks made of natural or acrylic fiber blends that draw the moisture away from your feet instead of trapping it. Some synthetic blends are designed to wick moisture away from the skin and work best to keep the feet dry. One hundred percent cotton socks absorb moisture but do not wick it away from the skin and frequently lead to blisters, so they should be avoided.

It’s also a good idea to change socks during the day. Stash an extra pair of socks at school or at work, and change socks mid-way through the day. Wear shoes that are made of breathable materials.

A technique called iontophoresis, which uses water to conduct a mild electrical current through the skin, has been found helpful for people with sweaty feet. People can purchase iontophoresis machines for at-home use.

When to Visit a Podiatrist

If your feet sweat excessively, see a podiatrist. According to the US National Library of Medicine, less than 40 percent of people with excessive sweating seek medical care. A podiatrist can help you control this embarrassing condition. Patients who talk to their podiatrists about plantar excessive sweating may also have concerns regarding extreme sweating elsewhere – such as in their underarms, on their palms, or on their face or scalp.

Diagnosis and Treatment

Most often, excessive sweating of the feet is diagnosed based on your reporting of symptoms and a physical exam of the feet. A podiatrist can also do a starch-iodine test to confirm the diagnosis. First, an iodine solution is applied to the bottom of the feet. After the solution has dried, cornstarch is sprinkled over the area. The treated area turns dark blue if excessive sweat is present.

Treatment options are tailored to your symptoms. Over-the-counter or prescription roll-on antiperspirants may be applied directly to the feet. Botox injections can temporarily control excessive sweating of the feet. (The effect generally lasts for about six to nine months.) Oral prescription medications, often anticholinergics, can be used. Severe cases of sweaty feet may be treated with a surgical procedure called a sympathectomy, which interrupts the nerve signals that tell the body to sweat excessively.

Prevention

Good foot hygiene can prevent foot odor and foot infections, two common side effects of sweaty feet.

What are Warts?

Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus and can appear anywhere on the skin. Those that appear on the sole of the foot are called plantar warts. Children, especially teenagers, tend to be more susceptible to warts than adults. Some people seem to be immune to warts.

Causes

The virus that causes warts generally invades the skin through small or invisible cuts and abrasions. The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.

If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, creating another route for spreading. Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.

Symptoms/Identification

Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses, which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.

Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.

When plantar warts develop on the weight-bearing areas of the foot (the ball of the foot, or the heel, for example), they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

Home Care

Self-treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self-treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use these medications in the presence of an active infection.

When to Visit a Podiatrist

It is wise to contact us when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis. It is possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart.

Diagnosis and Treatment

It is possible that your podiatric physician will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated.

Lasers have become a common and effective treatment. A procedure known as CO2 laser cautery is performed under local anesthesia in either your podiatrist’s office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.

Prevention
  • Avoid walking barefoot
  • Change shoes and socks daily
  • Keep feet clean and dry
  • Check children’s feet periodically
  • Avoid direct contact with warts from other persons or from other parts of the body
  • Do not ignore growths on, or changes in, your skin
  • Visit your podiatric physician as part of your annual health checkup