Our feet carry out quite a feat

By Richard Thomas, MD, FRCPC

Take steps to avoid infection

Walking, running, jumping, skipping - these are but a handful of activities our feet do, yet most of the time we take them for granted. That is, until we get an infection. While our feet are sturdy -- containing 26 bones, 33 joints, 107 ligaments and 19 muscles -- they are susceptible to disease.

The skin between the toes is soft, supple and often moist; while the skin on the heel is firm and the undersurface of the forefoot is tough enough to take consistent pounding but flexible enough to bend. It's important then to take steps to ensure the skin of your feet remains healthy. Here's some quick facts to get you motivated:

  • Conditions such as arthritis, diabetes, nerve and circulatory disorders can show their initial symptoms in the feet - so foot ailments can be your first sign of more serious medical problems.
  • 1/4 of all the bones in the human body are down in your feet, and when they are out of alignment, so is the rest of your body.
  • Women have about four times as many foot problems as men. High heels are partly to blame.
  • Walking is the best exercise for your feet. It also contributes to your general health by improving circulation, helping with weight control, and promoting well being.
  • The average person takes 8,000 to 10,000 steps a day, which adds up to about 115,000 miles over a lifetime. That's enough to go around the circumference of the earth four times.

Common foot problems:

Fungal infection, otherwise known as athlete's foot (Tinea pedis), feeds off the dead surface of human skin, hair and nails. It is most common after puberty, and more common in men, and fungus feet can spread to the groin, resulting in jock itch (Tinea Cruris). See www.FungalGuide.ca for more information.

Moist conditions and a lack of oil glands allow the fungus to grow, but is uncommon in people who don't wear shoes. Usually generated in locker rooms, gyms, and public facilities, there are three kinds - Microsporum, Trichophyton, Epidermophyton, the most common being Trichophyton Rubrum

Does it spread?

Infection is easily spread from the skin to the toenails (e.g. big toenail scratches itchy undersurface of foot and becomes infected). Cracking of skin especially between toes may allow bacteria into the skin and spread up the foot and leg. With jock itch the fungus may spread from the towel drying feet to groin. People who are diabetic, on chemotherapy, are HIV positive or on immunosuppressive drugs need to take special care of their feet.

Four patterns of infected feet

  • between toes (red, mushy changes in web spaces)
  • dry, scaly skin on whole underside of foot, and cracks on the heels are common
  • tiny blister-like eczema on instep
  • skin and toe nail involvement

Treatment of foot fungus

  • Antifungal creams
  • Descaling moisturizers containing lactic acid
  • Oral antifungal medication may be needed for those with chronic illness or if the nails are involved

There is a new treatment for early nail fungus infection called PenlacĀ®. It is an antifungal drug within a lacquer, which is painted onto the nail. It works on mild nail infections, and avoids any risks of taking oral antifungal medication.

Other foot problems to watch for:

  • Eczema: either dyshidrotic eczema (recurrent or chronic relapsing form of vesicular palmoplantar dermatitis) which is a variant of atopic eczema (chronic, itchy skin condition that is very common in children but may occur at any age). Causes very itchy tiny blisters especially in the instep. (Check out Eczema Guide.ca)

  • Allergic contact dermatitis: provoked from tanning products in shoe leather, and from glues, dyes, rubber and preservatives such as formaldehyde used in shoe production. Also caused by dyes and formaldehyde in socks.

  • Juvenile Planter Dermatosis: also known as sneaker dermatitis or sweaty dermatitis, and is common in children who are atopic, e.g. have hay fever, asthma, eczema. Also shows up as plantar infection in the forefoot, usually before puberty, as dry, glazed, cracked skin.

  • Hyperhidrosis: causes excessive sweating.

Is there a cure?

Fungus can be cleared but because these organisms have evolved to live on our skin where it is moist and susceptible, and are found in most damp places such as the floor of locker rooms where humans walk, re-infection is common. Using antifungal cream on the skin, and powders in the socks and shoes, is advisable to reduce recurrence of the problem.

When in doubt, see your doctor or dermatologist to ensure you get prompt and effective treatment.

For more information about fungal infections and treatments, go to Fungal Guide.ca


About the author:
Richard Thomas, MD, FRCPC is Assistant Clinical Professor of Dermatology, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.


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