Dr. Mark H. Tompkins ● 4402 Vance Jackson, Suite #146 ● San Antonio, Texas 78230
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Sweaty Feet (Plantar Hyperhidrosis)
by Dr. Mark H. Tompkins
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Plantar hyperhidrosis is a condition characterized by excessive sweating of the soles of the feet. Hyperhidrosis also occurs on the palms of the hands (palmar hyperhidrosis), and under the arm pits (axillary hyperhidrosis). It is a relatively common condition occurring in almost 1% of the population, with varying levels of severity.
There is no specific known cause or etiology for any type of hyperhidrosis; although it is know that it is mediated through the sympathetic nervous system. It is unknown whether it is an over-activity of the sympathetic nervous system or the sweat glands themselves. Heredity factors seem to play an important role as we see this condition more commonly within individual families.
Symptoms
Obviously, the most common symptom associated with plantar hyperhidrosis is excessive sweating of the soles of the feet. The condition may be brought on by emotion, stress, or physical exercise. However, it may also occur spontaneously with no antecedent stimulus.
The condition may present itself as just a mild degree of increased perspiration which is little more than a nuisance. However, severe degrees of excessive perspiration of the feet, can lead to severe foot order (bromhydrosis), and an increase in skin problems associated with both the bottom and top of the feet. Conditions such as athlete’s foot (tinea pedis), fungal toenails (onychomycosis), bacterial infections (staph or strep impetigo), and many different types of dermatoses can be caused or exacerbated by severe cases of hyperhidrosis.
Treatment
Initial treatment for plantar hyperhidrosis is supportive therapy including nonocclusive shoe gear (leather shoes with vents, cotton socks, and avoiding synthetics), absorbent foot powders, and the changing of socks and shoes frequently. This should be performed with any degree of plantar hyperhidrosis.
More moderate to severe conditions are treated with varying types of aluminum chloride hexahydrate medications such as Drysol®. If these treatments are not successful, then tap water iontophoresis is used. This involves the use of an ultrasound device submerged in tap water. The feet are immersed in the water and a 20 minute treatment is used for a variable course of treatment depending on severity and response.
More severe cases of plantar hyperhidrosis are treated with botulinum toxin type A injections. This treatment is currently not approved by the FDA for plantar hyperhidrosis, but is for palmar (hand). The treatment consists of injecting the hyperhidrotic sites on the plantar aspect of the foot with 50 units BTX-A + 5ml of sterile saline. The most common method performed is without a local anesthetic and the use of a Dermojet® device. However, a posterior tibial nerve block can also be utilized to achieve complete plantar anesthesia and the use of a small bore (27 gauge) needle technique. Response varies with individual patients, but the overall success rate has been promising.
Sympathectomy procedures for the treatment of plantar hyperhidrosis is NOT recommended, and is not approved by the FDA.
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