Flaming June – To Pong or not to Pong
Getting back to work
Infection control has always been important in Podiatry particularly to prevent transmission of bloodborne infections such as HIV and Hepatitis as well as fungal and bacterial infections. Medical professions such as ours have historic strict infection control guidelines in place which have now been enhanced to include management of the risk of Covid19.
When I started in practice in 1988 HIV was a relatively recent issue and caused a lot of concern amongst health professionals even though they were already aware of Hepatitis B and taking similar precautions to minimise the risk of transmission. This risk was minimal as the virus needed transmission of bodily fluids but as some procedures require the use of scalpels and sharp instruments blood can be exposed.
My approach has always been to assume that any patient could be a carrier and thus always be alert and take the appropriate precautions. Why am I sharing this –because with the advent of Covid 19 we suddenly had a virus much more easily transmitted and so I am convinced we will all do well to take a stance that anyone we come into contact with could potentially be not just infected but also potentially be a source of infection for you. Equally of course remember that though you feel well you could also be a source of infection and even if you had it weeks ago we still aren’t sure that it can’t flare up again and become infective. I encourage you to adopt a cautious approach to coming out of Lockdown.
My experience of the past two year with Covid has been most marked by the barrier in communication caused by PPE and not being able to share a smile or receive a smile. That said I have been really touched by just how much people have shared how appreciative they are of what my colleagues and I do for them and how they have missed our care
Whilst some of my returning clients have developed inevitable problems that can only be addressed by professional Podiatric care others have expressed real gratitude for my calling them and sharing with them tips for self care during the lockdown. These tips can be found in May’s Footnotes.
We are now looking towards flaming June here in the UK (although actually April and May were sunnier June is known as flaming June because it’s normally the beginning of the summer weather.) We are hopeful of some good weather in the summer months and as the aeroplanes take to the skies again trips to hot countries for holidays will hopefully become possible once again. With that in mind I want to just share here some top tips for one of the most unpleasant of foot problems and it’s not just unpleasant for the person the foot belongs to.
That’s right this month we’re going to take a look at an all too common problem that people face all year round but particularly in the summer – Foot odour. I hope to give you an insight into some of the causes and provide some of the potential solutions. I should point out that quite often there is more than one cause interacting together to give off that anti social stench.
Top causes of Stinky feet.
- The number one cause has to be Sweaty feet.
This is not entirely true as sweat in of itself does not really have a smell. However, it can very quickly be acted on by bacteria that break the sweat down and it’s their waste products that then actually cause the smell. So it stands to reason that the sweatier your feet the more likely they will be to smell. Your feet have over 250,000 sweat glands in them and they can perspire up to half a pint of sweat in a day. Think about that the next time you’re down the pub or pour yourself a nice cold can of drink.
Some of you may be thinking “can’t I just stop them from sweating” but it’s a bit more complex than that. God gave us sweat glands so we can regulate our temperature. They also keep the skin moist and supple otherwise it would crack creating a portal of entry for bacteria actually into our flesh where they can do a lot more damage than just smelling.
So, although in extreme cases people can have a sympathectomy carried out to sever the nerves that control the sweat glands, it is only indicated as an option in the worst of cases.
Hyperhydrosis is the proper medical term for excessive sweating and add in the bacteria that cause the smell and we call it Bromidrosis.
The problem is that the feet are meant to sweat and the bacteria are living on the skin normally.
The way to tackle it is to have a 2-pronged approach. On the one hand (or should I say foot) we need to tackle the excessive sweat and on the other we need to control the number of bacteria living on our skin.
What can you do to minimize sweat?
- a) Wear appropriate shoes.
Breathable Shoes – Most people immediately think of the shoes as being the problem and they certainly are one of the main culprits. Try to wear man made materials as little as possible. Leather uppers to shoes and where possible leather soles too can make a big difference to how sweaty your feet are by the end of the day
- b) Change Shoes at least daily to let them dry out- I once heard it suggested that to drill home the importance of this try pouring half a pint of water into your shoes in the evening and then wear them to work the next day. Hopefully you won’t feel the need to do this but it makes the point that if you wouldn’t wear them until they are properly dry why wear shoes with yesterdays sweat in them.
- c) Wear appropriate socks
Firstly, I should say that socks in closed in shoes are a must otherwise all the sweat goes straight into the shoe material. Socks and other hosiery should where possible be natural fibres such as cotton, wool, bamboo and even silk.
I find that many of my clients benefit from my advice that high cotton content sports socks which tend to be thicker are better than thinner dress socks of the same cotton content simply because there’s more material to soak up any sweat.
Whatever socks you wear consider taking a change with you (along with a sealable bag)
and then change them during your working day. Oh, and don’t be tempted to wear your socks for more than one day.
Your aim should be for the foot to be introduced to as dry an environment as possible at the beginning of the day and then hopefully that environment will not be too occlusive and won’t cause excessive sweating.
- d) Hygiene
One of the simplest yet most effective pieces of advice I give my clients is to not wash their feet in the morning if at all possible. Daily washing is important and ideally with an anti bacterial soap but if done in the evening will allow the skin to dry thoroughly. Conversely if you wash in the morning in a rush to go to work and even if you towel your feet dry you will inevitably be putting damp skin into the sock and shoe and be getting off to a bad start.
Have you ever tried putting a t-shirt on after a shower or swim. Even if you have towelled yourself dry it will stick to your skin because it is still damp. If you must shower in the morning make sure you allow time for the feet to dry well before you enclose them. I suggest drying with the towel but using a piece of kitchen paper folded up to “floss” the spaces between the toes dry. Then wear flip flops for a minimum of 15 minutes whilst you have your breakfast. You will then be putting your socks and shoes on to dry skin and not introducing more dampness from the beginning of the day.
- e) Applying Surgical spirit with cotton wool can help tone the skin up and Potassium permanganate footbaths can also help
- f) Other things you can try are using antiperspirant sprays, powders and wearing medicated insoles.
- g) Iontophoresis is a treatment for severe hyperhydrosis which uses electrical stimulus and can have good results in reducing the amount of sweating.
https://hyperhidrosisuk.org/treatment-options/iontophoresis/
- h) Botox
- i) Sympathectomy is usually only used in extreme cases of hyperhydrosis.
- Bacterial infections
Although most of the time once the sweating and hygiene are sorted the odour will improve and resolve, sometimes there is a need for antibiotics to kill the bacteria acting on the sweaty skin. This could be topical in a cream or in tablet form.
- Fungal infections. Fungus’s can live in the skin (athletes’ foot) or in the nail and once established can be difficult to get rid of. Keep an eye open for itchy patches on the feet often between the toes or on the soles and check your nails for areas of white or yellow discolouration. Fungus loves a dark warm and humid environment and so thrives on the feet with shoes providing a perfect habitat. Catch it early as it can be very difficult to get rid of especially if it gets in the nails – if you suspect something get an appointment with a Podiatrist
- Reduce Callus.
Callus is hard skin and in itself won’t cause a smell but when it gets soggy and white it can harbour more bacteria. In fact some bacteria make little pit marks in the skin. This can usually be resolved with a topical antibiotic cream and addressing the sweating issue.
- Wounds and Gangrene
Other causes of smelly feet can be more serious and indicate a wound with an infection. We commonly see ingrown nails with infection and often it’s a combination of pain and smell which brings the person to us. Don’t let a sore toe nail get to that stage’ get professional help as soon as possible. In the meantime strong salt water footbaths can also help.
If you have Diabetes you should be checking your feet daily especially if you have lost feeling and if you get a wound (smell or no smell) seek professional help from a podiatrist or your hospital foot team as soon as possible. A smelly wound would indicate a definite infection and is a medical emergency for someone with Diabetes so please take it seriously and get help immediately.
- Foods
Some people who eat a lot of garlic seem to develop a garlic odour to their sweat. I have to say I’m unsure whether it affects the bacteria – I don’t hang around to find out as second-hand garlic is not too pleasant.
If you would like further information on this topic or to book for an in clinic consultation, then please do get in touch.
Contact us at contact@circlepodiatry.co.uk for more information.