- Best ResultsVariable
- Treatment RecoveryNA
- Procedure TimeNA
- Skin SpecialistMedical dermatologist
- Duration of Results1-4 days
- AnaestheticNA
- Back to WorkImmediately
- Cost$
Sweaty Feet Treatments
Sweaty feet or plantar hyperhidrosis is a common condition affecting 2-3% of the population. Apart from the uncomfortable nature of this condition, excess sweat in this area can cause several medical problems including malodour (smell) as well as infections, eczema and blisters. Basic foot care forms the basis of management. Treatment for excessive sweating in this area is difficult, but possible. Treatments such as aluminium chloride & iontophoresis as first line treatments.
FactsFacts on Plantar Hyperhidrosis / Sweaty Feet
- This is a common condition which affects patients both at work & socially
- Sweaty feet often occur early in life and may persist for decades
- Basic foot care forms the foundation of treatments
- Secondary skin conditions such as infections, eczema & blisters can occur
- A simple absorbable shoe insert can help take up excess sweat
- Creams, tablets, and iontophoresis are first line treatment
- Anti-sweat injections are last line treatment for sweaty feet
- ETS surgery is not indicated for excessive sweating of the feet
What causes sweaty feet?
Hyperhidrosis or excessive sweating is a medical condition that affects 2-3% of the population. Excess sweat can occur in all places including the armpit, hands, feet, and face areas. In fact, some people have excessive sweating in more than one area.
Most cases of excessive sweating are idiopathic and primary- the cause is unknown, but maybe genetically linked. Excessive feet sweating is seen in 2% of the population and can be related to skin problems including secondary blisters, & infections.
Can anxiety worsen sweating?
Yes. Anxiety can worsen sweating in normal & abnormal sweaters. This is a physiological response that is seen in everyone, however patients who suffer hyperhidrosis are off the chart. Ideally anxiety associated with sweating should be treated by a psychologist. CBT is a commonly prescribed (non-drug) method to reduce anxiety related sweating.
How to manage sweaty feet?
Basic foot care forms the foundation of plantar hyperhidrosis (sweaty feet). This includes wearing cotton socks, using an absorbable insert to mop up excess sweat, & treating any secondary skin condition including bacteria, yeast & fungi associated with hyperhidrosis.
The next step is a trial of an antiperspirant with aluminium salts. 20% of patients may respond to this simple treatment, but it is worth a try! Failing that, you can try glycopyrrolate wipes. These can be sourced online from Canadian pharmacies. Typical concentrations range from 1 to 3%.
Iontophoresis involves using a current to carry ions, minerals and drugs into the sweat channels. This procedure can be successful in 50-60% of cases of plantar sweating. Dermatologists can either use tap water (given the high mineral content and hardness of Brisbane water), mineralised water, or compounded solutions of glycopyrrolate. Botox can also be used, however this is of academic importance only, & not practical as costs are prohibitive (it can also be injected, read below).
Tablets such as anticholinergics can help many cases of sweaty feet. The limiting factor of tablets are side effects such as drowsiness.
Anti-sweat injections with botulinum toxin type A, are great for axillary (armpit) sweating, as well as facial and scalp hyperhidrosis. These injections can also be used on areas such as the hands and feet. Most dermatologists recommend injections as last line treatment of sweating of the feet. The costs, coupled with the shorter duration of remission, limits its use in this setting.
What other skin conditions can be associated with sweaty feet?
Sweaty feet can be significant for patients, both at work and socially. Excess sweat on the feet can also result in skin disorders.
Smelly feet, or malodour is secondary to bacteria. This condition is due to a species of bacteria called Corynebacterium and may cause a condition known as pitted keratolysis. The bacteria is part of your normal skin population, but excess sweat provides a haven for growth. This in turn creates the smell of sweaty feet. Treating the infection is simple but treating the underlying cause of excess sweat can be challenging.
Excess sweating can also be associated with fungal infections, including tinea.
Other conditions associated with abnormal sweating of the feet include a condition called pompholyx eczema. This condition can present as tiny itchy bubbles which can form blisters on the feet and on the hands. This is thought to be related to dysfunction in the sweat glands. Friction blisters can also occur due to excessive sweating, and this is common in runners.
Your GP can diagnose & manage these conditions, failing that a medical dermatologist can help. For more hints on how to look after your feet, goto sweathelp.org
Disclaimer: I am a procedural dermatologist; I do not practice medical dermatology.
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What does iontophoresis do?
This procedure delivers an anti-sweating drug known as glycopyrrolate directly into the sweat glands. This in turn reduces the input for sweat production. Iontophoresis uses a very low electric current to draw ions and drugs directly into the eccrine or sweat units and concentrates the treatment where it is needed most.
This treatment has a success rate of over 80% for sweaty feet.
Do anti-sweat injections work on sweaty feet?
Sweat stopping injections (Botox) s is best used for excessive sweating of the axillary or armpit area. It can also be an excellent treatment for facial sweating and an option for sweating of the hands.
It can work for sweaty feet, but it is a last line treatment. Why? It is because the treatment tends to wear off by the third to fourth month, unlike sweat stopping treatments of the armpits, where it tends to last a lot longer. Secondly, more Botox units are needed in the palms and soles, which adds cost to this procedure. Thirdly, sweat stopping treatments to the hands & feet are not subsidised under the PBS, this compounds the cost for patients. Medicare covers Botox for excessive underarm sweating.
Injections on hands and feet can be painful, however that is a minor issue because our Specialists have special anaesthetic creams, blocks & nitrous gas to alleviate the discomfort of sweat stopping injections. In summary, we do perform sweat stopping treatments for sweaty feet, but we advise patients to try all other treatments first!
Do surgical procedures work for sweaty feet?
Surgery such as ETS can be successful for sweaty armpits and sweaty hands, however this procedure is not available for sweaty feet. Localised surgery can be used for sweaty armpits but removing sweat glands from the feet is not possible.
In summary, surgery is not an option for sweaty feet.
What are simple measures to try if you have sweaty feet?
Basic foot care cannot be overemphasized. Wearing cotton socks is both cool and can reduce irritation. Avoid nylon! Change your socks frequently – possibly 2-3 times a day. If you soak through one pair, wear two pairs, then change throughout the day.
If your feet have evidence of fungal infection, visit your GP for a skin scraping or treat with Lamisil. If your feet smell, consider secondary infection as a cause. Treat pitted keratolysis secondary to bacterial infection. Your GP can prescribe-
- Erythromycin 400mg 2 tabs twice a day, for 14 days
- Clindatech solution or Ery 2% gel: dab on twice a day
- Condy’s crystals: Pale pink solution, soak for 15 minutes twice a day
- Miconazole cream: Over the counter medication, twice a day
We advise all patients to try aluminium chloride antiperspirants before seeing a dermatologist. This can be effective in up to 20% of patients with excessive feet sweating.
A good tip to help absorb excess sweat is to buy an insert to place in your shoes. This helps mop up sweat and makes life a little more comfortable. Remember to also wear cotton socks, and if needed change your socks throughout the day.
For more on shoe inserts go to www.summersoles.com
Disclaimer: Though I have written the treatment algorithm for management of sweat disorders, I do not practice medical dermatology. Please consult your dermatologist for treatment options.
Davin’s Viewpoint on Plantar HH
Plantar hyperhidrosis or excessive sweating of the feet is one of the harder areas to treat. Compared to axillary or armpit sweating, anti-sweat injections are not subsidized under Medicare. Large units are required (200 u), and costing is a significant issue. Surgery such as ETS is not an option for plantar sweating but maybe useful for sweaty hands. Patients are left with antiperspirants, tablets, creams or iontophoresis.
Basic foot care forms the absolute most important cornerstone of excessive foot sweating, this cannot be overemphasized. Aluminium chloride is worth a try; however the success rate is less than 20%. Treating any secondary infection such as bacteria or fungus is very important. Using a very simple technique of Condy’s soaks can help!
Iontophoresis is the next step. In our experience up to 80% of patients respond to this treatment. I usually start with tap water, move up to baking soda (given the high mineral content of Brisbane water), then up to Glycopyrrolate solution. Tablets such as propantheline bromide can be helpful, but side effects are seen in the majority of patients. I sometimes use old fashioned formaldehyde soaks, or compound glycopyrrolate.
Disclaimer: I do not practice medical dermatology. For this type of sweating, procedures are not indicated. Please consult your medical dermatologist for management options.
