Conditions of the Foot
by Dr. Mark H. Tompkins


Sweaty Feet (Plantar Hyperhidrosis)

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.


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.


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.


Bromhidrosis/Excessive Foot Odor

Plantar Bromhidrosis (PB), or malodor occurring from the combination of bacteria and Plantar Hyperhidrosis (see above) is a common malady for many people. Severe cases of plantar bromhidrosis can affect many areas of a sufferer’s life: school, work, friendships, and athletic activities.

This condition rarely occurs before puberty or in the geriatric population. There is a strong correlation with palmar hyperhidrosis (excessive sweating of the palms of the hand). The diagnosis of PB can easily be made if the examiner has normal nasal function.

The malodor is caused by decomposition of apocrine sweat by bacteria living on the skin of the foot. There are ‘normal’ bacteria (and fungus, yeasts, and molds) that live on the surface of every human being. Collectively, these organisms make-up what is referred to as ‘normal body flora’. Some individuals have more body flora than others, and the level and extent can be affected by such factors as diet, stress, and activity. Individuals who suffer from plantar hyperhidrosis and an increase in normal body flora are very prone to PB.

Although personal hygiene habits may play a role, many people with PB wash their feet numerous times during the day and continue to have significant malodor problems. Treatment for PB depends on the level and severity of the condition. Mild cases of PB may be treated with OTC (over the counter) anti-perspirants and deodorants and increased hygienic habits. Whereas more moderate to severe conditions require prescription-level anti-perspirants such as Drysol®. Many times these products are used with occlusion (covering the feet with plastic wrap overnight after applying the medication). Occasionally, the use of topical antibiotics is used to help control and decrease the number of surface bacteria of the feet.

It is very difficult to treat PB if the hyperhidrosis component is not controlled. As noted in the hyperhidrosis section {please provide a link}, a new treatment involving the use of Botox® has recently shown favorable results. Surgical sympathectomy has also been used, but more effectively in cases of palmar hyperhidrosis.




Athletes Foot

Bio-Mechanical Pain


Calluses & Corns

Diabetic Foot

Flat Feet

Hallux Limitus/Rigidus

Hammer Toes

Heel Pain/Heel Spur

Ingrown Nails


Morton's Neuroma



Plantar Fasciitis

Plantar Warts

Running Injuries

Sclerosing Injection Treatments


Severs Disease

Shin Splints

Sweaty Feet/Odor

Toenail Fungus





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Dr. Mark Tompkins | 4402 Vance Jackson, Suite #146 | Phone: 210-341-2202

Copyright © 2001-2009 Dr. Mark H. Tompkins.  All rights reserved.