FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

GOOD HYGIENE AND DRUGS FOR INFECTION MAY CURE "STINKY FEET"

Question: My son has a terrible case of bad foot odor. His socks smell like a combination of bleach and a dead skunk. The foot doctor hasn't had any ideas that work for him. He washes, sprays, etc., without anything more than brief improvement in the odor. Can you please help him?

Answer: I'm sure that many readers chuckle about your question, assuming that this is an annoyance rather than a real medical problem. Well, some individuals do have a serious problem with foot odor. We're not talking about a slight unpleasant tickle to the nose when you take your shoes off, but rather, a severe odor that interferes with social interactions -- even with the shoes on. As I know from the rest of your letter, this occurs despite adequate bathing, and that is typical of those with this more severe problem.

Most of us spend the majority of our waking hours with our shoes on. This can make a local environment for the feet that is warm and moist. It is this combination of warmth and moisture that is the underlying cause of foot odor.

Sweaty feet, just like sweaty underarms, develop a distinctly human aroma. Because of the abundance of water, we have developed a cultural norm that favors smelling sweet and clean like the bathing products and toiletries that are readily available. The distinctly "human" aroma is considered socially unacceptable. Daily bathing may be sufficient for some individuals to maintain this socially acceptable scent, but most of us need the added help of antiperspirants or deodorants to forestall the onset of that undesirable aroma.

It wasn't clear from your letter whether your son has used an antiperspirant -- not a deodorant -- on his feet. If not, he should do so. It is also important that the inside of his shoes stay dry. This can be accomplished by wearing cotton socks, because they are the most absorbent sock material. A fresh pair should be put on at the start of the day and changed again at midday. In addition, shoe liners should be removed in the evening to facilitate their drying out. Also, any given pair of shoes or work boots shouldn't be worn more often than every other day for the same reason.

Additional simple measures that are often beneficial include a twice-daily foot soak. The water should be warm, but not hot enough to make the feet sweat, and approximately one ounce of distilled white vinegar should be mixed into the footbath water. After a few minutes of soaking, the feet should be patted, not rubbed, dry. An additional beneficial measure is to get those feet out of those hot sweaty shoes. Go barefoot or wear sandals when that's practical.

Most individuals with truly sticky -- in addition to stinky -- feet have an underlying bacterial or fungal infection of the feet. I suspect that your son has this problem, too. This is usually most apparent in the skin between the toes, although at times it may not be obvious to anyone but an experienced physician. It is essential to treat this infection with appropriate medication in addition to doing the other steps I've talked about. Without medical treatment the bacterial or fungal organism that's causing the infection can thrive in moist skin and even stay alive in the shoes. Once the underlying infection is cured, the foot odor usually vanishes also. Unfortunately, individuals who are prone to getting this type of foot infection may get it again. Your nose will tell you if this happens.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.