Do not touch your feet to the ground, they will soil. Let flowers be strewn where you walk so that you will feel only their softness, which still cannot match the softness of your delicate feet ‘. These words were uttered by a romantic to his beloved in a popular Hindi film & since then have been often used by a number of Romeos to date.
It goes to show how important good looking feet are even in this age & time. Pedicures, nail designs etc etc fall within the realms of beauty culture, but feet do show a number of dermatological problems which are not to be ignored. The skin on our feet, differs from that elsewhere on the body due to the functions of the foot. The skin found on the soles & palms in Humans is called ‘ GLABROUS SKIN’ i.e non – hairy skin. . This skin is grooved on its surface by alternating ridges & sulci, in a unique configuration that is characteristic to individuals. The Epidermis is thicker & more compact in this area because it has to deal with weight bearing , continuous stress , strain due to walking , running, footwear used etc. No one can undermine the importance of Feet.
Man strives day in & day out to wear different sorts of footwear to enhance the legs & our overall looks. Many a times this involves putting comfort on a back burner & fashion to the fore front. But does one stop & think of the far reaching follies of these actions.
Apart from causing backaches, spinal problems &,twisted ankles locally on the foot, we also see unsightly bunions & Corns. Corns , Callosities, bunions are acquired areas of thickened skin in varying degrees caused by repeated or prolonged trauma to the epithelium. This trauma is a result of pressure, friction of footwear & shearing forces of bone thro’ the skin against neighbouring toes. Corns are the most severe of pressure lesions. The corn has a central core which has a vascular & a fibrotic component which grows inwards into the foot , presses on the underlying nerves & causes extreme discomfort & pain while walking. Neglected corns can lead to a distorted gait which further leads to a change in spinal structure & chronic back problems. Its better to nip this problem in the bud rather than let it flower.
Treatment of callosities & corns is best done by qualified Dermatologists or Podiatrists. It involves very careful shaving of the lesion and shelling out of the central core in the corn. Salicylic acid plasters are also used at times to soften and rid the corn. The most important part is to relieve the pressure at that site. This is done by using corrective shoe support or corn pads (Scholl) etc which distribute the pressure to surrounding sites till the lesions heal. At times X Rays & orthopaedic opinion is necessary to rule out anatomical malformations. It has been necessary at times to use fillers like silicone, collagen or intralesional injections of Lignocaine to negate the pain caused by corns. Soft Corns are an entity that can be mistaken for plain maceration. These are commonly seen between toes & are caused by bone forces. If pared carefully they reveal a core which on removal causes untold relief.
Other commonly seen lesions are Plantar warts. This is a viral skin infection. It is seen as one or multiple lesions which on paring reveal a central core of black & red dots ,which bleed. These warts have a tendency to spread & treatment is slow because only physical modalities of treatment are employed by and large. Treatments include chemical cauterisation with trichloro acetic acid, salicylic acid , lactic acid, cryocautery or very very superficial electro cautery. I say ‘very very’ because it is very important not to damage the Plantar skin , as it can never heal entirely because of the constant shearing forces acting on it & hence always remains an anamoly.
The next commonest problem faced by people & maximally exploited by Advertisers are CRACKS & FISSURES on the feet. This can be plain constitutional or environmental at most times. Otherwise they can be indicative of an underlying Dermatological problem like Psoriasis, Eczemas or at times a severe fungal infection of the Foot (moccasin foot ). Diligence & clinical acumen go a long way in determining the cause & instituting the correct treatment. Treatment of cracked feet & eczemas is essentially the same except in use of additional local steroid creams & antihistamines in eczema cases. The basis of teatment is moisturizing the foot so that the skin recovers on its own. This involves ‘ Soaking ‘ of the feet in warm water with & without additives so as to soften the thick skin . This makes the plantar skin more amenable to penetration by medicaments used & also plumps up the topmost skin layer by moisture absorption. This moisture is to be then sealed in by immediate application of creams & heavier preparations like vaseline , petroleum jelly etc ,which in turn form a conducive environment for the skin to heal from within.
Itching, burning sensations are relieved by the use of mentholated creams , steroidal preparations & antihistamines. These prevent the patient from continuosly rubbing & scratching the soles thus impeding the healing process. Fungal infections of the foot are varied. As mentioned above Moccasin foot is one. The most frequent infection seen in children & adults is ‘ATHLETES FOOT’ ,which manifests as maceration, peeling and a thick whitish layer, accompanied by itching & burning sensations. The cause is prolonged use of occlusive footwear. Nylon socks, plastic shoes & long hours of wearing shoes predisposes to this condition. Sweat accumulates between the toes, fungal or yeast elements proliferate & athletes foot emerges.
In addition to medications this condition requires the patient to cleanse the affected areas thoroughly, and more important to ‘Air’ the area same as we do to a baby’s diaper area ! Gravitational forces acting on our lower limbs can give rise to what is termed as ‘gravitational eczema or varicose eczema’. This is because of improper drainage of blood from our legs due to a combination of gravitational attraction & incompetent venous drainage. Pooling of blood occurs ,leading to leaking of blood pigments in the skin which in turn cause discoloration of the skin & itching . As it is the skin in this area is compromised & scratching by the patient causes a damage which can result in eczema, wounds & non healing ulcers in severe cases. Here treatment is carried out in conjuction by a Dermatologist & Surgeon who would deal with the incompetent Veins. Sometimes skin changes can occur due to a particular footwear used. This could be in form of eczemas, termed FootWear Dermatitis or could show as Chemical Leukoderma. This last entity is loss of skin colour due to a complex interaction of the skin & chemicals present in the footwear. Footwear dermatitis is commonly caused by the following chemicals,….. Mercapto mix, Thiuram mix, black rubber mix ,paraphenilinediamines & monobenzone of hydroquinones.
It is necessary for us Dermatologists to have this knowledge because it helps to test the patient for the causative agent & in advising them on its avoidance. Lastly we come to foot affectations in children. In addition to the afore mentioned Athletes foot, we have Juvenile Plantar Dermatosis. This also has a variety of names like …….Atopic Winter Feet, Forefoot Eczema or Shoe dermatitis in children. This can be caused due to an inherent tendency or because of occlusive sweat retention & maceration. There is redness, pain & a glazed cracked appearance of the soles particularly on the ball of the foot & toe pads. It differs from Athletes Foot in the fact that the inter toe areas are spared. The treatment is prolonged & causes more anxiety to the Mother rather than to the child. Pompholyx (dyshidrotic eczema), means a ‘bubble’. This condition is literally seen as itchy bubbles under the skin and is also a type of eczema.
In enumerating all the various skin disorders affecting the soles, I sincerely hope to give you a better insight into the problems whose cure is not just a simple Pedicures. But do not underestimate the effect of a good Pedicure. Done by an expert a it is an indispensible regimen of footcare. What happens in our daily fast paced lives is that we are in such a hurry to go off to work that we invariably give our feet a perfunctory wash , dry up & rush off to work. Who will bend down, scrub our feet, scrape them etc etc.? This is taken care of by regular pedicures with an incentive nail trimming & colouring thrown in. It also gives a relaxed feeling in having our feet massaged, scraped & we come out feeling clean & neat .
Whether or not you go in for a professional footcare, please do not forget that basic footcare begins at home.
1. Keep your feet scrupulously clean. Give them a big scrub with soap & water not forgetting the areas between your toes.
2. Scrape lightly with a good foot scraper to remove dead skin & insiduous dirt.
3. Apply a light footcream if dryness or use Foot Antiperspirant Deo sprays (Scholl) for smelly or sweaty feet. Use one for Athletes Foot , if you have a prediliction for it. Plain dusting Powder also helps. Alpha Hydroxy foot creams or evening primrose oil containing ones (eg Glyderm, Onagrine, Neutrogena) are excellent for an overall conditioning of the Plantar skin , giving it a smoother youngish appearance.
4. Wear proper fitting & comfortable footwear, fashion be dammed !
5. On your return home, rid yourself of the shoes, wash your feet well & ‘air’ them a bit.
6. Try & wear cotton rich socks & air permeable footwear if you need to wear it for long stretches of time.
7. Consult a Dermatologist or Podiatrist for problems rather than leave them to heal thyself !
