II. Pathophysiology

  1. Warm, moist environment fosters Bacterial growth
    1. Sweaty athletic shoes
  2. Bacteria overgrows feet
    1. Corynebacteria
    2. Micrococci

III. Management: General Measures

  1. Keep feet clean
    1. Scrub feet thoroughly with antibacterial soap
    2. Rinse and dry carefully (consider blow dryer)
  2. Keep feet dry
    1. Wear absorbent socks (e.g. cotton)
    2. Change socks frequently
    3. Wear breathable shoes or sandals without socks
  3. Reduce shoe odor
    1. Air out shoes for 24 hours after use
    2. Wash shoes in detergent and bleach if odor persists
    3. Activated CharcoalShoe Inserts are not effective

IV. Management: Medications

  1. Over the counter and home remedies
    1. Apply to feet underarm antiperspirant
      1. Consider spray with Aluminum Chloride/chlorohydrate
    2. Black tea soak (tannic acid)
      1. Brew 2 tea bags in 1 pint boiling water 15 minutes
      2. Add tea to 2 quarts cold water
      3. Soak feet for 20-30 minutes each day for 10 days
    3. Benzoyl Peroxide 5-10% gel
      1. Apply to feet to decrease Bacteria
      2. Will bleach colored garments
  2. Prescription items
    1. Aluminum Chloride hexahydrate 20% (Drysol)
      1. Apply Drysol at bedtime
        1. Initial: Apply every night for 3-7 days
        2. Later: Apply 1-3 nights per week
      2. Wrap feet in plastic wrap overnight
      3. Apply lotion to feet in morning
      4. Titrate use to adequate control of perspiration
    2. Erythromycin 2% or Clindamycin 1% Solution
      1. Apply to feet twice daily
  3. In the emergency department
    1. Sodium Bicarbonate used to wash feet
    2. Maalox 30 cc applied to feet, and then feet sealed inside plastic bag
    3. Orman and Swaminathan in Herbert (2017) EM:Rap 17(6): 1

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