Treating Common Skin Problems On Your Feet

Skin conditions can develop on our feet for a number of different reasons. Not only are our feet a point of contact with the ground, we also stuff our feet into socks and shoes that can be home to moisture, bacteria and fungus. This can expose our feet to microorganisms and allergens that can cause problems for the sensitive skin on your feet.

But what are some of the most common skin conditions that can affect your feet? Here’s a closer look at a few different skin conditions that commonly affect the feet and toes:

Athlete’s Foot – Athlete’s foot is a fungal infection that can lead to raw, red and itchy skin. It’s caused by a group of fungi called dermatophytes, and they thrive in warm and moist environments. It can be spread through shared contact, which is why it can commonly spread in locker rooms or areas where people are regularly barefoot. Over-the-counter anti-fungal products and keeping your feet clean and dry can help resolve the infection.

Atopic Dermatitis – Atopic dermatitis, also known as eczema, is a noncontagious skin condition that causes dry, red and itchy skin. While there isn’t a cure for eczema, moisturizers and healthy lifestyle changes can relieve symptoms of flareups.

Toenail Fungus – The same type of fungus that causes athlete’s foot can get under your nail bed and cause a toenail infection. This can lead to yellowing and cracking of your toenail, and it can even make walking quite uncomfortable. Again, topical treatments or prescription medications can help to clear up the infection.

Plantar Warts – Plantar warts are hard growths that tend to form on the weight-bearing areas of your feet, and they are caused by the human papillomavirus. These hard, grainy and oftentimes painful growths sometimes resolve on their own over time, or a foot specialist can topically treat or surgically remove the wart.

Diabetic Foot Infection – Diabetics are at an increased risk of a foot infection as a result of nerve damage and inhibited circulation that can be a side effect of diabetes. When a wound develops and enough healthy blood can’t circulate to help the tissue heal, infection onset and ulcer development is more common. Managing your diabetes and working closely with a foot specialist can help you manage and treat any foot issues related to your diabetes.

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To get a better understanding of hospitalization risk after the onset of an infection, researchers at Johns Hopkins Bloomberg School of Public Health studied more than 12,000 participants in a community cohort study for an average for 24 years. When they reviewed evidence as it related to hospitalization risk after the onset of an infection, researchers were shocked at their stark findings:

• Patients with diabetes faced a 67 percent increased risk of infection-related hospitalization compared to those without diabetes.

• Risk of hospitalization because of a foot infection was nearly six times higher for diabetics compared to non-diabetics

• Diabetes may also be associated with a 72 percent increased risk of infection-related mortality.

In response to the findings, study authors called for “broader guidance on infection prevention and management” in individuals with diabetes.

Diabetes And Infection Risk

This isn’t the first study to highlight the connection between diabetes and infection risk, but it adds to our current knowledge and provides another possible link between the two. Aside from the potential for inhibited blood flow as a result of blood vessel damage because of diabetes, researchers say that glycemic control may also be a factor.

“One likely factor is glycemic control: emerging research suggests patients with diabetes with better glycemic control may be at significantly lower risk of infection-related complications,” researchers wrote.

As you can see, it’s imperative for diabetic patients and their care providers to do everything in their power to help reduce infection risk. For doctors, this involves meticulously reviewing patient charts, talking to the patients about the importance of blood sugar management, strict tool and operation room disinfection, and explaining to patients how to best care for their wounds after the operation.

Patients also play a big role in helping to prevent infections and complications in the wake of an operation. Strict monitoring and healthy adjustment of blood sugar levels is key, and it’s extremely important to clean the incision site regularly as advised by your physician. You’ll also want to choose a surgeon we has an impeccable track record when it comes to infection and complication prevention, like Dr. Silverman (read real patient reviews here).

So if you are diabetic and a surgical operation is in your future, especially if it is a foot surgery, talk to your specialist about infection prevention and how to spot the signs of an issue at the incision site. These infections can jeopardize the integrity of your surgery, lead to the loss of a limb, and can even be fatal on rare occasions. Trust your operation to an experienced surgeon who will do everything they can to ensure your operation and recovery are a success.

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Nicholas Michael Brown, MD, discussed his team’s results at the 2011 Annual Meeting of the American Academy of Orthopedic Surgeons.  Brown said although joint infection is rare following total joint replacement, when it does occur it can have harrowing physical, mental, and psychological effects.

Before implementing dilute betadine lavage, surgeons used a variety of techniques to address the incision before closure, including aseptic techniques, prophylactic antibiotics, and laminary air flow.  All of these processes helped reduce post-op infection rates, but doctors continued to look for ways to improve.

New Solution

In 2008, Craig J. Della Valle, MD, senior surgeon on Brown’s medical team, began addressing total joint replacement incisions with the dilute betadine lavage for 3 minutes prior to closing the wound.  Brown said the solution was made by adding 17.5 ml of 10% povidone-iodine to 500 cc of basic saline, which resulted in a 0.35% dilution.

“[The betadine] was followed by cleansing with 1L of normal saline pulse lavage … and then finally painting the skin with the 10% povidone-iodine solution from the swab sticks prior to the final closure,” Brown said. “This was in addition to the standard protocol, which all patients in the series received that included prophylactic antibiotics prior to the incision and for 24 hours postoperatively.”

Before switching to dilute betadine lavage, researchers examined 1,862 consecutive cases involving total knee or hip replacements.  They then compared their results to 688 consecutive cases where dilute betadine lavage was used to address a wound before closure.

Research Results

Brown and his team examined the post-op infection rates of each procedure and saw a significant reduction in infection rates for those patients who were treated with dilute betadine lavage.

“What we saw was a 0.97% infection rate prior to the use of betadine and a 0.15% infection rate after the onset of betadine usage,” he said. “This was statistically significant.”

There were 18 acute post-op infections out of the 1,862 cases treated without the solution, but only one such case in the 688 cases were dilute betadine lavage was administered.

“In conclusion, we saw that betadine is safe,” Brown concluded. “It has minimal toxicity to human tissue when it is dilute, it is inexpensive — about a dollar per packet — it is easy to use and, at least in our study, we found it to be effective as we saw a statistically significant decrease in acute postoperative infections. Given the retrospective nature of the study, however, we do interpret these results with caution and have initiated a prospective study to try to confirm these results.”

Dr. Silverman Comments

It has been the standard to thoroughly cleanse wounds before closure post-op. I was always told during my schooling that “the solution to pollution is dilution.” It appears that improved solutions can further our quest to prevent infections.

For the last several years I have been working with saline solutions mixed with antibiotics. Early last decade, articles started being published that supported irrigation with soap mixed with saline as the best option. However, with further study, the soap mix didn’t fare as well as hoped.

Now, betadine (a strong bacteria killing agent) seems to be favored.  Spine surgeons are switching to it, and two recent articles from surgeons who specialize in total joint replacement have identified a phenomenal drop in infections following surgery in which a dilute betadine solution was used.

Although the information is helpful, it can hardly be considered “new.” Betadine as means of diminishing peri-operative infections was used decades ago. The earliest studies demonstrating the potential benefits of dilute betadine irrigation in surgery date to 1977. It was first noted in General Surgery and Urology, and many other specialties have noted this effect over the last 35 years.

Related Sources:  Healio.com

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The study was published in the Journal of Bone and Joint Surgery in late October, and led by Gino M.M.J. Kerkhoffs, MD, PhD of the Orthotrauma Research Center in Amsterdam.

Researchers consistently found that obesity was associated with increased infection rates after total knee replacements. Obese patients were more than twice as likely to develop deep infections as non-obese patients.

Dr. Silverman Comments

Working on patients who are obese is very challenging. With obese patients, wounds are larger and surgery takes longer because it is more challenging to reach the bones and to close the wounds.

With more fat dissected, there is (by definition) more tissue damage. And tissue damage is directly related to infection.

In my practice I have noted anecdotally that patients with fat that appears a deeper yellow have less of these troubles. They have less pain and less wound troubles. These patients are always on some type of Omega 3 supplementation. While there is no similar study or proof that a better Omega 3:Omega 6 ratio leads to less infection, more doctors are prescribing Omega 3 to diminish inflammation. Cardiology physicians know that inflammation that leads to cardiac disease is influenced positively by Omega 3s. It makes sense that inflammation following trauma would be modified similarly.

Related Sources:

medscape.com

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