Skin disorders of the feet

What is it about ?

Skin problems are common in the feet. These problems may remain confined to a specific area or appear in other parts of the body as a generalized skin condition. People who have poor blood circulation and diabetes are more susceptible to skin conditions on the feet. This is the reason why these people’s feet are often examined and treated.

Common skin problems on the feet

• The calluses or ‘calluses on the foot’ are often due to excessive pressure exerted on certain points, for example with poorly adapted shoes or in case of poor posture of the foot.
• The ‘bulbs’ or ‘bells’ (traction vesicles) are small, fluid-filled cavities located under the skin. They are the result of friction, heating or cooling of the skin.
• The warts are small benign skin tumors caused by human papillomavirus (HPV).
• The paronychie is an infection of the cuticle, the skin along the nail.
• The piezogenic papules are small painful balls of fat that form in the heels.
• The chapping or ‘frostbite’ is a painful, blue-red swelling caused by cold.
• The punctate keratolysis is a skin infection caused by bacteria under certain specific conditions, such as excessive sweating or a hot or humid environment. It causes characteristic small holes to form on the soles of the feet.
• Xerosis plantar characterized by dry skin, accompanied by cracks on the soles of the feet, often has a hereditary character.
• The drop is a painful inflammation of a joint. It usually affects the big toe, which often becomes red, hot, and swollen.
• a diabetic foot is characterized by sores appearing on the feet of people with diabetes. They are the result of poor blood circulation and decreased sensitivity.
• Poor blood circulation
• THE’arteriosclerosis is characterized by the narrowing and involvement of an artery, which causes a decrease in blood flow to the affected area.
• The varicose veins result from a malfunction of the veins in the legs.
• Infections
• Erysipelas
• Cellulite
• Secondary infection of a foot ulcer

Other common skin problems in the feet

• THE’atopic eczema causes a rash accompanied by itching (pruritus). It mainly affects skin folds, face, neck and eyelids. Over time, the skin can also become thicker and rougher. Atopic eczema is often associated withasthma, to hay fever and food allergies. Atopic eczema often begins in childhood. Usually, the disease affects several family members.
• The irritant contact dermatitis is triggered by an external irritant such as perspiration or friction from shoes or socks. Inflammation is accompanied by redness and itching. People with sensitive skin and allergic predispositions are at greater risk of developing contact dermatitis.
• THE’allergic contact eczema is a red rash, which is itchy and occurs as a reaction to a product to which you are allergic, such as a skin care product, a textile, leather, plastic, …
• The ringworm is a yeast infection, a skin disease caused by a fungus. It can appear in several forms on the foot (tinea pedis). Infection can appear on the foot, between the toes and on the sole of the foot and can also take the form of blisters.
• THE’nummular eczema is a common and chronic variant of eczema. It often begins with a single blister or spot around which several new, similar lesions appear. These cluster together to form well-defined patches, round or oval, often red, scaly, sometimes moist and itchy.
• The neurodermatitis (chronic lichen simplex) is a skin condition that is itchy (itchy) and is fed by rubbing and scratching. The triggering factor is often unknown. The skin becomes thicker and darker. In exceptional cases, a scar is formed. The condition usually affects the top of the foot, ankle or lower leg.
• The stasis dermatitis is a form of eczema that develops on the lower legs and ankles of people with varicose veins.
• The scabies is a skin condition that is itchy, itchy, and scratchy and is easily passed from person to person. Scabies are caused by a parasite, the sarcopte.
• the psoriasis is a chronic skin condition. Red indurated (hard and thick), delineated patches covered with a layer of white skin flakes (scales) may form on the soles of both feet. Often the person also has lesions on the palms of the hands and scalp.
• The palmoplantar pustulosis is characterized by sudden pustules on the soles of the feet and on the palms of the hands. It is often linked to smoking.

How is the diagnosis made?

Your doctor can make the diagnosis after a detailed discussion and physical examination. There are a number of characteristic disorders of the foot, such as yeast infection, which are easy to recognize. For other conditions, it is often more difficult to make the correct diagnosis.

Discussion

Your doctor will ask you questions about the symptoms and progression of the lesions:

• Did the condition start suddenly or have you noticed the lesion for some time?
• Do you suffer from itching ?
• Do you feel pain?
• Does the lesion increase in volume?
• Does it happen that the lesions go away and then come back?
• Do you have the same lesions in other parts of the body?
• Do your family members have similar skin problems?
• do you have a diabetes ?
• Have you noticed that the skin problems worsen when you use certain products, for example when you wear certain shoes or socks?
• Have you a contact allergy to certain perfumes, depilatories, cosmetics or skin care, for example?
• Do you have any other symptoms?

Exams

During the’physical examination, the doctor examines not only the lesions, but also the rest of the skin. He will be attentive, among other things, to the location, delimitation and presence of scales, blisters, sores and ulcers, as well as signs suggesting poor blood circulation.

In patients diabetics, a caregiver does a thorough check of the feet at least once a year. In this context, he pays particular attention to sensory disturbances, circulation problems and deformities of the foot. If it finds the slightest anomaly, a very strict follow-up is absolutely essential.

For the rest, your doctor may also prescribe the laboratory tests following:

• a blood test (allergy tests, antibodies, inflammation, fasting blood sugar (glucose) level for diabetes);
• a microscopic examination of a few cells taken from the lesion;
• a culture fluid or pus to identify bacteria and possible fungi.

It is rarely justified to remove a small piece of tissue (biopsy) for additional examinations. From skin tests can be done to detect an allergy.

What can you do ?

• A good hygiene can prevent many infections. Fungi and yeast love moist environments.
  • After showering, dry your feet and the skin between your toes well.
  • If you must wear safety shoes, it is best to put on cotton or wool socks.
  • Change socks every day.
• Avoid contact with irritants.
• Avoid contact with products to which you are allergic.
• Treat painful cracks correctly by applying the ointments recommended in this indication, for example based on urea. Consult your pharmacist. You can also treat calluses and crevices with a foot rasp or pumice stone.
• Promote a good blood circulation :
  • Avoid standing for long periods of time. If this is not possible (due to the nature of your job, for example), try taking a few steps regularly. The contraction of the muscles stimulates the circulation.
  • If you suffer from accumulation of fluid in the legs (edema), raise them regularly, for example when you are in bed or when watching TV.
• try limit arteriosclerosis.
• Do enoughexercise.
• For specific measures intended for patients with diabetes, we refer you to the patient guide for the treatment of a diabetic foot.

What can your doctor do?

Your doctor will find the most appropriate treatment for your condition.

• When faced with an infection with a bacteria or fungus, a treatment with antibiotics or antimycotics will be prescribed.
• For ringworm between the toes, a local antimycotic cream for 2 to 4 weeks.
• Sometimes local treatment is not sufficient, for example in cases of yeast infection of the soles of the feet. In this case, your doctor will prescribe a tablet treatment at the same time.
• The treatment of eczematous conditions, neurodermatitis, psoriasis and palmoplantar pustulosis requires the application of cortisone creams for a fixed period.
• In conditions associated with thickening of the skin, such as calluses and crevices, treatment with a salicylic acid or urea ointment will be prescribed to reduce thickening.
• In the presence of some traffic problems, wearing stockings with varicose veins (compression stockings) is advised.
• Finally, in patients diabetics, the feet are regularly checked and treated.

To learn more about the specific treatment for each of these skin conditions, please consult the corresponding patient guides.

Want to know more?

• Wart (image) – Global Skin Atlas
• Ingrown toenail and paronychia (image) – DermIS – Dermatology Information System
• Frostbite (image) – DermIS – Dermatology Information System
• Diabetic foot ulcer (image) – Global Skin Atlas
• Atopic eczema (image) – DermIS – Dermatology Information System
• Acute irritant contact dermatitis (image) – DermIS – Dermatology Information System
• Contact eczema (image) – DermIS – Dermatology Information System
• Tinea pedis (between the toes) (image) – Global Skin Atlas
• Tinea pedis (sole of the foot) (image) – Global Skin Atlas
• Nummular eczema (image) – DermIS – Dermatology Information System
• Chronic lichen simplex (image) – Global Skin Atlas
• Stasis dermatitis (image) – DermIS – Dermatology Information System
• Scabies (image) – DermIS – Dermatology Information System
• Palmoplantar psoriasis (image) – Global Skin Atlas
• Plaque psoriasis (image) – Global Skin Atlas

• Allergological assessment (patch tests or prick tests), here, Where to find on this page of Cliniques St Luc UCL

• Eating and gaining years of life is possible! (video) – CSS – Superior Health Council
• Stop smoking. It’s possible – Tabacstop
• Physical activity – Eat Move – Health question

Source

Foreign clinical practice guide ‘Problemen van de voethuid’ (2017), updated on 24.05.2017 and adapted to the Belgian context on 16.03.2019 – ebpracticenet