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 The skin
on top and the bottom of the foot experiences some of the most extreme conditions
found anywhere on our bodies. We pound the skin with our activities. We rub it
with tight shoes. We trap it in hot, wet shoes. It’s amazing how the skin on our
feet can respond so quickly to keep up with our demands and lifestyle.
Occasionally we do see problems with the skin of the foot. And by far,
the most common problem we see is dry skin. A discussion of dry skin of the foot can
be broken down into several categories based upon the location of the dry skin.
Is the dry skin on the top of the foot? The bottom? The location of the dry skin makes a
difference in determining the reason why the skin is so dry. This chart
summarizes some of the reasons for dry skin based upon the location on the foot.
Top of the foot
- Dehydration
- Seasonal (dry winter air)
- Dyshydrosis (lack of perspiration)
- Hyperhydrosis (excessive perspiration)
- Excessive bathing or soaking the feet
Bottom of the foot
- Chronic fungus infections
- Dyshydrosis
- Hyperhydrosis
Dry skin on the top of the foot is usually due to a change in the environment
of the normal skin. Normal skin requires us to drink plenty of water each day,
particularly in the winter. So if we become dehydrated, the superficial layers
of skin will begin to flake away (exfoliate) prematurely. We can contribute to
this process by drying the foot with excessive soaking. For instance, Epsom
Salts may be helpful in many foot conditions but
repeated soaking will tend to strip away the normal oils found in the skin and
dry the skin. That's why frequent soaking is discouraged in patients with
diabetes or poor circulation.
Diabetics can see unique skin changes due to their disease. Dyshydrosis
or loss of sweating is a common condition found in end stage diabetes as a
result of loss of function of the parasympathetic nervous system. The
parasympathetic nervous system controls many of the functions that we take for
granted such as bowel motility, salivation and perspiration. Perspiration is a
function controlled by the parasympathetic nervous system. Once a diabetic
losses the ability to perspire, it’s all the more important to treat dry skin
to prevent cracking. Cracking or
fissures may allow bacteria to break through
the skin resulting in an infection. It's important for all diabetics to
learn and practice good
diabetic foot care.
The majority of cases of dry skin on the bottom of the foot are due to low
grade chronic fungal infections. Many patients describe trying every skin lotion
with no success when treating dry feet. That’s due to the fact that the bottom
of the foot is a common place for fungal infections. Acute fungal infections
show bubble and blisters. This isn’t true of a chronic fungal infection. A
chronic fungal infection, often called tinea rubrum, looks just like dry skin
and often shows an erythematous (slightly red) base due to the inflammation
caused by the fungus in the skin. Most importantly, when you see dry skin on the
bottom of the foot, think fungus.
For more information on fungus infection of the skin, visit our pages on
athlete’s foot.
Also, be sure to view our pages on
dermatitis
of the foot.
Treatment of dry skin
Not all dry skin responds to the same method of treatment. The treatment of dry skin
hinges upon identification of the cause of the dry skin. Adequate hydration
(fluid intake by mouth) is important. Control of perspiration (or lack of) and
allowing ventilation in the shoe is critical. Topical hydrating creams vary in
their components.
Water based creams act to restore moisture to the skin.
Lanolin based
products are also a natural way to restore moisture to tough skin like
cuticles. Petroleum based products trap moisture and can be used to
hydrate skin, but they also inhibit normal exfoliation.
Treating dry skin due to chronic tinea (fungus) can be frustrating. There’s
really no silver bullet that can be used as a one shot cure. It’s important to
realize that fungus is a plant. If the plant is given an environment in which it
can thrive, it’ll do just that. So it’s important to change the environment
to become less conducive to the growth of fungus. You can do so by the
following:
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