As the largest organ in (or on) our bodies, our skin endures more physical damage than any other organ. UV light, blunt trauma, chemicals, dryness and dampness; the skin is phenomenal in its’ ability to accommodate change. One of the harshest environments encountered by the skin is the environment we create by wearing enclosed shoes. And the worst culprit is a portion of the shoe called the toe box.

The toe box of the shoe is the semi-circle that covers and protects the toes. Remember those cute little red and white sneakers that your mom got you when you just started to walk? Remember how they had that white rubber toe? That’s the toe box. But consider what a rubber toe box like that can do to your skin. The rubber toe box prevents the release of perspiration. The rubber toe box also contributes to an increase of the temperature inside the shoe.  This contributes to excessive perspiration and creates a terrible environment for the skin. So we grew up and grew out of the rubber sneakers, but guess what? Most shoes have a toe box to stiffen the shoe and promote the durability of the shoes. As a result we see toe box problems in a host of other shoes including work boots (especially safety shoes), clogs, oxfords and others. Simply reach into the shoe and feel for the materials that make up the toe box.

Dermatitis is a generic term used to describe any condition that exhibits inflammation of the skin. The environment in a shoe is pretty harsh, but when you manufacture the shoe with materials that can’t vent moisture, dermatitis is bound to occur. Toe box dermatitis is the term usde to describe the skin reaction that takes place as a result of an enclosed or rubber toe box.  But toe box dermatitis can occur at any age. Toe box dermatitis is simply the result of the contrast found when wearing a shoe (sweaty and hot) compared to being barefoot (cool and dry). As a result we see peeling and redness in the skin or what we call dermatitis.

Treatment of toe box dermatitis

The most important aspect of treating toe box dermatitis is prevention. Avoid shoes with synthetic materials that trap moisture. Wear canvas or leather materials that will breath and accept moisture. Consider rotating shoes, wearing them only once every other day. And don't forget open toe sandals.  Drying agents like Onox can help to inhibit moisture. And lastly, frequent changes of socks will always help to wick away moisture, keeping the feet cool and dry.

Most cases of toe box dermatitis clear with these simple methods of care.  Occasionally we will see an opportunistic fungal infection of the foot that can be controlled with antifungal soap or antifungal cream.

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The symptoms of toe box dermatitis include maceration (wetness), peeling and occasionally itching. Significant itching often signifies a fungal infection.

Athlete's foot

Bacterial infections of the skin

Eczema

Hyperhydrosis

Immersion foot

Trench foot

• Athletes Foot

• Skin

• Trench Foot

• Immersion Foot

• Dermatitis

This article was written by Jeffrey A. Oster, DPM and last updated 4/30/10. No additional information is available for this topic.