Plantar hyperhidrosis is a chronic dermatosis characterized by increased sweating in the soles associated with impaired functioning of the eccrine sweat glands. The amount of sweat released does not correlate with physical exertion or overheating. Maceration of wet skin, the addition of fungal and bacterial infections lead to the appearance of an unpleasant odor, despite regular hygienic foot care. The diagnosis is made on the basis of examination data, diagnostic tests. Local treatment involves the use of antiperspirants, orthoses, the appointment of Botox injections. If local effects are ineffective, the patient is shown an operation – sympathectomy.
According to various data, increased sweating of the feet is observed in 1-10% of the adult population of the Earth. Among military personnel, this figure is 30-40% due to high physical exertion and wearing uniform shoes. Essential hyperhidrosis accounts for 1% of all cases of local increased sweating of the soles. More often, excessive sweating is a symptom or consequence of another pathological process occurring in the body.
The basis of the development of the pathology of sweating is a persistent violation of the sweat glands under the influence of external and internal factors. Identification of the causes of plantar hyperhidrosis is carried out in order to select the most effective method of treatment, prevention of relapses. The following factors can lead to the development of the disease:
- Genetic abnormalities. The development of local idiopathic hyperhidrosis is usually associated with an excessive number of sweat glands per unit area of the skin of the soles or an inadequate response of these glands to nerve stimulation. According to statistics, in 40% of patients with excessive sweating of the feet, one or both parents suffer from the same disease.
- Dermatological diseases. Excessive sweating of the extremities is one of the significant symptoms of a number of palmar–plantar keratodermia – a heterogeneous group of hereditary diseases characterized by the presence of diffuse or focal hyperkeratosis of the skin of the hands and feet. Hyperhidrosis of the soles in combination with gray-brown pigmentation of the skin is observed in the Zinsser-Engman-Cole syndrome.
- Neurological disorders. The local nature of the sweating disorder, as a rule, indicates a pathology of the peripheral nervous system. The changes in this case may be asymmetric. There is no psychogenic and thermoregulatory sweating in the affected area, but spontaneous and pharmacologically induced perspiration persists.
- Psychoemotional tension. Somatoform dysfunction against the background of chronic stress and fatigue develops in 25-30% of the adult population. Violation of the activity of the nerve centers responsible for thermoregulation leads to a local increase in sweating. At the same time, plantar hyperhidrosis often appears simultaneously with axillary or palmar, and the manifestations of the disease increase in response to emotional outbursts.
- Static deformations of the feet. Various forms of flat feet cause excessive sweating of the soles in 10-15% of cases. In athletes and military personnel, an increased load on the musculoskeletal system leads to flattening of the arches of the foot. To solve the problem in one way or another, the use of orthoses or tailoring of individual orthopedic shoes allows.
- Increases the risk of developing pathology local violation of heat dissipation. It is mainly associated with wearing uniform or incorrectly selected shoes that do not provide normal air, moisture and heat exchange. It is equally likely to be closed shoes made of low-quality leatherette or rubber beach slippers that are worn in hot weather for several hours a day.
In the genesis of idiopathic plantar hyperhidrosis, the insufficiency of the mechanisms of regulation of sweating from the peripheral sympathetic nervous system comes to the fore. Post-conservative sensitivity to endogenous catecholamines develops as a compensatory reaction. In the affected area, the glands begin to produce more sweat. The cause of excessive sweating can also be an excessive number of sweat glands, the number of which exceeds the normal value by 2-3 times by 1 cm2. At the same time, the sensitivity of the sweat glands to adrenaline and norepinephrine may be normal.
Chronic emotional stress by the feedback mechanism increases the existing autonomic disorders, which negatively affects the course of the disease. This is how the vicious circle “excessive sweating – stress – increased severity of symptoms” is formed. If this component of the pathological process is not taken into account in the treatment, then local and general therapy may not give a noticeable effect.
Along with axillary, palmar and craniofacial hyperhidrosis, foot sweating is one of the local sweating disorders. They are characterized by the involvement of one anatomical region in the pathological process. By origin, there are two forms of plantar hyperhidrosis, which differ in their causes and clinical picture:
- Primary (essential, idiopathic). Develops independently, out of connection with other pathological processes in the body. It is characterized by increased sweating of the skin of the feet during the day and its normalization during night sleep. An adequate reaction to changes in body temperature and the environment, emotions of anger, fear persists.
- Secondary. It is one of the symptoms of human pathology on the part of the nervous, endocrine systems and internal organs. Excessive perspiration is observed both day and night. Sweating of the feet is normalized during remission of the underlying disease.
Primary plantar hyperhidrosis, depending on the time of occurrence and the features of the course of the disease, is divided into two forms: permanent and remitting. With a permanent form, the initial signs of sweating disorders are noted in a child in the first decade of life. In the future, the course of the disease is chronic. The debut of the remitting form of the disease occurs in the second decade of the patient’s life. The presence of remissions is characteristic. Sweating disorders usually involve both soles, but cases of unilateral lesions have been described in the scientific literature.
The intensity of perspiration in patients varies significantly. A mild form of the disease is difficult to distinguish from normal physiological sweating. With an average degree of severity, the soles are constantly wet, which creates certain difficulties for the patient when moving and increases the likelihood of developing concomitant dermatological diseases of the feet by more than 2 times. Due to the abundance of moisture, the feet slip, which can make it problematic to go to the store, a long walk. The choice of suitable types of shoes is significantly limited.
With a severe form of plantar hyperhidrosis, it becomes difficult to move around the house, perform everyday tasks. The list of available professions is being reduced. The patient’s social adaptation is disrupted: difficulties arise in communicating with people, there is a persistent mood disorder. A number of studies have noted a decrease in sexual activity in patients with excessive sweating of the legs, which is explained by growing self-doubt.
The surface of the skin on the feet with hyperhidrosis is constantly wet and cold. A characteristic sign of a severe form of the disease is the appearance of sweat drops, which, under their own weight, flow down the soles. Constantly moist skin is subject to maceration, the appearance of painful cracks. Chronic irritation of the skin by the decomposition products of sweat causes diaper rash.
The rapid reproduction of bacterial and fungal flora leads to the addition of itching, burning in the area of the feet. Secondary fermentation of sweat, an admixture of ammonia compounds and fatty acids can cause bromidrosis – a sharp unpleasant smell. Following this, due to the constant emotional tension and fixation of the patient on the problem, bromidrophobia is formed – the fear of the appearance of a noticeable foot odor for others.
In patients with hyperhidrosis, fungal lesions of the skin of the feet and nails are observed 3 times more often than on average in the population. At the same time, mycoses are less amenable to treatment, often relapse, during exacerbations significantly aggravate the patient’s condition. Increased humidity and incorrectly selected shoes contribute to the development of fungal flora.
Patients with severe sweating pathology note pronounced limitations associated with the performance of daily chores and social interaction. Against this background, they develop various psychosomatic disorders: 74% of patients have anxiety reactions, 63% have sleep disorders, 38% of cases are diagnosed with depression of varying severity, 43% of cases – violation of autonomic reflexes.
Examination of a patient with excessive sweating of the feet includes a complex of laboratory and instrumental methods. The dermatologist is faced with the task of identifying the underlying disease and, if possible, the cause of the pathology. Quantitative diagnostic tests can confirm the presence of plantar hyperhidrosis and determine the severity of the disease:
- A Minor sample. Normally, starch applied to the skin on top of an iodine solution does not stain. With increased sweating, the skin becomes an intense purple color. A clear boundary of the zone of increased sweating allows differential diagnosis of local hyperhidrosis with other diseases in which excessive sweating of the lower extremities is noted.
- Gravimetric test. The method is used to determine the amount of sweat released by the skin per unit of time. To do this, filter paper is used, which is weighed before and after applying the sheet to the skin of the foot. Quantitative test results allow us to determine the severity of hyperhidrosis.
To exclude the deformation of the feet, an orthopedist’s consultation, computer photoplantography can be prescribed. If a disease of the nervous system is suspected, a neurologist is examined. Disorders of the psycho-emotional sphere require the attention of a psychotherapist. The diagnosis of essential hyperhidrosis can be made after the exclusion of diseases that can provoke increased sweating of the legs.
In clinical dermatology, medical tactics are determined by the form of dermatosis, the severity of the underlying disease, and the nature of the existing concomitant pathology. Therapy begins with conservative local and general treatment, and only in the absence of a noticeable effect, indications for surgery are determined.
In each case, the treatment is selected individually. With moderate and mild severity of the disease, it is enough to prescribe drugs for the period of exacerbation of symptoms. In severe cases, combinations of various techniques, including psycho- and physiotherapy with supportive local treatment, have proven their effectiveness. Patients with increased sweating of the feet are prescribed:
- The use of antiperspirants. For the feet, both conventional hygienic and medical antiperspirants based on aluminum hexachlorohydrate can be used. A prerequisite for their use is to apply the product to clean, dry skin so that the particles of the active substance can penetrate into the mouths of the sweat glands and block them.
- Local treatment. Powders and solutions for feet containing salicylic acid, zinc and bismuth salts, formaldehyde complement the action of antiperspirants. These drugs are intended for course use during an exacerbation of the disease to normalize sweating, eliminate skin maceration and unpleasant odor.
- Correction of psychosomatic disorders. In the complex treatment of local hyperhidrosis, it is advisable to use the method of systemic behavioral therapy, the appointment of antidepressants and daytime tranquilizers. A number of researchers have noted a good therapeutic effect of transcranial electrical stimulation.
- Radio frequency exposure. Under the influence of electromagnetic radiation, local heating of tissues occurs. As a result, the walls of the eccrine and apocrine sweat glands become denser, lose the ability to accumulate and secrete large amounts of sweat.
- Injections of botulinum toxin A. Introduction to Fabrics Botox, Dysport and other drugs of this group block the transmission of nerve impulses to the sweat glands for up to 6 months. The absence of a stimulating effect from the autonomic nervous system leads to a local decrease or complete cessation of sweating.
- Correction of static deformations of the feet. Correctly selected orthoses allow you to correct the longitudinal and transverse flat feet, deviation of the first toe. The use of self-forming orthoses with antifungal effect helps to reduce the time to achieve remission, reducing the likelihood of relapse within a year by 2.5 times.
A significant disadvantage of conservative treatment is that it must be carried out for life, and the result of the use of local and systemic agents does not always satisfy the patient. Endoscopic lumbar sympathectomy allows to solve the problem. During minimally invasive surgery, which is performed through small punctures of the skin in the lumbar region, sympathetic nerve trunks intersect.
Lumbar sympathectomy rarely leads to the appearance of compensatory sweating in other areas of the body. This allows you to cut the nerve trunks instead of clipping them, as is customary with thoracic sympathectomy. In fact, the operation allows you to eliminate the problem of plantar hyperhidrosis forever.
Prognosis and prevention
Plantar hyperhidrosis is a chronic disease that does not threaten the patient’s life, but significantly reduces its quality. In most cases, complex conservative treatment can minimize the manifestations of the disease and normalize the patient’s condition. Surgery is an extreme measure in severe cases, when excessive sweating of the feet limits a person’s daily activity.
Prevention of secondary plantar hyperhidrosis includes the selection of shoes made of natural breathable fabrics that are suitable in size, season and level of physical activity. First of all, this applies to sports shoes. Comfortable sneakers, ski boots, barbells do not disrupt the heat exchange of the feet, contribute to a uniform and soft distribution of the load on the lower extremities.