Over-the-counter Foot Care

Presented by: Sim Sui Theng Hospital Miri

Introduction  Common foot problems  OTC treatment options  Conclusion  References 

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Each foot is an engineering masterpiece made up of 26 bones, 33 joints and more than 100 muscles, tendons and ligaments Common foot problems include: corns and calluses, athlete’s foot, toenail problems, diabetic foot etc Over-the-counter drugs: non-prescription medicines that can be purchased without a prescription and are commonly used to treat symptoms of common illnesses that may not require the direct supervision of a physician (FDA) OTC drugs are beneficial because they are inexpensive and effective to treat minor but troubling foot problems (Bedinghaus & Niedfeldt, 2001)

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Corns & Calluses They are areas of thickened skin that occur in areas of pressure Corn is a hyperkeratotic nodule that appears as a cone shaped mass pointing down into the skin

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Soft corns: keratin nodules that have become macerated by perspiration and are extremely tender, appear between toes Hard corns: found on top or the end of the toes, or the soles of the feet (plantar keratoses/clavi)

Calluses can appear anywhere on the feet where persistent rubbing or uneven pressure occurs

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Common sites: heel, the ball of the foot and the side of the toes

Corn

Corn

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Corns & Calluses (OTC treatment options) Goal: To remove excess keratin and involve the relief the pressure Corn plasters: Medicated & Non-medicated

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Counseling point when using salicylic acid products:

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Medicated corn plasters: contain salicylic acid to soften and break down the hard skin (commonly used: 40% salicylic acid) Non-medicated corn plasters: small doughnut-shaped metatarsal pad will relieve pressure on the plantar metatarsal heads Should not be used in between toes Should never to be used by diabetic patients Unaffected skin surrounding the corns should be protected with vaseline or a plaster Using a pumice stone can help to remove hard skin but they don’t work well with corns  tend to remove overlaying hard skin but leaving deeper and more painful corn “root” Stop use immediately when irritation occurs. Start again once the irritation has settled down

Prevention of recurrences: Proper shoe fitting etc Pressure on toes may be relieved with properly fitting shoes, Silipos toe sleeves, polymer gel (eg Cushlin Gel), or with padding of lamb’s wool

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Cracked heels Heel fissures that commonly caused by dry skin (xerosis),and made more complicated if the skin around the rim of the heel is thick (callus) The skin is normally dry and may have a thick callus which appears as yellow or dark brown discolored area of skin, esp along the inside border of the heel

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Cracked heels (OTC treatment options) Goal: To promote hydration to dry skin Apply an oil-based moisturizing cream twice daily (Eg Eulactol Heel Balm contains 25% urea promote hydration) Pumice stones may be used to reduce the thickness of the hard skin Never try to reduce the hard skin with a razor blade or a pair of scissors  Infection! Avoid open-backed or thin soled shoes

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Plantar warts They are benign growths caused by HPV that occur on the sole (plantar surface), heel, or ball of the foot Generally appear as small lesions that appear on the sole of the foot and are typically cauliflower-like in appearances Some of them have small black specks within them that ooze blood when the surface is shaved

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Plantar warts (OTC treatment options) Goal: To remove the warts Several brands of salicylic acid combined with lactic acid in a base of flexible collodion are available (Eg. Duofilm, Compound W, Wart-Off) for the treatment of warts Podophyllin ointment can be applied to warts and good skin should be avoided Often requires multiple applications over the course of several weeks, disintegrates viral cells and allows healthy skin cells to replace them Treatment of warts with 17% salicylic acid is as effective as cryotherapy with liquid nitrogen (Bunny, Nolan & Williams, 1976)

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(4) Athlete’s 

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Foot / Tinea pedis Caused by Trichophyton fungus infecting the skin on the foot due to predisposting factors such as heat and dampness It makes the skin itchy, red and sore. If untreated, the skin soon becomes soggy and starts to crack and peel

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Athlete’s Foot / Tinea pedis (OTC treatment options) Goal: To eradicate the fungus and prevent recurrence Topical antifungal agents are available in cream and powder form: clotrimazole, miconazole, terbinafine Spray powder can give even cover over the sole and between the toes Non-spray powders may clump, but are good for putting in socks or shoes to help reduce re-infection Topical terbinafine is a logical first-line choice: cost-effective (Bedinghaus & Niedfeldt, 2001)

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Generally, it is recommended that antifungal treatment should be applied for 1-2 weeks after the infection is cleared to prevent recurrence

Tolnaftate spray

Aluminium chlorohydrate (20%)

Miconazole spray

Terbinafine spray & 12 cream

(5) Smelly 

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feet Also known as foot odor; malodorous; bromhidrosis can be embrassing and uncomfortable Can smell as foot sweats and its trapped inside footwear resultant from interactions with bacteria

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Smelly feet (OTC treatment options) Goal: To prevent and remove the odour from smelly feet Strong anti-perspirant deodorant may be rolled or sprayed on the feet to prevent the feet perspiring Powder may be used or put in the socks Counseling point:

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Check for an infection eg athlete’s foot Do not use the same container of deodorant on feet and underarm because of the risk of cross-infection Avoid use nylon socks or plastic shoes Best not to wear same pair of shoes two days in a row Bath feet daily in lukewarm water and dry thoroughly, esp between toes Change the socks at least once a day

Undecylenic Acid -antifungal agent

Aluminium chlorohydrate (20%) to reduce perspiration of

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Generally if diabetic patient develop diabetic foot ulcer best to refer physician/podiatrist  Best way: PREVENT its development  The key to successful wound healing is regular podiatric medical care to ensure following “gold standard” of care: 

Lowering blood sugar  Appropriate debridement of wounds  Treating any infection  Regular friction and pressure  Restoring adequate blood flow 

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Counseling on diabetic foot care: 

Wash feet daily: use mild soap and lukewarm water, dry carefully with a soft towel, esp between toes and dust the feet with talcum powder to wick away moisture

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Inspect feet and toes daily: check for cuts,bruises,sores or changes to the toenails (thickening/ discoloration)

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Wear thick, soft socks: choose socks that made of an acrylic blend, avoid mended socks or those with seams

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Cut toenails straight across: never cut into corners, use an emery board to gently file away sharp corners/snags

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Exercise: Weight reduction and improve circulation

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Buy properly fitted shoes and don’t go barefoot: don’t wear high heels, sandals and shoes with pointed toes

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Never try to remove calluses, corns or warts by yourself: Commercial OTC products should be avoided 16

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BBC Health Website, 2008. Foot Problems. Retrieved from: http://www.bbc.co.uk/health/conditions/footproblems1.shtml Bedinghaus JM, Niedfeldt MW, 2001. Over-the-Counter Foot Remedies. American Family Physician. Retrieved from: http://www.aafp.org/afp/20010901/791.html Bunny MH, Nolan MW, Williams DA, 1976. An assessment of methods of treating viral warts by comparative treatment trials based on a standard design. Br J Dermatol 1976;94:667-79. ePodiatry.com, 2007. Foot Corns & Callus (hyperkeratosis). ePodiatry.com. Retrieved from: http://www.epodiatry.com/corns-callus.htm ePodiatry.com, 2007. Cracked Heels. Retrieved from: http://www.epodiatry.com/cracked_heels.htm Lipsky , BA, Berendt, AR, Deery, HG, Embil JM, Joseph WS, Karchmer, AW, LeFrock, JL, LEW, DP, Mader, JT, Norden C, Tan, JS, 2004. Diagnosis and Treatment of Diabetic Foot Infections. Guidelines for Diabetic Foot Infections.39(OCT). Pp. 885-910

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