Hyperhidrosis of the Feet

Understanding and Managing Plantar Hyperhidrosis

Plantar hyperhidrosis, or excessive sweating of the feet, is a condition that affects 1-2% of Americans, often in conjunction with palmar hyperhidrosis (excessive hand sweating). This condition stems from an overactive sympathetic nervous system, leading to more sweat production than necessary for cooling the body.

Causes and Associated Conditions

Primary hyperhidrosis refers to excessive sweating without an underlying medical cause, typically affecting the feet, hands, and armpits. In contrast, secondary hyperhidrosis indicates sweating due to another medical condition, such as menopause, hyperthyroidism, or Parkinson’s disease.

Symptoms and Complications

Plantar hyperhidrosis, characterized by excessive sweating of the feet, manifests through various symptoms and can lead to several complications if not properly managed. Understanding these can aid in early detection and prompt treatment, mitigating discomfort and preventing further issues.

Primary Symptoms

  • Excessive Sweating: The hallmark of plantar hyperhidrosis is increased perspiration that surpasses normal levels needed for body temperature regulation, often leading to constantly damp feet regardless of temperature or activity level.
  • Foot Odor: The moist environment can foster bacterial and fungal growth, contributing to persistent foot odor that can be challenging to control.
  • Slippery Feet: Excess sweat can make feet slippery within shoes, affecting stability and increasing the risk of slips or falls, especially when barefoot or wearing open footwear.

Secondary Symptoms

  • Skin Changes: Prolonged moisture can lead to skin maceration, where the skin becomes excessively soft, white, and susceptible to injury or infection.
  • Athlete’s Foot and Other Infections: The damp conditions are ideal for fungal infections like athlete’s foot, as well as other bacterial infections, leading to itching, burning, and painful lesions.
  • Blisters: Friction from footwear on moist skin can more easily cause blisters, which can be painful and impede daily activities.
  • Wart Development: The human papillomavirus (HPV), which thrives in moist environments, can more readily infect the foot, leading to the development of warts that may require treatment.


  • Social and Emotional Impact: The visible symptoms and foot odor associated with plantar hyperhidrosis can lead to embarrassment, social anxiety, and decreased self-confidence, significantly impacting emotional well-being.
  • Footwear Damage: Constant moisture can shorten the lifespan of shoes and socks, leading to material breakdown and necessitating frequent replacements.
  • Skin Integrity: Over time, the ongoing cycle of wetness can compromise the skin’s integrity, making it more prone to cracks, cuts, and other entry points for infection.
  • Impact on Daily Activities: Severe cases can limit footwear choices, restrict participation in sports or physical activities, and require frequent changes of socks and shoes to manage discomfort.

Addressing Symptoms and Preventing Complications

Managing plantar hyperhidrosis and its symptoms requires a multifaceted approach:

  • Good Hygiene: Regular washing and thorough drying of feet can help manage odor and reduce the risk of infections.
  • Appropriate Footwear: Shoes made from breathable materials, along with moisture-wicking socks, can help keep feet drier.
  • Over-the-Counter Solutions: Antifungal and antibacterial powders or sprays can address infections and reduce odor.
  • Medical Treatments: For persistent cases, consulting a healthcare professional for treatments like prescription antiperspirants, botulinum toxin injections, or oral medications can offer relief.

Treatment Options

  • Topical Treatments: A common initial treatment involves topical ointments containing high concentrations of aluminum chloride. While effective for some, others may find the irritation it causes intolerable.
  • Botulinum Toxin A Injections: Botox injections directly into the feet can temporarily block the nerves that trigger sweat glands. These treatments, needing renewal every 4 to 9 months, can significantly reduce sweating.
  • Oral Medications: Prescription medications may offer relief by internally reducing sweat production, though efficacy varies among individuals.
  • Lifestyle Adjustments: Going barefoot or choosing open footwear can provide immediate, though temporary, relief by reducing foot temperature and sweat.

Surgical Considerations

Surgery, while a potential option for severe cases, is less effective for plantar hyperhidrosis compared to palmar hyperhidrosis and carries risks due to its invasive nature. This procedure involves cutting nerves in the central nervous system to stop sweat signals to the feet and is typically a last resort after other treatments have failed.

Living with Plantar Hyperhidrosis

Managing plantar hyperhidrosis requires a comprehensive approach that combines medical treatments with lifestyle adjustments. Regular foot care, including thorough drying, wearing moisture-wicking socks, and choosing breathable footwear, can help mitigate symptoms. For those severely affected, consulting with a podiatrist can open the door to specialized treatments like Botox injections or explore the suitability of surgical options.


Plantar hyperhidrosis poses both physical and emotional challenges, but with a range of treatments available, individuals can find relief and improve their quality of life. Early consultation with a healthcare provider can help tailor a treatment plan to manage symptoms effectively. Remember, each individual’s experience with hyperhidrosis is unique, and what works for one person may not work for another, highlighting the importance of professional guidance in managing this condition.

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