All About Stinky Feet
How to Fell the Smell...
There is something about foot odor that makes one’s nose wrinkle just to think about it. I have seen this problem in little girls, teenage boys, adults, and less often, the elderly. The main thing you have to think of in terms of foot odor is BACTERIA. Foot odor does not necessarily mean you have a bacterial infection. It can mean you have a great environment for hosting a smelly bacterial colony on your skin. Our skin naturally hosts a bunch of microscopic critters—bacteria, yeast, and fungi, so keeping them in the correct proportions is the goal. Here are some tips to keep our critters in balance. First, let’s talk treatment. Then, we can get to the essentials of prevention.
Treatment:
Wash your feet thoroughly to remove debris, then
Use a topical antibacterial scrub solution. This is the same stuff surgeons wash you down with before surgery. You should be able to buy it over the counter at your larger pharmacies. Buy a small bottle of Hibiclens (or other Chlorhexidine wash) and soap every bit of your clean foot up. Leave on for 5 minutes. Rinse. Repeat and soak another 5 minutes. Rinse again. That’s it! You can also use Betadine, which is iodine based and doesn’t produce suds—so you just kind of paint your foot with it twice in a row. I am allergic to betadine, so I prefer chlorhexidine-based products. Also, I like suds and betadine stains things and chlorhexidine doesn’t. For most people, this simple double antibiotic soaking wash takes care of the problem. If not, repeat again in the next day or two. And yes, this does work on persistently stinky armpits too, as I found out from having three teenage boys as test subjects. When using on armpits, first trim the armpit hair to a length of about 1 inch or so, as long hairs trap bacteria and odor. Do not use this treatment as a daily wash as it will cause too many good bacteria to die and your skin will get out of balance. You should only need to use this treatment once or twice per occurrence for treatment of an active problem. Usually, it will take months before this treatment is needed again. It works that well.
Prevention:
Don’t seal your body parts in their juices. Body parts that sweat a lot need to breathe. This means wearing moisture wicking socks. Air your feet out. Wear shoes made of breathable materials, or that have mesh top-covers. In the episode on Toenail fungus, I talked about how these same tricks can keep fungus from growing. It turns out bacteria grow well in the same sweaty stew. One of the smelliest feet I ever encountered were on a cute little girl who loved her plastic shoes. Juices just sealed right in. Plastic does not breathe. There is a reason why Crocs have holes.
If you have excessive sweating, use a spray underarm antiperspirant REGULARLY on the bottoms of your feet and between your toes. This can be a big help in keeping the problem from returning.
Add 1/2 cup white vinegar to your prewash of your laundry cycle to help kill bacteria and resolve odor on socks and bedsheets. You can also use a temperature of 100F/40C water in your laundry cycle containing bacterially contaminated clothes. Consider using bleach if you have bleach safe clothes or bedsheets that stink. Usually, vinegar is enough.
Wash your shoes when they start to smell bad (using vinegar and 100F/40C water if tolerated). Or set your shoes in the bright sun to allow for UV light to work on killing what it can. It works great for fungus/musty smells. If you can’t get the smell out of the shoes, throw them out and replace them as they will be a holding ground for bacteria to recolonize your feet.
Wash your feet with soap and water daily, and always use a fresh pair of socks. Dry your feet thoroughly, especially between your toes, before putting on your next pair of socks. This is hygiene 101 but should not be ignored.
If you have this issue frequently, use white cotton socks you can bleach regularly.
If you still have sweaty feet after using underarm antiperspirant regularly, try taking your shoes and socks off after your workday and rubbing your feet down with hand sanitizer. It has alcohol which is drying (and you need dry) and kills bacteria also.
Have an alternate pair of shoes to wear if your shoes get wet. Work boots and shoes typically take a long time to dry, so have an alternate pair to wear if you can and switch off every other day to give them a chance to dry out.
PITTED KERATOLYSIS
The worst cases of bacterial colonization can cause a condition called pitted keratolysis. This condition makes the sole of your foot look wet and light colored with little punched out holes in the light areas. And it smells incredibly bad and can be very embarrassing. If you have that condition, try the steps above. If your skin does not return to normal, see your podiatrist who can prescribe you an antibiotic gel (usually Clindamycin gel) which you can apply regularly until your condition is under control. Typically, oral antibiotics are not necessary because it is a colonization of your skin, not an infection (such as cellulitis).
Pitted Keratolysis
Please don’t be embarrassed if you have skin odor. It’s natural and it’s quite treatable. Happily, it’s usually a fix you can do at home without an expensive doctor visit.
As always, I am NOT your doctor and I have not diagnosed your specific problem. If you have any questions about your foot, please see your local podiatrist for a full workup and treatment plan specific to your foot. Thank you for being curious!