Foot maceration: tips and solutions

The maceration of the skin of the feet is a fairly common occurrence that can happen

due to:

• Hyperhidrosis (excessive sweating)
• exposure to a hot and/or humid environment
• wearing non-breathable shoes (e.g. rubber boots, safety shoes, etc.)
• keeping feet immersed in water for long periods of time
• working at high temperatures (around ovens or furnaces, etc.)

Maceration

Pseudomonas and other proteolytic bacteria

Tissue breakdown is not caused by moisture or perspiration, but by colonisation by proteolytic bacteria on the skin. The bacterium most commonly involved is the Pseudomonas species. This bacterium produces enzymes that break down proteins (proteases) and thus destroy the epidermis, causing extensive erosion.
Other proteolytic bacteria can be isolated from the macerated skin, such as Proteus, Escherichia coli and Klebsiella.
When colonisation is caused by Pseudomonas, the macerated skin turns green and a particularly pungent odour develops.

Trench foot

In certain circumstances, the foot is kept in water or mud for long periods, as is the case in some agricultural and fishing jobs, or for soldiers in the trenches and in other situations.
Soaked foot syndrome causes widespread maceration, deep erosion, and a risk of both skin and systemic infection.
In such cases, appropriate and prompt action must be taken.

Maceration caused by hyperhidrosis

Plantar hyperhidrosis is a medical condition in which the feet become damp with sweat regardless of the ambient temperature.
Treating plantar hyperhidrosis is not easy, and it is sometimes necessary to block the lumbar nerve ganglia to bring it under control.
Whilst treating hyperhidrosis is difficult, it is easier to prevent foot maceration by following the steps outlined below.

How to treat foot maceration

What to do

The aim of the treatment is to dry out the skin so that the bacteria causing maceration can no longer multiply.
To do this, Dermasana, which contains aluminium chloride, is used.
This gel has antiperspirant, moisture-absorbing and antibacterial properties. It is applied between the toes and wherever there is erosion or maceration.
To prevent the toes from touching each other and trapping moisture, thereby inhibiting bacterial growth, a cotton gauze pad (not non-woven fabric) is placed between the toes after applying Dermasana.
The dressing should be changed daily.

What not to do

You should avoid washing or getting your feet wet until the skin has fully healed.
Do not take antibiotics, as the bacteria involved are mostly multi-drug resistant.
Do not apply creams, as they make the skin damp.

Prevention

It is often difficult to prevent maceration effectively because it occurs during work or tasks that require the use of safety shoes, boots, military footwear, etc.
However, using Dermasana after work helps to prevent maceration.