THE VALUE OF BARE FEET: GIVING THEM TIME TO RECOVER

In summer, your feet can sweat about a cup of fluid a day, especially if you have packed them into socks and laced them into leather shoes. Because there is nowhere for the sweat to go, by evening you may find yourself peeling back sodden socks and revealing feet that are boggy and sour smelling.

The damper and the warmer the interior of shoes becomes, the more suitable they are as breeding grounds for foot-loving bugs. Two families of microscopic bugs flourish in the airless, darker regions of such shoes.

First, there are the bacteria. As these rot the skin, they give off a pungent odour and may cause superficial pitting on the sole. In the normal course of events, these corynebacteria break down the keratin in the outer layers of skin. But in the close, humid environment of a shoe, the moisture encourages them to multiply and the process becomes frenzied and smelly.

Second, there are the fungi. If you see white, scaly skin under your baby toe, you’re probably carrying the baby-boomer fungus, tinea pedis. While it may cause you no problems at the moment, there is an excellent chance it will come to an unaesthetic end. Left unchecked, this fungus may cause your toenails to become crusty, discoloured and smelly. The same thing can happen to your fingernails, although this is less common.

On the feet, this fungus can turn once-pristine pink nails a strong shade of yellow and make them so thick that wearing ordinary shoes is difficult.

Curiously, fungal infections of the nails have only been seen this century. They are caused by a tropical fungus called Trichophyton rubrum, which was originally encountered in South-East Asia, where it causes tinea of the body.

Earlier this century this fungus left the tropics and headed for Europe, where it found a warm, moist niche in the toe-web spaces of Europeans, who liked to wear shoes and socks. It was in these shoes and socks that it became tinea pedis, or athlete’s foot, and was then transported across the world as a result of the increasing mobility of people.

In the last 30 years, because of the baby-boomer lifestyle, it has reached epidemic proportions. People with tinea pedis walk across carpet in a hotel room, for example, and shed skin scales that contain fungal elements. These elements can remain viable for up to a year and lie in ambush, waiting for the next person to come along and become infected.

Most people don’t realise they have tinea pedis because it can be subclinical. More than 20 per cent of the population are carriers and can usually identify themselves by the white, scaly skin under their baby toe.

People can have tinea pedis unwittingly for many years, until finally it declares itself in their nails and they begin to see white spots, powdery patches, thickening or areas of opacification. Fungal nail infection, or onychomycosis, as it is known medically, is the end stage of tinea pedis.

In the fifties and sixties, the matting at bathing facilities was associated with athlete’s foot. Now these areas are tiled and the fungus can be washed away. Today carpet is a culprit, and people are picking up the fungus at sporting clubs, gyms and public spaces by walking barefoot on floor coverings.

Transmission from human to human via the foot is very efficient, and with age, the incidence of onychomycosis increases. By the age of 60, at least 20 per cent of people will have evidence of this fungal infection in their toenails or fingernails. Infection is about eight times more common in toenails than in fingernails.

Nails grow so slowly that once they have become infected the fungus under them can be very difficult to eradicate. Prior to 1960 there was no treatment for fungal nails; more recently there have been a few options of varying effectiveness.

In 1993, a drug called terbinafine revolutionised treatment. After 3 months on this drug, about 80 per cent of people have eradicated the fungus (and their athlete’s foot with it). However, as it takes a year for the nail to grow out fully, the nail still looks infected for several months after the fungus dies.

About 50 per cent of lumpy, unsightly, discoloured or sore toenails are due to other things. Psoriasis of the nail, for example, often looks just like onychomycosis but is a separate condition.

Dermatitis and inflammation of the nail folds have symptoms that mimic fungal infections, while thickening of the nail due to repeated trauma can also be misleading.

Nail infections can have unexpected consequences in a man’s life. One poor bloke’s fungal toes kept him out of the marital bed. It wasn’t just the awful odour emanating from the fungus heaped up under his nails that turned his wife off but also the fact that his nails were so crusty and twisted that they were like weapons. When he rolled over they could be positively dangerous.

The bugs that cause tinea pedis can also hitch a ride up to the top of the legs where they can settle in as jock itch – especially if you use the same towel for feet and groin.

Less often these fungi lodge on the face in what is known as ‘scrum pox’.

Over a lifetime, feet take a battering. By the time you reach 50, you have walked more than 120 000 km and subjected your feet to tremendous stress. But while feet are mechanically robust, the soft tissue surrounding them is more vulnerable and highly susceptible to these bugs.

About 40 per cent of men suffer from an excess of dermatophytes (which produce tinea) and corynebacterium at some time. Some produce such an acrid smell that they cannot kick off their shoes in company. In many cases, the condition flares up and then seems to die off but is really lying low, waiting for an opportunity to rage again.

One of the first practical steps in dealing with this is to throw away synthetic socks and replace them with ones made of natural fibres, such as cotton and fine wool.

Natural fibres draw moisture away from the feet and allow them to breathe. Some podiatrists recommend wearing two pairs of natural-fibre socks. It is not as hot as you may think, and the theory is that the inner sock draws moisture away from the foot while, in turn, the outer sock draws the moisture out of the inner sock. This leaves the foot dry in a dry sock. Men with hyper-hidrosis – excessively wet feet – should take spare socks to work and change over at lunchtime.

While the first line of treatment is to eradicate these bugs with over-the-counter creams, powders and lotions or by taking the drug terbinafine, the cycle of infection has to be broken. There is no point putting cream all over your feet and then stepping into the same old shoes where the bugs are lying in wait.

Like good suits that need to be rested for a couple of days before being worn again, so work shoes need rest so they can dry out. Sprinkling their interiors with antifungal powder and putting them in the sun is a good idea. Fungi hate direct sunlight. But they don’t mind a damp shower recess. While treating your feet, it is prudent to disinfected your shower too, and avoid using public gyms, pools and showers.

Some podiatrists suggest punching three tiny holes in one side of each leather shoe, below the arch and just above the sole. This transforms shoes into mini-bellows. With every step, the movement of the foot causes air to be sucked in and then pushed out. This increases air circulation and keeps the mini-climate in the shoe drier and cool.

Others tell patients to take care to dry their feet after washing, even to the extent of using a hair dryer to dry between the toes.

Whatever you do, at the end of the day it is good practice to release your feet from their foetid confinement and, providing you are not a diabetic suffering from poor circulation in your extremeties, walk around barefoot.

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