Happy Feet, A Strategic Guide

Tired, achy feet? Itchy? Dry? Strange neuropathies in your feet? Fibro feet? MS feet? Feet that burn or ache at night? Well I have some suggestions based on real science, and they actually work. These ideas may be used by anyone, and are especially appropriate for those who work standing and senior citizens.  If you want to skip the why's and wherefores, scroll down to the techniques section.  But first, a story.

My father in law suffered a stroke and soon afterward he had difficulty maintaining a good self care routine. Both my in laws are very responsible about their feet because my mother in law has a rare condition called Charcot Feet, and my father in law had frostbite in WW2. I'm guesstimating that since their 60's they've had a routine of self care with their feet. But it's easy to let it slip when you're suffering the aftereffects of a stroke. And the slower immune system of seniors can lead to a rapid progression from Athlete's Foot to severe infection of both toenails and feet. I won't gross you out, but those icky pictures you've seen in advertisements aren't lying or overstating the case.

When my father in law was in a nursing home after the stroke, I pointed out the deterioration of his feet to the nurses (why did I have to bring it up?). The doctor (who has won zero points with me) gave him a "painted on" treatment for toe fungus, with the instructions to do that for a year before expecting results. Hah, so much for prescriptions. Honestly, why is that guy not listed in Quackwatch? The general consensus was that old people's feet were yucky, and that's just normal. Well I disagree. Totally disagree.

If I may be so bold, I think the feet of a veteran deserve better.  He should've been given fluconazole and the actual infection should've been tested so we could see if he might've needed an antibiotic for it.  Nail fungus is especially hard to treat and telling someone in their 80s to wait a year for results is not acceptable.  Such levels of infection are painful and can prevent movement, which is the last thing he needs.

My efforts to help his feet were vigorous and while I can't claim total victory, I can say that I made more progress than that useless nursing home doctor. Besides it was more fun for my FIL to get foot massages and warm soaks in water that smelled good due to antifungal lavender. This article, is in part the culmination of what I've learned both from my father in law, and my mom , whose feet got out of control during cancer therapy.  Plus I'll share some productive internet searches with you.

There are some generalizations though,  such as,

  • As you age, your feet will be more vulnerable to infections and neuropathy.
  • Athlete's Foot is not just for athletes, it's on your carpet at home.
  • You can be allergic to Athlete's Foot and this is confusing because your feet look fine.
  • Plantar warts are painful and usually forever.
  • Wide shoes are not a shame, they're a long term life saver.
  • Venous insufficiency is real, but it's not as common as doctors think.
  • Most foot creams and even the prescribed ones, are worthless.
  • Not every burning sensation in feet is Athlete's Foot though.  
  • Many foot problems have similar symptoms like burning and stabbing sensations so it's easy for a problem to be ignored and called idiopathic neuropathy.

Things I Don't Use

  • Powder - because talc is bad for lungs, and starch is food for microbes
  • Creams with antifungals - because they eventually lead to resistant fungus and bacteria
  • (I rarely use) shampoo with antifungals like Nizoral or Zinc based Head and Shoulders
  • Internal antifungals (pills) but not because they don't work, because no doctor prescribes them anymore, in my experience.  Actually fluconazole works wonders after taking it daily for a week. But it seems like nobody bothers to prescribe it these days. 

The lack of taking fungal infection seriously has led to serious new varieties of fungal pathogens such as Candida auris. Hardly anyone has taken a serious look at what's effective for fungal or skin infections other than pharmaceutical companies who sell creams.

One of the reasons I turned away from antifungal creams is that the science for their effectiveness is a minefield of industry funded studies. While I don't think all industry funded studies are bad, I don't trust them unless I can find a similar study by an independent scientist. Usually I can't. I make an exception for antifungals that are used internally like ketoconazole, or agents that work with the immune system like Zinc based shampoo. I also make an exception for coal tar shampoo, but that's harder to find. Since I like the coal tar shampoo for the exfoliation effect, there are other options to replace it, more natural ones.

Drying is an important step, but powder is not helpful unless you're preventing chafing.  I let my feet dry naturally for a few minutes before putting on socks instead of using powder. Besides the chemical fragrances, powders have a mess problem, and they can be food for microbes if they have starch. I also have no reason to want to breathe in any talc, there are plenty of warnings about that. already. If you really like your powder, or it helps to avoid chafing, I suggest you use a dry washcloth to apply it. Apply the powder to the washcloth, and the washcloth to the feet. It's much less messy and gets less of it in the air. Also try to find one without starch.

Update February 2020: Talc has been implicated for asbestos contamination recently. 

Thank you, my feet, for carrying me everywhere I need to go. 🤗

Things I Do Use

Left to right in the picture above:

Espom Salt, with lavender essential oil -  the one in the photo was a chance find at Whole Foods, but in the future I'll be using a better lavender oil and adding it separately. The smell wasn't very convincing, it may have been synthetic.  An organic lavender oil is more trustworthy.  However, this is simple and cheap and didn't irritate my feet.

Tiger Balm - this comes in white and red, for your own sanity, stick with the white one.  The red tends to get all over and stain everything.  It's great for an area that will be covered and then washed, but for use before bed, on my feet, under socks that may slip, I'd rather not worry about staining.  There's also Zheng Gu Shui which is a liquid which is even more powerful as a liniment.  I love it but you may find the cream easier to use.  Keep both out of reach of kids because they'll love the smell and may get it on hands and then touch eyes leading to serious crying. The reason I use it is because these kinds of lotions and creams contain phenol and camphor, both are great at annoying pathogenic microbes. Tea tree oil is a good alternative, if you have that at home already.

Rubbing Alcohol, very few microbes can live in the presence of rubbing alcohol.  It dries them out and they die almost on contact.  Be sure to let it dry completely before taking any further steps like putting on socks or lotions.

Baking Soda, for reasons explained in the next section, Baking Soda is better than Vinegar for treating itchy, burning feet.  It has the advantage of being deodorizing and not making people go "P-U!"

Jason's Lavender Lotion, this brand is gluten free and generally has good ingredients.  It's not filled with so many ingredients that you wonder if you'll be allergic to some of it either.  It soaks in very quickly.  An alternative I like for feet is Queen Helene's Cholesterol Cream, which has the advantage of being slightly alkaline.  The body naturally produces cholesterol on the skin to keep it healthy.  But it soaks in much more slowly than the Jason's.

Gluten free matters for many body care products because if you cover your hands with gluten and then go eat a gluten free pizza, you'll definitely ingest gluten. More and more body care products are gluten free and some are even certified gluten free.

DMSO (diluted), that little spray bottle you see is diluted DMSO, about 2 parts water and 1 part DMSO, mixed and then put in an eyeglass sprayer.  This is totally optional.  Some people, including me, get a pain reduction effect from DMSO and it also helps things to soak into the skin faster.  Its use is controversial.  But it beats taking pain drugs, by miles.

Aspercreme, with lidocaine 4% can really help numb the feet, especially when the neuropathy starts up and there's a stabbing pain every few minutes, preventing sleep.

Liquid or even solid coconut oil can be a one step, one ingredient solution to problems with allergens in lotions and creams.  It's also filled with caprylic acids which annoy many types of microbes.  Pay special attention to letting it soak in before donning socks. The smell is wonderful too, but be careful, some people are allergic to coconut.

Peroxide 3%, not pictured.  I put my peroxide in a spray bottle and use it once a week during the big foot healing session. It tends to bleach out dead skin so you can see it very easily.  Don't use it just before you want to wear sandals and show off your feet, you might end up with white spots. 

About nail polish, I think it's perfectly fine as long as you're putting it over healthy nails.  It can even reduce problems since it's pretty toxic stuff and not a food for microbes.  However, the chemicals in it might not be such a good idea for everyone.  There are lots of wonderful alternatives out there now.

The only tools you absolutely need are a large flat nail clipper with a cuticle pusher / nail file attached, and a bucket or basin to hold water while you're soaking your feet.  Have a couple of towels and whatever products you're using all around you before you put your feet in.  And a pair of clean socks, of course!  

The Strategy or What Works

Maybe the first thing to talk about is the skin biome and how it can get messed up.  One of my suspects is a food and body care additive called PEG# or Tween#.  Usually this is listed on labels as PEG 20 or PEG 80.  My beef with this additive is that it's also used to feed microbes in labs.  As creepy as that sounds, the assumption is that it's safe because if there's other food around, then the microbes don't bother to break down the Tween.  Quote:

"The induction level of the esterase activity was found to be well correlated with fungal growth [of candida] and was dependent on the Tween 80 concentration. Such esterase activity was observed only in medium containing Tween 80 or other Tweens as the sole carbon source..." from: https://iai.asm.org/content/iai/64/8/2936.full.pdf

Now I realize candida isn't the main pathogen on feet (we'll get to that in a minute), but this Tween stuff is used to grow many microbes, and this is just one example of a dose-response relationship between Tween and microbial growth.  To understand why it would be a problem on skin, you have to know that skin produces esertases naturally, so the microbes don't even have to break down the Tween, the skin does it for them. This is chemistry, there's no "reaction police" saying, "No don't break down the Tween, stick to the important stuff like acetylcholine."  Chemical reactions occur because two substances that can react get close enough to react.  In this case, skin esterase and Tween.

The main pathogen of feet is Athlete's Foot fungus, Trichophyton rubrum, among others, and as shown in the article, it can live on any surface, carpet, bedding, towels, even your socks and shoes.  Getting rid of it requires strategy.  Most advice says that vinegar is what you should soak your feet in.  Some rarer advice says to use yogurt, and even more rarely, baking soda.  As tempting as it is to believe that the skin has an "acid mantle" and therefore vinegar always works, in this case, it leads to helping the fungus.  This fungus can live in a pH of 3.5, and the only substance I know that's in your house that's more acidic is straight lemon juice.

Baking soda is a better bet for controlling Athlete's foot fungus. Yogurt has its charms too.  It can help outcompete the fungus, but only if the fungus is already weakened.  There's more insight in that article:

Quote; "The color change could be repeatedly reversed by adding acid or alkaline (Fig 2B and S1 Video). However, adding H2O2 bleached the liquid and no further color change could be induced. (later in the article:) At alkaline conditions, T. rubrum has a red pigmentation, whereas at acid condition T. rubrum has a yellow pigmentation."

 H2O2 is peroxide.  The reason the color change is important is because it's linked to a virulence factor of the fungus.  The substance that is bleached and hopefully deactivated causes the immune system to ignore the athlete's foot fungus.  However, it's an open question whether peroxide killed the fungus when it bleached it. In my experience the fungus is at least severely weakened by peroxide.  Here's some evidence for why:

Quote: "Since Xanthomegnin is the main pigment in T. rubrum and isolated Xanthomegnin also changes color from yellow to red by alkalization, we attribute our observations of the color change mainly to Xanthomegnin.  Xanthomegnin can influence the immune-response by inhibition of Inducible Nitric Oxide Synthase [15]. Further it has effects on mitochondria, as measured in rat liver mitochondria [16][17] and interacts with serum albumin [18]. "

That's not all, there's a lot more in that article, but at some point I have to stop with the fascinating science and get down to the business of annoying the fungus at least as much as it annoys me, by inhibiting it. 

The first avenue of attack is exfoliation, fewer dead skin cells, means fewer sources of nitrogen (keratin protein in this case), which is the ideal food for this fungus.  In the color change tests, SC medium is the ammonium sulfate one, providing direct nitrogen source of food.  This being the most likely source of food on the human foot, we can assume that the fungus creates an ever more acidic environment for itself.  Dare I say that this is the source of the burning sensation? Certainly looks that way. I've given several ideas for exfoliating in the techniques section.

From those charts it's clear that it prefers acidity and probably can't live in a pH much higher than 8.5, which is slightly more alkaline than sea water. Again, baking soda is a better route of attack than vinegar in this case. Actually even better is real soap, applied directly to the skin and allowed to sit for a few minutes during a foot bath.  Do NOT use drain cleaner (did I have to say that?).  And ammonia is not helpful since it provides nitrogen, so as soon as the pH normalizes a bit, the residue feeds the fungus.

If you're totally desperate, then diluted bleach can do wonders, but don't use it full strength directly on the skin.  Skin irritation will just help the fungus along.  Diluted bleach or Dakin's solution is a great way to start a serious cleanup of neglected feet.  But try soap first, something old fashioned like Dr. Bronner's bar soap.  Bar soap has a higher pH than liquid.  Be sparing in the use of bleach.  

Coldness is another issue that may arise with foot problems.  My cheap and easy solution is to wear socks, then cover them with leg warmers, thus avoiding the toe compression that may happen with full thermal socks, or multiple pairs.  Leg warmers are much cheaper than real thermal wool socks, and work equally well, unless you're on your feet a lot, in which case it will probably be more comfortable to buy the expensive hiking socks. Cold feet are bad because it causes lower circulation which reduces the activity of the immune system.  I sleep with leg warmers too.  I pull them down so that only my toes are not covered.

Photo Credit

Techniques for Happy Feet

When I was young, my mom bought me a year's supply of Mary Kay and invited friends over to have a sales party.  There was a very useful demonstration and explanation of how to take care of my face in multiple steps and I still use that as the measuring stick for skin care.  It's complicated, but the results are amazing.  I got through high school with maybe one or two zit days.  I never worried about zits, and in comparison to the acne creams this smelled better and hurt less. So my solution to feet (another skin area), is a similar multi step process to keep the skin glowing and happy.

My feet have specific needs such as, if I have pain or neuropathy activation in my feet, it's a migraine trigger.  And I'm allergic to mold so I react to Athlete's Foot long before you can see much beyond a basic dryness of skin.  The symptoms of Athlete's Foot for me include swelling of my feet, which looks like venous insufficiency.  But it's not, it's an allergy.  My doctor assumed that due to my obesity, it was venous insufficiency.  However, I've found that not to be true.  I wore special compression socks for a long time before I realized this.  But the redness and swelling continued, not to mention the tellltale stabbing pains of neuropathy.  I wasn't satisfied with the results of just compression socks so I kept looking for better solutions. 

The Mary Kay method for skin care (face) can be adapted to feet, the steps are:

  • Clean
  • Exfoliate
  • Mask (once a week)
  • Astringent
  • Moisturize
  • Protect (by this they meant sunscreen but for feet I have another idea)

For feet, the once a week process is:

  • Alkaline Foot bath with soap directly on skin (Dr. Bronner's), and Baking Soda in the water.
  • Exfoliate, rub with a wet washcloth, paying attention to folds of skin
  • Soak a bit more, then dry (sting warning, if your feet have cracks!)
  • Refresh with regular Peroxide, allow to air dry (I use a spray bottle)
  • Clip toenails now if needed, and clear any debris under the nails gently
  •  Moisturize / lotion (Jason's)
  • Numb if necessary, then allow to soak in until not sticky to the touch. (Aspercreme Lidocaine 4%)
  • Socks 🧦

Nightly routine:
  • Rubbing alcohol (on a washcloth, full strength)
  • allow to dry
  •  lotion or numbing agent (DMSO optional, Tiger Balm, optional)
  • allow to dry/ soak in
  • check for the need to clip toenails or for any debris under the nails
  • wear socks

After your feet have healed, start reducing the rubbing alcohol used until you're down to just lotion/ numbing agent and socks.

Warning:  If you have cracks in your skin, and they're deep and bleeding, be sure to check with a doctor before you start a program for healing it.  Such cracks can be serious. You may need a chlorhexidine based cleanser to prevent infection, or the doctor may recommend something else. As a general rule, if you're using a numbing cream, don't add something else on top of it because if a rash develops you might not feel it.  

Keep in mind that wearing socks all the time is a good way to limit direct contact between the floor and your feet. And it limits transfer of microbes to your bedding and back to your feet.  If you have itch problems and you've been walking in your house barefoot, you can re-infect your feet over and over.  You can limit that by wearing socks, although I'm not aware of any testing that proves that.  In any case, anything you can do to make your feet harder to touch and less friendly to fungal life, make it a habit. Another good self defense is to have your carpets cleaned twice a year, even if it's only the high traffic areas.This is recommended for people with allergies as well.

In the best case, we'd be wearing slippers every day at home.  But the low quality of most slippers makes this impossible for me.  I can't stand fake fur, fake sheepskin, or fleece up against my feet.  It makes my feet sweat and increases itch.  I'm allergic to latex too, so there you have it.  No slippers made today are really right for me.  I tend to wear sandals all the time though, even in the winter, whenever I can. I just don't see a need for other shoes really.

These slippers would be good, except to be comfortable, I'd need more padding on the bottom.  I'm in the desert of "either the slippers are minimalist, or fuzzy and sweaty." 

Exfoliation Methods

Exfoliation needs special mention because it's targeted by so many products and treated like a special and expensive thing by day spas.  All it means is, you scrub off some of the outer layer of skin, revealing healthier skin underneath.  It leaves less keratin around for microbes to feast upon, and it makes your skin look good. 

1.  Skin brushing -  this is the classic method , but it doesn't work as well for feet, for one thing it's ticklish, and another, you'd have to use a toothbrush to get in between toes.  Plus, even if you do this daily, as some beauty experts recommend, you'd need to start at a time when your skin is already clear of pathogens.  Otherwise the brush is a reinfection risk.

2.  Coal tar shampoo -  I rarely use this but it does work.  Think of it as a chemical peel, it exfoliates by breaking the bonds that hold dead skin cells together.  The percentage of coal tar in shampoos has gone down lately, but try to find one in the 2-5% range.  Neutrogena used to make a good one called TGel, but it's getting weaker.

3.  Baking Soda / Yogurt -  you can soak your feet with some baking soda ( 1 tsp per gallon, or two Tablespoons per 5 gallons ) , then rinse, then apply yogurt for at least 1 minute, then wash and dry your feet.  This acts like a chemical peel as well.  The acids in yogurt also break down the bonds that hold dead skin cells together.  And a probiotic yogurt can help control the fungus by crowding it out.

4.  Bleach - yes plain household bleach (8.25% sodium hypochlorite), 1 Tablespoon per gallon, can kill many pathogens on feet and exfoliate the skin.  After you soak your feet in such water, the dead skin literally rubs off.  If your feet have deep cracks, this can be extremely painful though, so you might want to wait for some healing before using this method.  It's used in MRSA treatment, even on children, so it's not unsafe.  But it's also an intense treatment that shouldn't be overused.  Some people will react with a rash on contact with chlorine bleach.

5.  By far my favorite method is to soak my feet in water with epsom salt, then take each foot individually and soap it then use a scratchy glove to rub the dead skin off.  If you do this once or twice a week, you can avoid the need for chemical exfoliation.  They have the advantage of being found in all local pharmacies and being cheap enough to throw away when they become iffy. This method has the advantage of being simple and inexpensive.

Using Yogurt

Using yogurt is a tricky thing.  Since you need to clip toenails and sometimes you're exfoliating rather roughly, it's not a good idea to use yogurt during the weekly foot bath time.  Probiotics are only "friendly" as long as your skin isn't broken, they can become pathogenic if you have a tiny cut or a deep crack in your skin.  It's best to choose a day when you're not clipping toenails or exfoliating much, and use it instead of the lotion step of the nightly routine.

Set yourself up so you can reach the tub spigot with your hands and are able to put your feet under the water when it's on.  Scoop some unflavored  plain yogurt into a bowl and bring it into the bathroom with you.  That way, you don't contaminate the entire yogurt container.

Apply the yogurt to the feet and let it stay for 1-5 min. If it stings, wash it off right away, and try again in a couple of weeks after some healing may have taken place.  Rinse your feet, use soap and water to wash them only if you felt any stinging.  Otherwise it's fine to jut rinse off with water and let your feet dry before donning socks.

 Day Spas

I recommend against using a Day Spa for feet.  The chances are too high that you'll get something hard to kill, from the water, even with liners and such already in use. Day Spas are a wonderful place to get a relaxing chair massage or a manicure though!

Photo Credit

What next?

Well we've reached the end of another in depth article.  I'm in the midst of an experiment that is baking with a bread machine and I hope you've been following it.

I took a few days to visit some family and it was great fun, but I'm really wiped out now.

I found some new ideas in a couple of new books I"ll tell you about next time, and I bought a Vitamix, which I'll compare with a Preethi!

All this and more coming up, so if you haven't subscribed yet, head on up to the top of the page and hit the Subscribe button.  Leave me a note in the comments too!

Stay well and always look for rainbows.


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