Presented by:

Sim Sui Theng

Hospital Miri
 Introduction
 Common foot problems

 OTC treatment options

 Conclusion

 References

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 Each foot is an engineering masterpiece made up of 26
bones, 33 joints and more than 100 muscles, tendons
and ligaments
 Common foot problems include: corns and calluses,
athlete’s foot, toenail problems, diabetic foot etc
 Over-the-counter drugs: non-prescription medicines that
can be purchased without a prescription and are
commonly used to treat symptoms of common illnesses
that may not require the direct supervision of a
physician (FDA)
 OTC drugs are beneficial because they are inexpensive
and effective to treat minor but troubling foot problems
(Bedinghaus & Niedfeldt, 2001)

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(1) Corns & Calluses
 They are areas of thickened skin that occur in areas of
pressure
 Corn is a hyperkeratotic nodule that appears as a cone
shaped mass pointing down into the skin
 Soft corns: keratin nodules that have become macerated by
perspiration and are extremely tender, appear between toes
 Hard corns: found on top or the end of the toes, or the soles of
the feet (plantar keratoses/clavi)
 Calluses can appear anywhere on the feet where persistent
rubbing or uneven pressure occurs
 Common sites: heel, the ball of the foot and the side of the toes

Corn Corn Callus

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(1) Corns & Calluses (OTC treatment options)
 Goal: To remove excess keratin and involve the relief the pressure
 Corn plasters: Medicated & Non-medicated
 Medicated corn plasters: contain salicylic acid to soften and break down the hard skin
(commonly used: 40% salicylic acid)
 Non-medicated corn plasters: small doughnut-shaped metatarsal pad will relieve
pressure on the plantar metatarsal heads
 Counseling point when using salicylic acid products:
 Should not be used in between toes
 Should never to be used by diabetic patients
 Unaffected skin surrounding the corns should be protected with vaseline or a plaster
 Using a pumice stone can help to remove hard skin but they don’t work well with
corns  tend to remove overlaying hard skin but leaving deeper and more painful
corn “root”
 Stop use immediately when irritation occurs. Start again once the irritation has
settled down
 Prevention of recurrences: Proper shoe fitting etc
 Pressure on toes may be relieved with properly fitting shoes, Silipos toe
sleeves, polymer gel (eg Cushlin Gel), or with padding of lamb’s wool

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(2) Cracked heels
 Heel fissures that commonly caused by dry skin
(xerosis),and made more complicated if the skin
around the rim of the heel is thick (callus)
 The skin is normally dry and may have a thick
callus which appears as yellow or dark brown
discolored area of skin, esp along the inside border
of the heel

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(2) Cracked heels (OTC treatment options)
 Goal: To promote hydration to dry skin
 Apply an oil-based moisturizing cream twice daily (Eg
Eulactol Heel Balm contains 25% urea promote
hydration)
 Pumice stones may be used to reduce the thickness of
the hard skin
 Never try to reduce the hard skin with a razor blade or
a pair of scissors  Infection!
 Avoid open-backed or thin soled shoes

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(3) Plantar warts
 They are benign growths caused by HPV that occur on the
sole (plantar surface), heel, or ball of the foot
 Generally appear as small lesions that appear on the sole of
the foot and are typically cauliflower-like in appearances
 Some of them have small black specks within them that
ooze blood when the surface is shaved

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(3) Plantar warts (OTC treatment options)
 Goal: To remove the warts
 Several brands of salicylic acid combined with lactic acid
in a base of flexible collodion are available (Eg. Duofilm,
Compound W, Wart-Off) for the treatment of warts
 Podophyllin ointment can be applied to warts and good
skin should be avoided
 Often requires multiple applications over the course of
several weeks, disintegrates viral cells and allows
healthy skin cells to replace them
 Treatment of warts with 17% salicylic acid is as effective
as cryotherapy with liquid nitrogen (Bunny, Nolan & Williams, 1976)

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(4) Athlete’s Foot / Tinea pedis
 Caused by Trichophyton fungus infecting the skin on the
foot due to predisposting factors such as heat and
dampness
 It makes the skin itchy, red and sore. If untreated, the
skin soon becomes soggy and starts to crack and peel

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(4) Athlete’s Foot / Tinea pedis (OTC treatment options)
 Goal: To eradicate the fungus and prevent recurrence
 Topical antifungal agents are available in cream and powder
form: clotrimazole, miconazole, terbinafine
 Spray powder can give even cover over the sole and
between the toes
 Non-spray powders may clump, but are good for putting in
socks or shoes to help reduce re-infection
 Topical terbinafine is a logical first-line choice: cost-effective
(Bedinghaus & Niedfeldt, 2001)
 Generally, it is recommended that antifungal treatment
should be applied for 1-2 weeks after the infection is
cleared to prevent recurrence

Aluminium chlorohydrate Terbinafine spray &

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Tolnaftate spray (20%) Miconazole spray cream
(5) Smelly feet
 Also known as foot odor; malodorous;
bromhidrosis can be embrassing and
uncomfortable
 Can smell as foot sweats and its trapped
inside footwear resultant from interactions
with bacteria

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(5) Smelly feet (OTC treatment options)
 Goal: To prevent and remove the odour from smelly feet
 Strong anti-perspirant deodorant may be rolled or sprayed on the feet to prevent
the feet perspiring
 Powder may be used or put in the socks
 Counseling point:
 Check for an infection eg athlete’s foot
 Do not use the same container of deodorant on feet and underarm because of the risk of
cross-infection
 Avoid use nylon socks or plastic shoes
 Best not to wear same pair of shoes two days in a row
 Bath feet daily in lukewarm water and dry thoroughly, esp between toes
 Change the socks at least once a day

Undecylenic Acid Aluminium chlorohydrate

-antifungal agent (20%) 14
to reduce perspiration of
 Generally if diabetic patient develop diabetic
foot ulcer best to refer physician/podiatrist
 Best way: PREVENT its development
 The key to successful wound healing is
regular podiatric medical care to ensure
following “gold standard” of care:
 Lowering blood sugar
 Appropriate debridement of wounds
 Treating any infection
 Regular friction and pressure
 Restoring adequate blood flow

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 Counseling on diabetic foot care:
 Wash feet daily: use mild soap and lukewarm water, dry
carefully with a soft towel, esp between toes and dust the feet
with talcum powder to wick away moisture
 Inspect feet and toes daily: check for cuts,bruises,sores or
changes to the toenails (thickening/ discoloration)
 Wear thick, soft socks: choose socks that made of an acrylic
blend, avoid mended socks or those with seams
 Cut toenails straight across: never cut into corners, use an
emery board to gently file away sharp corners/snags
 Exercise: Weight reduction and improve circulation
 Buy properly fitted shoes and don’t go barefoot: don’t
wear high heels, sandals and shoes with pointed toes
 Never try to remove calluses, corns or warts by
yourself: Commercial OTC products should be avoided

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 BBC Health Website, 2008. Foot Problems. Retrieved from:
http://www.bbc.co.uk/health/conditions/footproblems1.shtml
 Bedinghaus JM, Niedfeldt MW, 2001. Over-the-Counter Foot
Remedies. American Family Physician. Retrieved from:
http://www.aafp.org/afp/20010901/791.html
 Bunny MH, Nolan MW, Williams DA, 1976. An assessment of
methods of treating viral warts by comparative treatment trials
based on a standard design. Br J Dermatol 1976;94:667-79.
 ePodiatry.com, 2007. Foot Corns & Callus (hyperkeratosis).
ePodiatry.com. Retrieved from:
http://www.epodiatry.com/corns-callus.htm
 ePodiatry.com, 2007. Cracked Heels. Retrieved from:
http://www.epodiatry.com/cracked_heels.htm
 Lipsky , BA, Berendt, AR, Deery, HG, Embil JM, Joseph WS,
Karchmer, AW, LeFrock, JL, LEW, DP, Mader, JT, Norden C, Tan, JS,
2004. Diagnosis and Treatment of Diabetic Foot Infections.
Guidelines for Diabetic Foot Infections.39(OCT). Pp. 885-910

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