There are many dermatological conditions that affect the skin of the feet, ankles and lower legs (lower extremities), ranging from harmless (yet uncomfortable) to painful or even dangerous. Read on to discover the most common dermatological issues podiatrists treat.

Hyperkeratotic Lesions, Blisters, and Cracked Heels

Bony deformities, biomechanical disorders, repeated friction or improper footwear can lead to corns, calluses or blisters. 

Corns and calluses (hyperkeratotic lesions) make the skin thicken and harden in response. Corns are small, deep and sometimes painful lesions with a hard center, while calluses are typically larger with irregular shapes. The uncomfortable symptoms of corns and calluses can be reduced with medicated patches, cushioning pads, custom orthotics, or by trimming the lesion or removing it surgically.

Blisters are a natural defense mechanism the body creates where the outer layer of skin has separated from underlying layers of skin. They can be caused by repeated friction from shoes, extreme temperatures, chemical exposure, or certain medical conditions. These protective, fluid-filled sacs can be treated with pads to offload pressure, or with antibiotics if infection sets in. 

Cracked heels occur when extremely dry skin on the heels thickens and hardens, and the body’s weight bearing down on the heels causes the skin to split. If they are left untreated, they may deepen, bleed, or become infected. Cracked heels may be treated by debriding and or sanding the dead, thickened skin. Infected cracked heels may need to be dressed and treated with antibiotics.

Fungal and Bacterial Infections, and Rashes

There are common infections that can affect the feet, ankles and lower legs. These infections are often contracted via direct contact with an infected individual, through exposure to different organisms that thrive in damp, warm areas or on skin that suffers from poor hygiene.

Infections:

• Athlete’s foot is a fungal infection (Tinea pedis) that produces various symptoms such as itchy, scaly rashes on the feet and in between the toes, which can be treated effectively with prescription strength anti-fungal medicines (oral or topical).

• Erythrasma is a bacterial infection caused by the  Corynebacterium minutissimum organism. The infection causes itchy, swollen, brown or red patches predominantly in the folds of the skin, or in between the toes.Yellow or green pus may sometimes be present as well. Although less common, erythrasma is often confused with athlete’s foot, yet it must be treated with anti-bacterial oral or topical medications.

Rashes:

• Allergic Reactions on the lower extremities can be caused by irritants in certain soaps, materials or dyes in socks and shoes, poison ivy, and more. Cool compresses, antihistamines, oral corticosteroids or steroid creams are sometimes used to treat allergic  reactions.
• Palmoplantar psoriasis is an inflammatory skin disorder. It causes painful, itchy, dry, red plaques and scales that build up on the bottom of the feet (and hands) due to genetic or environmental issues. As the disease progresses, it may affect the joints and nails. Your podiatrist might treat this condition with topical corticosteroids, epidermal barrier repair creams, or phototherapy.
• Dermatitis can either be contact dermatitis causing inflammation, crusting, blistering, and oozing in the skin from various irritants, or stasis dermatitis where blood builds up in the legs, feet and ankles when veins fail to adequately carry blood back to the heart. Contact dermatitis can be treated with prescription moisturizers or topical steroids, while compression socks, corticosteroid creams or vein surgery can be used to treat stasis dermatitis.

Toenail Issues

Ingrown toenails occur when a toenail grows into the skin along the edges of the nail, rather than over it. Ingrown toenails can be very painful and make the affected skin red and swollen. The nail may become infected if left untreated. Podiatrists may treat an ingrown toenail by gently lifting it, and placing cotton or a splint under the nail to help it grow above the edge of the skin. Or, they may remove part or all of the nail. If the ingrown toenail becomes infected, your podiatrist will prescribe either oral or topical antibiotics.

Toenail fungal infections (Onychomycosis) are stubborn infections that can leave your toenails discolored, brittle, thickened, misshapen, odorous and crumbly. Because home treatment does not adequately or permanently treat toenail fungal infections, your podiatrist will treat this bothersome and sometimes painful condition with anti-fungal medications, laser therapy, or surgery to remove infected parts or the entire nail.

Warts and Lesions

Both warts and lesions are troublesome growths with different origins and levels of severity.

Plantar warts are warts that form on the sole of the foot and are caused by the human papilloma virus. They are flat, thick masses that often present with a black “dot” at their core, which is actually miniscule blood vessels with dried blood in them. Plantar warts are sometimes painful, and are always stubborn. Your podiatrist may use topical medications, cryotherapy, salicylic acid, or FDA-approved laser therapy to get rid of plantar warts.

Foot lesions are areas, marks, patches, growths, etc. that do not resemble surrounding skin. They range in color which can be due to hereditary conditions, infections, trauma, allergic reactions, bites, underlying medical conditions or even cancer (melanoma). Your podiatrist will take a small sample of the lesion’s tissue (biopsy) to properly diagnose the root cause of the lesion. How your podiatrist treats a lesion depends on their diagnosis, and can range from topical antibiotics/anti-fungals, to antimicrobial dressings, to cryotherapy, electrosurgery, or traditional surgery.

If you have any dermatological issues affecting your lower extremities, see your podiatrist to have your condition diagnosed and treated properly.