To Soak, Or Not
Foot Soaks May Be Terrible
I had a patient the other day who was asking me as I was making them slipper casts about whether soaking their feet would help with calluses. As a pedorthist, I explained that from my perspective the best way to treat calluses is to understand why and how they occur in general (typically, pressure & friction causing increased production of keratinized epithelial cells). We had a review of why they were occurring for this patient (significant subtalar overpronation, significant abductory twist, medial hallux friction with lateral propulsion) and how orthotics could help with better biomechanics, pain reduction and even pressure distribution.
Of course, I did say that foot soak as a treatment is currently out of my scope of practice but I knew that anyone who is diabetic or prone to fungal infections like tinea pedis should avoid exposing their feet to prolonged moisture for a number of reasons (post-soak slip & fall accidents, scalding due to peripheral neuropathy, maceration/weakening of skin between toes, fuelling harmful bacteria with trendy added sugar, allowing waterborne bacteria to enter microscopic wounds in fragile feet, fuelling fungi with residual moisture under nails, etc.), .
The patient thanked me for my honesty and is now the happy owner of Ashfield custom foot orthoses to good effect.
What prompted the discussion was that the patient had apparently been looking online and saw a lot of "cures" based on foot soaks. Afterwards, I did a bit of Googling myself and found everything from sea salt to vinegar to cider, tea, even sugar water as soaking cures for multiple foot ailments. This is of concern to me as a foot health professional since anyone with skin integrity issues (fissures on heels, foreign bodies under the nails causing inflammation, people with fragile skin, ulceration, diabetic feet, etc.) should only undertake foot soaks with advice and review of a medical doctor - a physician - or a non-medical doctor who nonetheless is a foot specialist with advanced foot care training - a podiatrist.
As a pedorthist, here's what I do know: The skin of diabetics is often already fragile, often has poor underlying blood supply to nourish it or remove wastes, is prone to breakdown and injury from otherwise innocuous insults and must be protected. And the skin of people prone to foot or nail fungi need less exposure to moisture, not more, as a rule. These so-called home remedies of foot soaking that are around the web may sound great (actually they sound like "snake oil" sales pitches to me) but they can result in contamination and aggravation of wounds, fueling of bacteria, maceration of the skin, slip and falls in people with poor balance. The list goes on.
Why not just have a warm bath, briefly soak everything in plain old water - natures universal solvent - exit carefully onto a non-slip mat, pat yourself dry, remembering to dry gently between your toes, pop some clothes on or a robe then have a cup of your favourite tea... (Just don't soak in it.)
“Enjoy your feet!”
Rodney Ashfield, BA, Cert. Rehab.
Certified Pedorthist (Canada)
Certified Pedorthic Tech.