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Hi all,
Today I saw a M 27 YOA very fit; member of the military, plays competitive basketball, runs marathons and Martial Arts 3X week.
Complaining of pitted hyperkeratosis plantar BF reported gets quite sore after activity. Reports Hyperhydrosis in military and basketball boots althought not during barefooted martial arts.
Military boots were very well ventilated today (have come a long way).
This client is very resistive of debridement and just thinned off pitting today with mandrel.
He has been using methylated spirits for some time plantarly to help 'dry out' the plantar callous o/e today no signs of maceration and quite uniform in hydration with no fissures just a uniform thickening with pitting (almost a sand blasted appearance).
He has changed into woollen socks and continues to wipe the area with methylated spirits daily.
He wears his military boots for extended periods of activity and I understand that this combined with some excessive sweating would 'temporarily macerate' the hyperkeratosis and would possibly make it quite sore.
Interestingly he had done some investigation on the internet and thought that he required a topical antibacterial like erythromycin to stop the callous from pitting.

FYI the palms of his hands do not have it.

Questions
1.What do you think is causing the callous to pit?
2.Whats the deal with topical erythromycin?
3.How would you manage the hyperhydrosis(bearing in mind it is not really TRUE hyperhydrosis and occurs secondary to prolonged occlusion)?

Interested.........

 

The diagnosis is likely to be Pitted Keratolysis.

Read about it here.

Topical erythromycin, clindamycin or mupirocin works well, along with good hygiene practices.

LL

 

Thanks LL and Admin

 

i use to see a lot of this in young farmers when I was in private practice in the country mid summer, especially during harvesting.

Our local pharmacist was a bit of a legend and worked out a concoction of 5% Formalin in 80% alcohol, used for 2-3 weeks only. It tended to kill off the bacteria, reduce the sweating, turned the feet and interesting shade of yellow but worked a treat. Was only to use while symptomatic, maintain good hygiene then move to metho or foot deodorant of choice. Got rid of the stench, the crumpet feed and sweating quick smart.

Hope that helps :)