Non-Prescription Drug Products

The types of OTC products for foot health include pain medicines such as nonsteroidal anti-inflammatory drugs and products that treat athlete's foot, corns, calluses, blisters, and warts.

Depending on the intended use, some OTC foot products, such as lotions for moisturizing the skin, are considered cosmetics and not drugs. There are medicated powders and creams to treat athlete's foot. For corns and calluses, there are nonmedicated pads to improve comfort when walking, as well as medicated pads and patches that work to get rid of dead skin. Similar products are used to shrink warts. These products are typically made of salicyclic acid. They should be used with care so that healthy skin isn't harmed, and they should never be used by people with diabetes or poor foot circulation.

Matthew Holman, Ph.D., a scientist in the FDA's Office of Nonprescription Products, says consumers need to pay close attention to drug labels. "Consumers should read the indications, directions, and warnings carefully," Holman says. "A product won't be effective if you are trying to treat a condition that's not in the label. If it says to only use the product on intact skin with no open sores, that's important. If a product isn't working or the condition becomes worse, you need to seek a doctor's advice." People with heart disease, diabetes, and circulation problems should never self-treat because of the risk of infection.

Prescription Drugs

Prescription drugs for treating the feet include pain medicine, antibiotics for infections, and antifungal medicine. For instance, an ingrown toenail may require antibiotic or antifungal treatment if it becomes infected. For bunions and hammertoes, a cortisone injection may be given to relieve inflammation and pain.

Fungal nails make toenails thick, brittle, and discolored to white, yellow, or brown. The fungus grows deep in the nail bed, and it won't go away on its own. It also can spread to other toenails. "Discolored nails aren't always from fungus," says Andersen. "They could also be from trauma due to exercise or psoriasis, so we take a fungal culture to make a diagnosis."

Penlac (ciclopirox), made by Dermik Laboratories of Berwyn, Pa., is an example of a topical antifungal. It is generally used daily for several months for mild to moderate nail fungus. Side effects include irritation and redness around the nails. Oral medications for fungal infections, including fungal nails and athlete's foot, are Lamisil (terbinafine) made by Novartis Pharmaceuticals of East Hanover, N.J., and Sporanox (itraconazole), made by Janssen Pharmaceuticals of Titusville, N.J. These medicines travel through the bloodstream to attack the fungus. The tablets are taken daily for about 12 weeks. It takes about nine months for a healthy nail to grow in.

The most commonly reported side effects of the oral antifungals are headaches and stomachaches. In 2001, the FDA put out a public health advisory about both drugs and announced labeling changes. Both drugs have been associated with serious liver problems resulting in liver failure and death in rare cases. The FDA and the maker of Sporanox also warned against using Sporanox for those who have a heart condition, because of safety concerns.

Patients using these drugs should immediately report symptoms of persistent nausea, anorexia, fatigue, or vomiting, upper right abdominal pain or jaundice, dark urine, or pale stools. A simple blood test is used to check liver function during treatment.

Foot Surgery and Other Procedures

Common types of foot surgery include surgery to correct bunions, surgery for fungal nails when medications don't work, and surgery to reduce arthritis pain. For people who have chronic ingrown toenails, a procedure called matrixectomy may be used to prevent recurring problems. Andersen says, "We numb the toe and remove the smallest amount of the nail on the side, usually about one-eighth of an inch, and then use a chemical to kill the root or remove the root of the nail surgically."

Sometimes, bunions can be treated without surgery, but when bunions limit or affect one's daily activities, bunion surgery may be appropriate. Pain is the big factor here. Kaye says, "Bunion surgery may also be warranted if there is chronic inflammation and the person gets no relief from nonsteroidal anti-inflammatory drugs and other conservative treatments."

Kaye says there are two main components to bunion problems. "One problem is the pain associated with shoe pressure against the bony enlargement," he says. "The second condition is a stiff toe joint that causes internal joint pain during movement of the big toe. Both or either of these problems can occur."

Advanced surgical techniques have improved outcomes for bunion surgery. The type of surgery needed depends on the patient's age, activity level, and degree of deformity. Kaye says he doesn't only remove the "bump of bone," which won't usually produce lasting results. "We realign the bone and use a surgical screw for stable bone alignment," he says. Recovery time usually takes about four weeks.

"The precision in which the bone is cut, shaped, and realigned is critical," Kaye says. Though consumers may see lasers publicized to treat bunions, lasers can't cut bone or correct bunions, he says. Lasers are not cleared by the FDA for these indications.

According to the American College of Foot and Ankle Surgeons, there have also been advances in less invasive foot and ankle surgery. Newer surgical plates and screws let surgeons repair fractures with less trauma. Smaller incisions mean less bleeding and tissue damage.

In ankle arthroscopy, surgeons look at the ankle joint with a fiber optic camera system. This technique has been applied to knee surgery for several years, but now it's being used for bones and joints in the foot and ankle. This type of surgery can relieve inflammation from arthritis and ligament damage, with reduced recovery time as compared to open surgical procedures.

Before considering any surgery, people should always explore and discuss the nonsurgical options with their doctor, and the benefits and risks of surgery. It is also important to consider the doctor's experience and results with the procedure.

The American Orthopaedic Foot & Ankle Society (AOFAS) has released statements warning about trends in cosmetic surgery to improve the appearance of the foot. "Some women are getting surgeries to shorten toes and narrow their feet so they can fit into fashionable shoes," says Sharon Dreeben, M.D., chairwoman of the AOFAS Public Education Committee and an orthopedic surgeon in La Jolla, Calif.

"A woman recently called asking if I would inject collagen into her heel, and she will probably go doctor shopping to find someone who will do it," Dreeben says. "Some people want more padding to have cushion for high heels. But cosmetic foot surgery can result in chronic pain, infection, and nerve injury."

Dreeben has had to fix problems from cosmetic foot surgery that went wrong. "One woman had bunion surgery even though she hadn't been experiencing pain," she says. "She ended up with more problems, including nerve pain and difficulty walking."

The AOFAS defines cosmetic foot surgery as surgery that is aimed at only improving appearance. Dreeben says, "Foot surgery should only be used if the goal is to provide pain relief, improve function, or enhance quality of life during normal activities of daily living."

"I tell people: One difference between cosmetic surgery on the face and cosmetic surgery on the feet is that you don't walk around on your face. When you readjust one piece in the foot, it can affect everything."

Shock Wave Therapy

The most common cause of heel and arch pain is painful stretching or tearing of the plantar fascia, which runs along the bottom of the foot and supports the arch of the foot. Extracorporeal shock wave treatment is an outpatient procedure in which a medical device uses shock waves to relieve chronic heel pain. A dome filled with water is placed against the heel so shock waves pass through. The shock waves increase blood flow to trigger the healing process so that inflammation and pain subside.

FDA-approved devices for this procedure are the Ossatron, made by SanuWave Inc. of Marietta, Ga.; The Epos Ultra, made by Dornier MedTech, Kennesaw, Ga.; and the Orsabone Pain Relief System, made by Orthometrix Inc., White Plains, N.Y. People who have bleeding disorders, who are taking blood-thinning medication, or who are pregnant, should not undergo shock wave therapy. Complications can include mild neurological symptoms and tears in the tissue in the bottom of the foot.

Common Foot Ailments

Fungal Nails

Discolored toenails. Infection can spread to other nails. Fungal infection can be picked up in damp areas like swimming pools and locker rooms. Clean, dry feet help prevent it. Treatments are topical and oral antifungal medications and, in severe cases, surgery to remove the nail.

Ingrown Toenails

Nails whose corners or sides dig painfully into skin, often causing infection. Can be caused by improper nail trimming, pressure from shoes that are too small, injury, fungus infection, heredity, and poor foot structure. Trim toenails straight across to prevent problems. Soak the foot in soapy water, apply antiseptic, and bandage. Wear well-fitting shoes. If a toenail is painful or infected, the doctor may remove the ingrown portion.

Athlete's Foot

A skin disease that can spread from the feet to other parts of the body and is caused by fungus. This disease doesn't typically spread from person to person. Signs are dry, scaly skin; itching; inflammation; and blisters. Athlete's foot can be prevented by daily washing with soap and water, drying feet, changing sweaty shoes and hose and socks regularly, and wearing shoes or sandals in public environments like the locker room or pool.

Warts

Caused by a virus that enters the skin through small cuts and infects the skin. Children tend to be more susceptible than adults. Most warts are harmless, though they can be unsightly and painful. They can be caused by walking barefoot on dirty ground. Treatments include over-the-counter and prescription topical acids, and laser or surgical removal.

Bunions

Misaligned big toe joints that can become swollen and tender. The first joint of the big toe slants outward, angling the big toe toward other toes. Bunions tend to run in families, but can be aggravated by tight shoes. Conservative treatment includes padding, choosing shoes with wide toe box, and orthotic devices. Pain medicines and surgery to relieve pain may be needed in severe cases, but should not be done for cosmetic purposes.

Hammertoes

The toes are bent like a claw. This condition occurs most frequently with the second toe because of bunion slanting. It can be caused by muscle imbalance or can be made worse by tight shoes or tight socks. Pain medicine or orthotic devices may help. Surgery may be needed to realign toes.

Blisters: Caused by skin friction, especially from poorly fitting shoes. A band-aid should be worn until the blister heals, and socks should be worn with shoes. If the blister breaks, it should be washed, and an antiseptic and sterile bandage applied. It shouldn't be popped. It should be drained only by a professional.

Corns and Calluses

Protective layers of dead skin cells. Calluses appear on the soles of the feet, and corns appear on top of toes. They are caused by friction from skin rubbing and shoes. Pain may be relieved by moleskin or padding. They should never be cut with an instrument.

Plantar Fasciitis

Stretching or tearing of the plantar fascia, which runs along the bottom of the foot and supports the arch of the foot. Heel pads, pain medicines, or cortisone injections may help. Other conservative care includes splinting, stretching, avoiding walking barefoot, and physical therapy. Shock wave treatments use shock wave energy to relieve inflammation and are an alternative to surgery.

Neuroma

Enlarged benign growths of nerves, most commonly between the third and fourth toes. This nerve condition is caused by bones rubbing against and irritating the nerves. It is also caused by abnormal bone structure or pressure from poorly fitting shoes. It may cause pain, burning, or numbness between toes and in the ball of the foot. Treatment includes padding, taping, orthotic devices, and cortisone injections. Sometimes, surgical removal is required.

Heel Spurs

Calcium growths on the underside of the foot bones often associated with plantar fasciitis. Pain may occur if there is inflammation. Treatments range from exercise and custom-made orthotics to anti-inflammatory medication.