Plantar hyperhidrosis or sweaty feet often accompanies severe sweaty hands, however in some people, it’s only the sweaty feet that is troublesome. People with this problem know how bothersome sweaty feet can be; they can’t wear sandals or flip-flops because they slip out of them. Expensive closed toe shoes get ruined because they absorb the salt minerals in sweat.
We recommend starting with a topical aluminum product and if that’s inadequate, adding tap water iontophoresis. Botox therapy in the feet can be very painful. It is possible to reduce the pain by performing a nerve block with local anesthesia before injecting the Botox, but none the less, results from Botox in the feet are temporary, as the Botox usually wears off in 3-4 months.
There are a variety of over the counter products that can be very helpful to deal with sweaty feet, and they can be used in conjunction with antiperspirants or iontophoresis.
ETS or endoscopic thoracic sympathectomy is not recommended for plantar hyperhidrosis. In our experience when ETS is performed for palmar hyperhidrosis or sweaty hands, approximately 50% of people state that their feet improve as well. It is unclear why a thoracic sympathectomy would have this effect considering the lumbar sympathetic nerves innervate the sweat glands in the feet. It is possible that as the emotional stress resulting from sweaty hands resolves, the neurostimuli to the lumbar sympathetics also recedes resulting in reduced plantar sweating. But because the response is unpredictable we do not advocate ETS for plantar hyperhidrosis.
ELS or endoscopic lumbar sympathectomy is a minimally invasive surgical procedure that interrupts the lumbar sympathetic nerve. This procedure is also associated with compensatory sweating like ETS, but also other potential serious side effects because the sympathetic innervation to the pelvic organs and genitalia are also effected. We do not advocate this procedure for plantar hyperhidrosis because of the surgical risks involved, and the potential for serious permanent side-effects.