Over the Counter Foot Products: The Good, The Bad and The Ugly

Google and other search engine technologies has moved us from the information age, into the knowledge age and how that knowledge is used can land anywhere on the spectrum from brilliant to disastrous. How this easy access information affects the feet may seem insignificant to the most of the population, compared to other happenings in the world. But the impact on the quality of life of individuals can be incredible, with some basic over the counter products being an absolute no-go for diabetic patients and the warnings in tiny writing it can be easily missed. So today, we look at the most commonly purchased over the counter podiatry products.

Anti-fungal Agents
Antifungal agents are a commonly bought, quick grab product when a cutaneous issue like tinea pedis presents itself. Tinea pedis thrives in warm, damp areas such as in between the toes. However, left untreated the condition can spread across a more diffuse area of the foot, leading to increased dry flaky skin – this is known as moccasin type tinea pedis, sometimes this will require more aggressive treatment in the form of systemic antifungal therapy.
The most widely available topical antifungal creams include:shutterstock_89663761
Caneistin (Clotrimazole)
Moni-stat-Derm (Miconazole)
Lamisil (Terbinafine)
Tinactin (tolnaftate)
Desenex (undecylenic acid)
A number of controlled studies have shown that all of these substances have a high rate of mycologic cure and symptom relief. However strong argument still stands that terbinafine remains the most effective. Additionally, improved hygiene practices are essential for reduced chance of re-infection post symptom relief. Tea tree oil has been found to reduce symptoms associated with tinea pedis, however, its mycologic cure properties have been found to be no more beneficial than a placebo.

Wart Treatments
A number of wart resolving treatments are available to the public, prescription free, through supermarkets and chemist outlets. The evidence for any and all wart treatment is quite poor, with many treatments being shown to be no more effective than the other and spontaneous resolution also being a contributor to a cure.
The primary mechanism behind wart resolution is the sparking off an immune response from the body to remove the pathology.
Whether cryotherapy, salicylic acid or lactic acid is the primary treatment product it should be made quite clear that those with an impaired vascular system, diabetes or neurological conditions should seek medical advice prior to purchase of any products which may cause cutaneous damage to the body.

Corns, Blisters and Excess Skin
Excess skin is commonly referred to in the podiatric community as hyperkeratosis. A corn is a hyperkeratotic lesion usually as the result of increased pressure specific to the area in which it is situated. Corn pads are an item readily available to the public, they typically use a sal acid compound designed to blister the area of skin where the corn lays with the aim of having the area resolve by falling off. Unfortunately, something we see far too often in the podiatric community is the disasters that grow from the use of these items. Quite often macerated tissues, some which have developed into full blown wounds are presented which require conservative treatment multiple times a week until completely healed.
Similar stories occur with the use of abrasive rollers and dry skin removing products which can cause further damage when used either incorrectly or too aggressively in the hope of developing silky smooth tooties.
In some circumstances the use of padding to offload areas of increased pressure may be absolutely appropriate, however, ensuring that the padding is placed in the correct area of the foot is a difficult task that some professionals will even have trouble with every now and then. Your best option is to see a podiatrist and give your feet a proper clean up and health assessment.

Insoles, Arch Supports and Orthotics
One of the most pressing and misunderstood products on the market and a regular question proposed to podiatrist on arrival to a consult – “ I have already tried orthotics from the chemist, what makes these any different?” …cue active sigh – let’s get some definitions out in the open to reduce the possibility of confusion.
Sock liner: the removable product in most athletic shoes designed to give mild cushioning while protecting the midsole stitching of the shoe.
Offloading Devices: products sold which often can be used individually or in conjunction with an orthotic device to achieve a desired outcome. These are inclusive of but not limited too; Metatarsal Domes, Heel Lifts, Rearfoot Wedging, Varus/Valgus bars and Tri-planar wedging.
Insole/Arch support:  a generic over the counter product with varying arch heights and cushioning properties, which supplies very little rearfoot or forefoot support.
Semi-Custom Device: a product available to podiatrist which can be heat moulded or adjusted in a way to partially customize the device for the individual. It is often a cheaper product than a custom device and is used for post-op care or if the offloading is only seen to be necessary for a short period of time.
Customized Orthotic Device: A 100% customized device made by an allied health professional for the purpose of offloading an area of concern, increasing function or increasing performance.

As described in all my articles, an offloading device is not the be all and end all for any biomechanical related condition. A program designed specifically for the improvement of strengthening and mobility is always a must. A multi-faceted approach will always produce better clinical results than a one-size fits all management plan.
In relation to the over the counter topical and cutaneous treatment products – please, always seek medical advice before purchasing that which you saw on a search engine produced website.

Until Next Time,

Jackson McCosker
Director/Chief Editor

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