Most patients who have sweaty hands will also have sweaty feet, known medically as Plantar Hyperhidrosis. Excessive foot sweating can be as severe as hand sweating, sometimes worse. Problems in everyday life such as social and functional settings can be difficult. Shoes can be ruined, sandals cannot be worn, heels can be too difficult to wear, and foot odor and fungal infection can become problematic. It can lead to marital problems as well as difficulties at the work place. The odor and the discomfort caused by excessive foot sweating (plantar hyperhidrosis) can lead to difficulties that are not well known in the medical community. Fortunately there is finally a surgical solution to this problem with a 97% success rate.
Proven Cure for Sweaty Feet - Endoscopic Thoracic Sympathectomy (ELS):
A proven surgical solution, specifically for excessive foot sweating, is now offered by Doctor Reisfeld. This new procedure offers an amazing 97% success rate. Why not 100%? There are some rare cases in which anatomical abnormalities can be found preventing the surgeons ability to complete the operation safely. Also in some rare cases severe scarring from previous unrecognized infections, previous chemical lumbar sympathectomy or other surgeries can prevent the surgeon from completing the operation safely. Safety always comes first in these elective procedures. Doctor Reisfeld is one of only a handful of doctors in the World that specialize in this new procedure. You may ask why is this important? Many hyperhidrosis surgeons will offer a completely different and much less effective surgical solution for excessive foot sweating called Endoscopic Thoracic Sympathectomy (ETS). The long term success rate of ETS for foot sweating is only 15-20%. Dr. Reisfeld performs Lumbar Sympathectomy (ELS) which has a much higher success rate of 97%. A recent survey conducted by Dr. Reisfeld (3500 patients who had previous ETS) shows that some of the patients did get some improvements after ETS for their foot sweating but a great number of them still suffer from excessive foot sweating. For these patients the Lumbar Sympathectomy is offered as a effective option with high success rates.
For Former ETS Patients:
Performing upper Thoracic Sympathectomy (ETS) for excessive hand sweating often times does not fully solve the problem of excessive foot sweating. Only a small percentage of patients had the desired improvement. Until recently no specific operation was offered for patients suffering from excessive foot sweating. Surgeons in other countries developed Lumbar Sympathectomy which is specifically targeted for excessive foot sweating. In this special approach a specific segment of the sympathetic chain within the lumbar region is cut or clamped to relieve excessive foot sweating. The important difference between Thoracic Sympathectomy and Lumbar Sympathectomy is that the Thoracic Sympathectomy helps specifically with excessive hand sweating while Lumbar Sympathectomy helps specifically with excessive foot sweating. It should be understood that even though patients who suffer from hand sweating also suffer from excessive foot sweating the Thoracic Sympathectomy (ETS) helps mainly with excessive hand sweating. For those patients who underwent Thoracic Sympathectomy and did not see improvements with their foot sweating they now have the new and proven option of Lumbar Sympathectomy to eliminate their excessive foot sweating. This is great news for anyone suffering from excessive foot sweating.
Currently Dr. Reisfeld performs unique procedures for each type of focal hyperhidrosis. To learn more about each procedure please see our hyperhidrosis treatments page.
Doctor Reisfeld is currently the only known surgeon who has the expertise to perform both the Endoscopic Thoracic Sympathectomy and the Endoscopic Lumbar Sympathectomy procedures. This speaks greatly to his years of dedication and practice in the field of hyperhidrosis.
Plantar Hyperhidrosis and mild Palmar Hyperhidrosis:
For patients who have plantar hyperhidrosis as well as mild palmar hyperhidrosis and decide to do the ELS surgery first they might experience an increase in their palmar hyperhidrosis to a level that was not significant before. How long this increased level of palmar hyperhidrosis will occur is not yet known but the patient should be aware of this possibility. Whether ETS will be necessary or not is still unknown.
Causes of Excessive Foot Sweating:
As far as we know the same gene that causes palmar hyperhidrosis (excessive hand sweating) is responsible for excessive foot sweating as well. The gene causes heightened activity in the sympathetic chain which is part of the involuntary nervous system. The difference is that clinical manifestation of palmar hyperhidrosis will show itself earlier in life than plantar hyperhidrosis. This is to say that excessive hand sweating is usually a problem earlier in life than excessive foot sweating. In our estimation the reason for that is that the maturation process of plantar sweat glands takes longer than palmar sweat glands. Of interest is the fact that plantar hyperhidrosis (feet) as well as palmar hyperhidrosis (hands) are limited to a specific part of that organ. In the plantar hyperhidrosis the excessive sweating appears from the ankles down. In the case of palmar hyperhidrosis the excessive sweating appears from the wrist and down to the hands.
Diagnosis of excessive foot sweating:
How do I know if this surgical procedure is right for me? Plantar hyperhidrosis usually is associated with palmar hyperhidrosis. In about 5-10% of the patients plantar hyperhidrosis is the major presenting symptom requiring attention. If a patient has to change their socks a few times a day, routinely has ruined shoes due to sweat, has macerated skin and or recurrent infections that produce smell. Any of the above or combination of the above can be a reason to consult with a physician and to try some conservative measures. This is a subjective issue that must be brought by the patient to the attention of his or her treating physician.
History on Lumbar Sympathectomy:
Since about 2005 much more information was obtained with regard to the performance to lumbar sympathectomy for those patients who suffer from plantar hyperhidrosis as a primary problem or for those patients on whom their excessive sweaty feet did not improve after endoscopic thoracic sympathectomy. This information about lumbar sympathectomy was gathered initially in countries such as Brazil, France and Austria. Lumbar sympathectomy became the operation of choice for those patients. It is done equally on female and male patients. The question of whether or not the operation will affect retrograde ejaculation in the male patients was proven not to be a problem as long as the level of the lumbar sympathectomy is below lumbar vertebrae #2. This particular question should be discussed at length with the surgeon before any male patients proceed with lumbar sympathectomy.
Percutaneous chemical denervation of the lumbar sympathetic chain is tried in some places but depending on the material used the effect can be temporary or run the risk of associated injuries to nearby organs such as ureters or blood vessels. The reason for that risk is that when the chemical component is injected it can progress to nearby structures without any ability to limit the spread of this chemical. The benefit of surgical lumbar sympathectomy is that those organs nearby are recognized and protected throughout the procedure.
Pain after the operation is typically minimal and temporary. So far the pain after lumbar sympathectomy is described as less than the pain experienced after ETS. A decision to go forward with this operation should be considered only after a detailed discussion with the surgeon to perform the procedure occurs. To learn more about the details of lumbar sympathectomy click the link. Most of the patients had a one night stay and occasionally some patients go home the same day.
In summary, as excessive hand and foot sweating becomes better understood in the medical field we can now say that those problems are best helped with surgical approaches once the conservative measures have been tried with no success. Excessive hand sweating (palmar hyperhidrosis) can be helped in about 98% of the cases with upper Thoracic Sympathectomy but with this procedure excessive foot sweating can be helped only partially. Now thanks to extensive clinical work done in other countries such as Brazil and Europe, as well as with the United States, excessive foot sweating can be helped with lumbar sympathectomy. For patients on whom Thoracic Sympathectomy did not help with their excessive foot sweating Lumbar Sympathectomy is a valuable and available procedure.
For patients that have compensatory sweating in the groin / buttocks areas after having first done the ETS procedure there is some observed improvement after performing the lumbar sympathectomy at a level of L2 or close to L2 as possible. This observation came about after Dr. Reisfeld performed lumbar sympathectomy at this level for patients with foot sweating and they claimed that their groin / buttock sweating improved.
Learn more about Lumbar Sympathectomy for foot sweating treatment.
Foot Sweating (Plantar Hyperhidrosis) Summary:
Excessive foot sweating can be a serious problem both in social settings and everyday functional activities such as being comfortable in your home or working environments. This can also affect intimacy between couples due to the smell, discomfort and embarrassment it causes. This is especially true for women having difficulties wearing the appropriate footwear.
You may ask what should I do? Those affected should first discuss the matter with their doctor and then first try the conservative hyperhidrosis treatment measures available. If those measures do not give satisfactory relief then consideration should be given to the hyperhidrosis surgical treatment options to hyperhidrosis. At present the endoscopic lumbar sympathectomy was refined to the level that it can now be done on an outpatient basis allowing patients to return home or to their hotel on the same day as the procedure. The success rate for the surgical procedure is excellent - 98%
Lumbar Sympathectomy Doctor/Peer Reviewed Paper:
Dr. Reisfeld finished working on an important published paper regarding his experience with the initial 65 patients who underwent lumbar sympathectomy. The paper is very significant because it adds further proof to the validity of performing endoscopic lumbar sympathectomy for patients who suffer from resistant plantar hyperhidrosis. The paper is available for review:
Endoscopic Lumbar Sympathectomy for Focal Plantar Hyperhidrosis Using the Clamping Method - August 2010.
A second paper, completely dedicated to the topic of lumbar sympathectomy, will appear soon in one of the peer reviewed surgical journals. With this paper dealing with the issue of lumbar sympathectomy the accumulative experience of about 154 patients is reviewed. The experience gained between the first paper (2010) and now is reflected and obviously as time goes by and the increased number of cases performed is going to shed more light into the problem, improve the technique outcome and satisfaction of patients involved.
What if I have only plantar hyperhidrosis (foot sweating) without any palmar hyperhidrosis (hand sweating)?
We are seeing more cases where the patients only problem is plantar hyperhidrosis. It is a somewhat smaller group of patients but their foot sweating is severe enough to pose as many problems and patients that have severe hand sweating. Dr. Reisfeld is happy to discuss your specific condition on a one on one basis to help you determine if the surgery is the right option for you.
"I am able to wear whatever shoes I want. I can buy a beautiful dress, a beautiful pair of shoes and not the shoes that are "ok" just because my feet will sweat."
Florijana Read More From Florijana
"I not only love my dry hands, but I love my dry feet and armpits as well. In the summer I was able to wear sandals and even flip-flops.! I just can't believe how well my body has responded to the procedure."
Susana Read More From Susana
"I believe the surgery took place sometime in 2001, I am happy to say that everything is going well. I contribute the ETS procedures as a major part of my success." (7 Years Later)
Paul Read More From Paul
"I admire your impeccable professionalism and your utmost skill in the performance of this highly technical and precise surgical procedure. I have waited many years since I was a young girl to properly get rid of this problem. My knowledge as a dermatologist led me to the best procedure and to the best doctor."
Ligaya.B, M.D. Read More From Doctor Ligaya
"I had the ETS surgery for palmar hyperhidrosis in 2003 and wanted to thank you and your staff for all of help. Taking a standardized test in the past was nearly impossible without handing in a sopping wet ScanTron sheet. Since my surgery date, I was able to take the paper and pencil medical school entrance exams. I applied to medical school and now I am a second year medical student in Ohio! This surgery changed my life."
Sarah Read More From Sarah
"I would also like to thank all of your staff for such a pleasant experience. They were very friendly and helpful from the first time that I made a phone call to your office up to the time in the recovery room. Everyone made me feel very comfortable and well taken care of."
Peggy.P Read More From Peggy
Read from several touching thank you letters Dr. Reisfeld has received over the years since 1996.
Frequently Asked Sweaty Feet Questions:
Do you have any questions that were not answered here? Would you like to speak with Dr. Reisfeld to answer those questions? To learn more about what we can do for you, contact The Center for Hyperhidrosis by contacting our office. Please view our disclaimer.