Proven Cure for Sweaty Feet


Sweaty FeetSweaty feet (excessive foot sweating) is known medically as plantar hyperhidrosis. Most patients who have sweaty hands will also have sweaty feet. Excessive foot sweating can be as severe as hand sweating, sometimes even worse.

Problems in everyday life, both socially and functionally, can be difficult as a result. Shoes can be ruined, sandals cannot be worn, heels can be too difficult to wear, and foot odor or fungal infection can become problematic. It can lead to relationship and marital problems as well as difficulties at the work place. Fortunately, there is finally an outpatient surgical solution to this problem with a 97-98% success rate.

Sweaty Feet Treatment – Surgery Success Rate

The proven surgical solution, specifically for excessive foot sweating, is now offered by Doctor Reisfeld. This procedure offers an amazing 97-98% success rate. Why not 100%? There are some rare cases in which anatomical abnormalities can be found, preventing the surgeon’s ability to complete the operation safely.

Also, in some rare cases severe scarring from previous unrecognized infections, previous chemical lumbar sympathectomies, or other surgeries can prevent the surgeon from completing the operation safely. Safety always comes first in these elective procedures.

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 reduction rate of ETS for foot sweating is only 15-20%.

Dr. Reisfeld performs the Lumbar Sympathectomy (ELS), which has a much higher success rate of 97-98%. A recent survey conducted by Dr. Reisfeld (3500 patients who had previous ETS) shows that some of the patients did see 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 the most effective option with high success rates. Doctor Reisfeld is the only surgeon in the U.S. and one of only a handful of skilled doctors in the world that performs this highly specialized procedure. Technically this procedure is basically different from the thoracic sympathectomy in that the space to get to the lumbar sympathetic chain has to be created by the surgeon which makes the operation a bit longer. Compared to the Thoracic Sympathectomy which can take anywhere from 30-40 minutes, the lumbar sympathectomy is somewhat longer between 75 minutes to 90 minutes (just over an hour). Once the space is created a delicate process takes place in order to isolate the sympathetic chain from the surrounding structures. For more details on the procedure visit our details of hyperhidrosis surgery page.

Sweat Free Feet

Symptoms of Plantar Hyperhidrosis

As mentioned before, palmar hyperhidrosis (sweat hands) is one type of hyperhidrosis. There is a unique manifestation of sweat that is limited from the ankles to the toes. This particular anatomical distribution is missed by regular physicians who are looking for different causes to explain plantar hyperhidrosis.

Usually plantar hyperhidrosis is associated with palmar hyperhidrosis in more than 99% of the cases. Palmar hyperhidrosis is uniquely limited to the wrist and the fingers. When the patient has both excessive foot and hand sweating, this should direct the treating physicians to the diagnosis of focal hyperhidrosis.

As said before throughout this website, it is highly likely a genetically determined pathology (meaning someone in the family has or had it). A conservative treatment should be tried first, but keep in mind that the success rate is limited. Nevertheless, attempts should be carried out.

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 estimates, the reason for that is 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 plantar hyperhidrosis, the excessive sweating appears from the ankles down. In the case of palmar hyperhidrosis, the excessive sweating appears from the wrist 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 patients, plantar hyperhidrosis is the major symptom that requires 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, these are all signs.

Any of the above or a 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 to the attention of a physician.

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 the 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 a Thoracic Sympathectomy and a 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 a Thoracic Sympathectomy and did not see improvements with their foot sweating they now have the new and proven option of Lumbar Sympathectomy to help with their symptoms. This is great news for anyone suffering from excessive foot sweating.

Unique Hyperhidrosis Expertise

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. He has authored or co-authored multiple peer reviewed papers and studies on the topic. This speaks greatly to his years of dedication and practice as a pioneer in the field of hyperhidrosis. When it comes to selecting the very best hyperhidrosis surgeon in the world, Dr. Reisfeld tops most people’s lists.

Currently, Dr. Reisfeld performs unique procedures for each type of focal hyperhidrosis. To learn more about each procedure, please see our hyperhidrosis treatments page.

Plantar Hyperhidrosis and mild Palmar Hyperhidrosis

For patients who have plantar hyperhidrosis as well as mild palmar hyperhidrosis, there’s something to note. If you decide to do the ELS surgery first, you might experience an increase in 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.

History of The Lumbar Sympathectomy

Since about 2005, a lot of information was obtained in regards to the performance of a lumbar sympathectomy for those patients who suffer from plantar hyperhidrosis. This new information also helped people who underwent an endoscopic thoracic sympathectomy and didn’t see improvements.

This information about lumbar sympathectomy was gathered initially in countries such as Brazil, France and Austria. The 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 male patients was proven not to be a problem.

The solution was to adjust the level of the lumbar sympathectomy below lumbar vertebrae #2. This particular question should be discussed at length with the surgeon before any male patients proceed with lumbar sympathectomy regardless.

Percutaneous chemical denervation ( chemical lumbar sympathectomy) of the lumbar sympathetic chain is practiced 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 the 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 its spread. 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 a 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 used with no success. Excessive hand sweating (palmar hyperhidrosis) can be fixed in about 97-98% of the cases with an upper Thoracic Sympathectomy.

With this procedure, excessive foot sweating can only be partially healed. 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 cured with a lumbar sympathectomy. For patients on whom Thoracic Sympathectomy did not help with their feet, the Lumbar Sympathectomy is a valuable and viable procedure.

New Observations

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 a lumbar sympathectomy at this level for patients with foot sweating and they claimed that their groin/buttock sweating improved.

Learn more about the Lumbar Sympathectomy for foot sweating treatment.

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 the lumbar sympathectomy. The paper is very significant because it adds further proof to the validity of performing endoscopic lumbar sympathectomies for patients who suffer from resistant plantar hyperhidrosis. The paper is available for review here:

Endoscopic Lumbar Sympathectomy for Focal Plantar Hyperhidrosis Using the Clamping Method – August 2010.

Second Paper

A second paper, completely dedicated to the topic of lumbar sympathectomy, will appear soon in peer reviewed surgical journals. This paper deals with the issue of lumbar sympathectomies. The accumulative experience of about 154 patients is reviewed. The experience gained between the first paper (2010) and now is reflected and, as time goes by, the increased number of cases performed is going to shed more light into the problem. This will 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 patient’s 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 as people with hand sweating. Dr. Reisfeld is happy to discuss your specific condition on a one-on-one basis to help you determine if surgery is the right option for you.

As more experience is gained over time a solitary presentation of plantar hyperhidrosis only is not a good indication to do ELS. For some unexplained reasons those patients with only plantar hyperhidrosis do not respond as well to lumbar sympathectomy. They might get some temporary relief of plantar hyperhidrosis but it is not a long lasting relief. The reason for that is not known however if more information becomes available in the future then the approach might be changed. It is imperative for the patient, who suffers only from excessive foot sweating, to talk with the doctor who understands the problem and is aware of the unique situation of plantar hyperhidrosis.

What is The Truth about Subdermal Curettage as a Treatment Method for Plantar Hyperhidrosis?

You may have read that subdermal laser curettage is being used by some doctors as a treatment for plantar hyperhidrosis. This is a way to entice patients to go this route with no proven success rate or any value to it. Patients who chose this route describe total failure with this approach and a tremendous amount of pain and discomfort.

They also describe an inability to use their feet, which confines them to wheelchairs (temporarily). Laser suction curettage, or simply suction curettage, in the axillary area has some value in isolated cases of axillary hyperhidrosis.

These days, doctors could offer another approach for the treatment for axillary sweating (armpit sweating). The reason there is no value in this approach in cases of plantar hyperhidrosis, is because of the fact that there is almost no subcutaneous tissues in the plantar region.

Foot Sweating (Plantar Hyperhidrosis) Summary

Excessive foot sweating can be a serious problem, both in social settings and everyday functional activities. 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.

At present, the endoscopic lumbar sympathectomy procedure has been refined to the level that it can now be done on an outpatient basis. This allows patients to return home or to their hotel on the same day as the procedure. The success rate for the surgical procedure is excellent at 98%

Hyperhidrosis Testimonials

“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 attribute 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 done in 2003, and wanted to thank you and your staff for all of the 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 about foot sweating 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 or post your comments or questions below and we will do our best to reply.

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