Bare your soles… to infection?

by Hillary on October 4, 2012


(c) anjrued, flickr creative commons license

This chinchilla is checking shoes for infection. Or eating them. Source: Flickr Creative Commons, (c) anjrued

My feet hate me. They have been subjected to barefoot and minimalist running, pool decks, rocky creek beds, and the hardwood floors of martial arts studios. I do my best to take care of them, especially given all the nasty stuff out there that one can encounter while barefoot/minimally shod. Today I’d like to introduce you to some of the unpleasant infections you can acquire through your feet.

MRSA (Methicillin-resistant Staphylococcus aureus)

Community-associated MRSA infections have grown increasingly common in recent years. Once limited to healthcare settings, MRSA can now be acquired through things like high-contact sports and puncture wounds. Athlete’s foot, eczema, and ingrown toenails seem to particularly put one at risk. The problem with MRSA is that in addition to resisting treatment and causing  painful, pus-filled boils it can result in an infection of the bloodstream if untreated. These systemic infections (sepsis) can infect vital organs, cause Toxic Shock Syndrome, and result in flesh-eating infections (necrotizing fasciitis).

  • Prevention: Wear shoes and cover scrapes and cuts while in public areas; wear “shower shoes” (i.e. flip-flops) while in public showers and pools. Contact a doctor if a wound is healing unusually slowly, and let a health care professional take care of any ingrown toenails. See a doctor for any puncture wound.

Plantar Warts (Human papillomavirus )

Human papillomavirus (HPV) has been a recent topic of discussion in regards to vaccines. Unfortunately for those at risk for plantar warts, the vaccine will not protect against the strains of virus that cause warts on the feet. Unlike MRSA, plantar warts can clear up on their own, and sustained infection will only result in satellite lesions – new warts that form in close proximity to the original wart. These eruptions can be painful, and they grow larger over time. If warts do not respond to over-the-counter treatments, doctors may choose to pursue cryotherapy (freezing), laser treatments, or even surgery. Treatment is important, since warts are contagious.

  • Prevention: Don’t share shoes, socks, or towels. Avoid going barefoot in moist, public areas.

Athlete’s Foot (tinea pedis)

Athlete’s foot is a fungal infection that thrives in warm, moist environments. It’s a relative of Jock Itch and results in stinging, burning, and itching at the infection site, usually in between the toes. The infection can spread to the toenails and other parts of the body, and it can also cause an allergic reaction. As we saw with MRSA, athlete’s foot can result in a secondary bacterial infection.

  • Prevention: Wear shoes in public spaces (I feel like this might be a take-home message), and wear shoes and socks that provide air circulation. Change your socks daily. As with plantar warts, don’t share items that come in contact with feet.

Appropriate foot care is important! Many of these protections from infectious disease can also prevent painful injuries. Don’t suffer from the agony of the feet!


Margaret October 4, 2012 at 11:27 am

I actually know someone that has gone unshod for the last 18 years. Oddly enough he has not had any of these problems, though I told him he had to wash his feet before coming inside, because I was more worried about what his feet might be carrying. Is this a valid worry based on your research? This was informative, but brief. Thanks for the feet health tips.


Hillary October 5, 2012 at 4:55 pm

Hi Margaret,

While I was researching this article, I did see some primary literature on exactly that subject. Researchers looked at foot pathogens among populations in India that went barefoot, and noticed that they had very few compared to populations that only went barefoot occasionally. Of course, now I can’t find the article, but as soon as I find it again I’ll post a link here.
As far as cleaning his feet, I request that people remove their shoes when they come in to my home (to prevent both dirt and pathogens), so asking him to quickly wipe down his feet seems like it would be in line with that.

Thanks for reading and commenting!

John Spevacek October 4, 2012 at 12:45 pm

I’m wondering if the order in which presented these diseases was the best. You started out with the big guy, MRSA, which then made the warts and mold seemed pretty tame, or even non-issues even though they are far more common and should therefore be a larger concern. Just a suggestion: try putting the MRSA paragraph at the end and see if anyone likes the order better.

Hillary October 5, 2012 at 5:00 pm

Hi John,

Thanks for the suggestion! I was torn stylistically between having the eye-catching pathogen “above the fold” or having the pathogens in order of virulence. Since plantar warts (as openings in the skin) and athlete’s foot can both make one more vulnerable to MRSA, do you think it would look more coherent to discuss those two pathogens as potentially leading to MRSA in addition to inflictions in their own right?

Thanks again,

Paula Johnson, PhD, MPH October 4, 2012 at 1:28 pm

Thanks for the sound advice. However, I agree that it was very brief, and it got a little boring. If you could tie it into some latest research article on the topic, it could be more interesting and current. Also, the picture is cute, but I fail to see a strong connection with the information.

Gaythia Weis October 4, 2012 at 2:38 pm

I think that starting with MRSA is what gives the article it’s unique and attention grabbing aspects. I do agree though that the article should not run down in significance towards the end. I think it could be tied together by focusing on overall foot health, and in particular, how having other problems leading to broken skin could make one more vulnerable to MRSA. Then the advice part could be phrased to apply to preventing all of the above.

Hillary October 5, 2012 at 5:02 pm

Hi Gaythia,

Thanks! I mentioned in my reply to John that in future I might consider tying-in all the pathogens together, if I write on a set of pathogens like this again.


Elizabeth Fryer October 5, 2012 at 9:30 am

While first-person language is appropriate for some of these blog posts, this post would be better without it. Rather than start with how YOU risk your foot health, just be general; say how people risk their foot health. **When using first person, you should use it throughout or at least again in the conclusion.**

Removing second-person “you” would make this post stronger too, as “you” was used only in the last sentence of the intro and in the suggestion to “change your socks.” So it’d be easy to write out.

Again, if you use “you,” you should use it throughout. Otherwise, the change in perspective will confuse readers. It’s not *such* a big deal for short pieces like this, just be aware.

The article has good info, but it would be better presented all in third person.

Angela October 5, 2012 at 6:30 pm

This is perhaps not very good feedback, but I have to say that I couldn’t get the song ‘Agony of Defeet’ by Parliament out of my head since reading your last sentence!

*mentally inserts youtube video here*

Otherwise I wondered if there were speculations/studies why MRSA infections are on the rise outside of healthcare settings (e.g. people going crazy with disinfecting things). Do the other inflictions you mention have interesting recent developments associated with them such as a rise in infections, new strains that are hard to combat or odd geographical movement? Thought that might also be useful for the reader, e.g. in terms of showing that/how diseases co-evolve.

PF Anderson October 6, 2012 at 10:55 am

Good topic, very good topic, but a lot leaps to my mind that could have also been included. I’ve seen this in some of the other blogposts as well — as soon as you start to include any kind of laundry list, then people naturally want you to include everything relevant. Perhaps really choose just ONE of these, and focus in?

Next, this seems to assume that the audience lives here. I know if you even shift one or two states down South, there is a big risk of picking up parasites from going barefoot. I’m sure in other countries, there are other risks. Is there a resource that maps common foot diseases by area, to help people discover their local risks of going barefoot? That could make a very interesting tool, if it doesn’t already exist.

There are a lot of popular MRSA foot treatments / home remedies mentioned out on the Internet. How effective are they? Alcohol wipes of feet after public showers; epsom salt soaks; probably more. Part of the point of MRSA as a problem is that it is resistent to antibiotics, so it makes sense to take the time to educate people about appropriate use and risk of OTC antibiotic creams or lotions for topical use and surface injuries, and the alternatives. That might make a good followup post? There has been some interesting work in the news lately about the dangers of OTC antibiotic lotions when overused.

The links you provide for MRSA are to consumer health information, and I couldn’t find any links to research articles (which is what I thought was the point of this blog?). One of the links you include to show some of the scarier dangers actually don’t support the argument that MRSA infections in the feet causes the risks you claim. I’m a bit concerned about the level of evidence selected to support your arguments. Especially since there is NO evidence linked for the other two topics! Of course, I’m also going to ask that a bibliography or end notes be provided for evidence cited or linked in the main body of the text.

For plantar warts, you mention OTC treatments, but give no clue what they are or what works. My doc recommends the duct tape treatment, for example. There are chemical topical treatments you can purchase in drug stores. There are old witch remedies involving tree trunks and the dark of moon, or the full of the moon, or chickpeas, or other wart charming strategies. There are people who still believe in those. Lots and lots of potential here. What’s the science? Also, people who read the popular science literature will certainly have heard about the association of HPV with many cancers. Are plantar warts a cancer risk? (Not as far as we know at this time.) But what is the science behind it? What makes plantar warts different from HPV infections in the rest of the body? Can HPV in the feet spread to other locations on the body? You say it’s highly contagious. How worried should we be?

I’m going to pass on athlete’s foot. Same ideas. Where’s the science? What are the risks? What are best practices? There is a very prominent emerging view recently that by NOT going barefoot or by not getting out really into the dirt and pathogens and parasites, we are actually creating a higher risk of disease. There was a well-done post to that effect on this blog last year. That this post proposes the opposite, and has inadequate science cited to support the argument, makes this a very risky post.

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