Persistent Foot Odor: Bacterial Infections and Treatment Options

Bacterial infection of the feet can lead to odor?

Hello Doctor, I visited a dermatology clinic at the end of July due to an odor coming from my feet.
My feet appear completely normal, and I maintain good hygiene, including exfoliation.
It is not one of the four types of athlete's foot, there is no itching, no nail fungus, and when my feet are wet, there are no individual indentations.
Therefore, the dermatologist diagnosed me with a bacterial infection and prescribed me a cream and a gel, as well as antibiotics.
It has now been over a month, and I feel that my condition has not improved.

I assess my situation by smelling my shoes.
Here’s what I’ve noticed: I have a tendency to sweat a lot; when I wear slippers at home with odor-absorbing socks, there is "no smell" (although I still sweat in winter).
However, when I go out wearing enclosed athletic shoes, "the shoes smell." After taking off my shoes, my heels and socks do not smell, only the shoes do.
The shoes are not cheap, low-quality ones, and the odor-absorbing socks are quite effective.
In the past, when I wore cheap socks, they would also have a strange smell after washing.

The odor I experience is not like the sour smell after exercising, but there is definitely a smell.
The shoes I wear on the same day must be disinfected with bleach to eliminate the odor; otherwise, the smell intensifies with each wear.
Spraying alcohol or leaving them in the sun does not help.
Typically, people with foot odor are afraid of the smell escaping when they take off their shoes, but I am the opposite; I fear wearing enclosed shoes that cause the shoes to smell and emit an unpleasant odor.

Recently, I bought new shoes, but there is still a slight odor.
I also wear five-toe odor-absorbing socks when going out to prevent bacterial growth between my toes.
This issue has troubled me for many years.
I visited a dermatologist a long time ago, but it was never resolved.
After many years, I wanted to try again.
I have tried many home remedies and deodorizing products, including antifungal treatments, but nothing has worked.

The current doctor, possibly due to the air conditioning in the clinic, has not noticed any odor during my follow-up visits, even when I ask him.
However, I believe that in the narrow, poorly ventilated space outside the consultation room, other patients, even if wearing masks, might still sense something.
This thought always makes me anxious and embarrassed.
As the treatment days increase, the doctor has assessed my symptoms as mild, but I do not feel that way; the problem persists, and I sense that the doctor is gradually losing patience with me.
He has instructed me to finish the topical medications before returning for another visit, but my antibiotics are only for a week, and I am worried that without them, my condition will worsen.

I mentioned earlier that I had seen a dermatologist before without resolution.
Recently, I have been wondering if there is antibiotic resistance.
I am considering whether I should go to a larger hospital for a consultation to test what bacteria I might be infected with, to receive stronger antibiotics and a more potent topical treatment.
Can hospitals test for what bacteria is causing a skin infection? Is blood work necessary, or should I continue to be patient with my original dermatologist? The treatment has been ongoing for over a month, but I am gradually losing confidence.
If it were athlete's foot, it should be easy to treat since it can be observed externally, but my appearance is normal, indicating a stubborn bacterial infection, which is truly frustrating.
Thank you.

Chen, 20~29 year old female. Ask Date: 2023/09/07

Dr. Wu Yuxin reply Dermatology

Would you like to see a dermatologist directly, as I really don't know what the main issue is?

Reply Date: 2023/09/07

More Info

Persistent foot odor can be a frustrating and embarrassing issue, especially when it seems resistant to treatment. Based on your description, it appears that you may be dealing with a bacterial infection, which can often be exacerbated by excessive sweating and the enclosed environment of shoes. Here’s a comprehensive overview of the situation and some recommendations for addressing your concerns.

Understanding the Cause of Persistent Foot Odor
Foot odor is primarily caused by bacteria that thrive in warm, moist environments. When your feet sweat, the moisture can create an ideal breeding ground for these bacteria. While you mentioned that your feet do not have an odor when wearing breathable sandals or when at home, the problem arises when you wear enclosed shoes. This suggests that the issue is likely related to the combination of sweat and the materials of your shoes, which may not allow for adequate ventilation.

Bacterial Infections and Treatment Options
1. Diagnosis: It is crucial to confirm whether the odor is indeed due to a bacterial infection or another underlying condition. A dermatologist can perform a culture test to identify the specific bacteria involved. This can help in tailoring the treatment to target the specific pathogen effectively.

2. Antibiotic Treatment: If a bacterial infection is confirmed, your doctor may prescribe a more potent antibiotic. It’s essential to complete the full course of antibiotics as prescribed, even if symptoms improve before finishing the medication. If you are concerned about antibiotic resistance, discussing this with your healthcare provider is important, as they can adjust your treatment plan accordingly.

3. Topical Treatments: In addition to oral antibiotics, topical antibacterial creams or gels can be beneficial. These should be applied as directed by your physician. If the current topical treatments are not effective, your doctor may consider prescribing a stronger formulation.

4. Hygiene Practices: Maintaining good foot hygiene is vital. Wash your feet daily with antibacterial soap, and ensure they are thoroughly dried, especially between the toes. Consider using foot powders or antiperspirants designed for feet to help control moisture.

5. Footwear Choices: Since you mentioned that your shoes contribute to the odor, consider wearing shoes made from breathable materials. Rotate your shoes to allow them to air out between uses, and avoid wearing the same pair every day. Additionally, using odor-absorbing insoles or foot sprays can help manage the smell.

6. Socks: You mentioned using odor-reducing socks, which is a good practice. Ensure that these socks are made from moisture-wicking materials that help keep your feet dry. Changing socks during the day, especially if they become damp, can also help reduce odor.

When to Seek Further Help
If you have been following your current treatment plan for over a month without improvement, it may be time to seek a second opinion or consult a specialist at a larger medical facility. A comprehensive evaluation may include skin scrapings, cultures, or even blood tests to rule out any systemic issues that could be contributing to your symptoms.

Conclusion
Persistent foot odor, particularly when associated with a bacterial infection, can be challenging to manage. It is essential to work closely with your healthcare provider to ensure that you receive the appropriate diagnosis and treatment. By implementing good hygiene practices, making informed choices about footwear, and possibly seeking further medical evaluation, you can take significant steps toward resolving this issue. Remember, it’s important to advocate for your health and seek the care you need to feel comfortable and confident.

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