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As a practicing podiatrist for over 30 years, I have listened as thousands of my patients over the years have apologized for their foot odor. When I ask them what they do to try and control it, most often the answer is either powder or nothing. Yet, it causes them extreme distress and embarrassment. There are many causes of malodorous feet and the underlying etiology gives rise to excessive perspiration (hyperhidrosis) that is a great breeding ground for bacteria. Excessive perspiration can often be controlled through antiperspirant therapy. Just because we don’t often see TV commercials for foot odor, the first line of therapy would be to “fix” the problem with a roll-on or spray antiperspirant, the same ones used for underarm issues. When these don’t work, there are more powerful prescription antiperspirant that may be beneficial. Side effects of some of these products are excessive drying of the skin or skin irritation/sensitivity. For those patients who are willing to be more proactive, changes in lifestyle and diet can be very helpful in controlling foot odor. Diets high in refined carbohydrates will often serve as food for bacteria and fungus in the body, giving rise to discharge phenomenon. One such discharge is to expel these bacteria and fungus into the skin to slough off with dying skin cells. However, when they collect in the skin of the foot through perspiration and are enclosed in a shoe, the odor can become extreme. Correcting the diet by eliminating refined carbohydrates and balancing protein, healthy fats and complex carbohydrates can be very effective in reducing or eliminating foot odor. Additionally, reducing alcohol consumption and cessation of cigarette smoking will also go a long way to relieve the perspiration and therefore, the odor. Another cause of excessive perspiration is adrenal stress. The hormones that alert the body to danger can become elevated in patients that are exposed to chronic stress. These patients will experience increased perspiration and hence, succumb to malodorous foot problems. Moderating stress can be accomplished in many ways. Developing a calming meditation practice, yoga, regular exercise, psychotherapy, massage therapy, diet and lifestyle adjustments and herbal and nutritional supplements are all helpful in reducing the stress reactions that ultimately can worsen the odor. But what if none of the above works? Are patients doomed to suffer with the stress and embarrassment of smelly feet? The answer is no. For these patients, we can inject Botox® (botulinum toxin) to reduce perspiration. Although Botox is primarily used to relieve chronic muscle spasm and facial wrinkles, it is an excellent alternative for disabling the sweat glands and minimizing the release of moisture in the form of perspiration. The process is fairly simple. Each foot is treated at a separate session. The entire bottom of the foot is divided into a small grid system. An anesthetic injection is then given at the side of the ankle, numbing the entire bottom of the foot. The Botox can then be injected into each of the small grid squares at the level of the skin (usually around 40 to 50 injections per foot). Care is taken not to inject the Botox® into the deeper structures, as this will not stop perspiration and may disable some of the intrinsic muscles of the foot (causing temporary disability). Other than some possible tenderness in the foot for a day or two, side effects are extremely rare and mild (other extremely rare side effects can be discussed with your doctor). The effects of the Botox can last anywhere between three months and up to one year. Some patients will notice considerable improvement, while others will still need to use a topical antiperspirant in addition to the Botox injections for maximum results. There are some patients who will notice increased perspiration in the lower leg, however, since it is not contained in a shoe, there is no associated malodor as a result. In addition, some patients will need to come back for a second treatment to address areas that may have been missed in the first session. Results may be noticed in as quickly as a few days or up to a few weeks after injection. And yes, unfortunately, there are those patients who do not improve after treatment with Botox. Botox represents a viable alternative for the large number of patients suffering with hyperhidrosis of the feet when other therapies have failed to control or reduce the symptoms. It is also used successfully in patients with excessive underarm perspiration as well.