Hyperhidrosis is a condition characterized by excessive sweating. Although it affects up to 3% of the US population, many people with hyperhidrosis are too embarrassed to discuss it with their healthcare providers. When left untreated, hyperhidrosis can significantly affect quality of life. Excessive sweating of the feet can cause discomfort and embarrassment, limit footwear options, make exercise difficult, and negatively impact self-esteem.
Fortunately, people with foot hyperhidrosis have effective treatment options. Botulinum toxin, commonly referred to by one of the brand names, Botox®, is routinely recommended as a first or second-line treatment that consistently reduces sweating.
Botox® or other Botulinum toxin brands, binds to synaptic proteins and blocks acetylcholine release from the neurons near the eccrine sweat glands. The results last six to nine months and come with minimal side effects, especially when using the right tools and techniques.
Here's what medical professionals should know to get the best results for their clients.
If you have experience injecting Botox® elsewhere, the process of injecting it into the feet for hyperhidrosis isn't much different. However, because this is a highly sensitive area and a treatment that requires multiple injections, anesthesia is crucial for patient comfort.
You'll start by sterilizing the target area with alcohol or a cleansing solution. Then, you'll block the pain. Since the stratum corneum on the sole of the foot is thick, a topical anesthetic like 4% lidocaine isn't usually strong enough to penetrate the area sufficiently. Instead, nerve blocks can be ideal because they numb the entire area, allowing for more precise injections and superior patient comfort. For foot injections, clinicians should block the sural and posterior tibial nerves.
Vibration anesthesia is another option that works well for certain patients. Providers may use two massagers, one on the dorsal side and another on the volar surface of the sole. Using a glove on top of the massager can help prevent blood contamination. Finally, some providers opt for cryoanesthesia, which uses pressure with ice, cold packs, liquid nitrogen, or ethyl chloride.
Pain tolerance varies, and management must be tailored to the individual. It's essential to review the pros and cons of different pain management options with your patients. Once the area is prepped, it's time to mark the injection sites and fill syringes with the proper dilutions.
Depending on the clinician's preference and the number of required injection sites, a range of injection volumes and dilutions may be used.
The general dilution recommendations are 4 units per 0.1mL using 2.5 mL of diluent (0.9% saline). Another possibility is 2.5 units per 0.1mL using 4mL of diluent (or any concentration that's convenient for delivering the required units per injection). The reconstituted solution should always be clear and colorless. It should never contain free particulate matter, regardless of whether preserved or non-preserved saline is used.
It's ideal to use Botox® within four hours of reconstitution. However, some studies suggest that longer storage time does not compromise its efficacy so long as the proper temperature and conditions are maintained.
Injections should be spaced 2 cm apart to ensure good coverage. To prevent bleeding and product loss, some experts suggest creating a longer injection track by injecting an oblique angle. Others recommend removing the thumb from the syringe plunger and waiting a few seconds for the pressure to normalize before withdrawing the needle.
To treat hyperhidrosis, clinicians should inject Botox® into the deep dermis and near the subcutaneous tissue junction, reaching the depth of the sweat glands. It's important to be mindful that the arch and center of the foot tend to have a thinner stratum corneum than the rest of the foot.
Patients should be educated about possible adverse effects of anesthesia and Botox® injections before the procedure. Any infections near the injection site or hypersensitivity to ingredients must be confirmed and evaluated before the procedure.
In addition, patients with peripheral motor neuropathic diseases or neuromuscular functional disorders have a heightened risk of systemic side effects from Botox®.
Clinicians should also be sure the patient is not pregnant or breastfeeding. Let patients know that they may require assistance for several hours after the injection until the numbness wears off. They should arrange a ride home and get extra help following the procedure.
The feet are a highly sensitive area. Since hyperhidrosis treatment requires overlapping coverage with several injections, sharp, high-quality needles from trusted brands like TSK are non-negotiable. Choosing the right needles will help minimize pain and ensure your patient's satisfaction.
Low dead space hubs are also a smart choice. Instead of throwing away expensive neurotoxins, choose a product like the low dead space MinimLL syringe to prevent unnecessary waste and keep more money in your pocket.
Air-Tite has specialized in hypodermics since 1926. We directly import high-quality products sourced from around the world, including companies in Germany, Japan, and the USA.
Click below to shop for needles and syringes online and stay stocked for your hyperhidrosis and other Botox® clients.