Kicking Veterans’ Foot Problems

A leading authority on diabetic foot health, foot care, and amputation prevention talks about common foot problems.

By Dr. Mark Hinkes, DPM

What is a podiatrist?I haven’t been to Vietnam, but as a podiatrist who has treated hundreds of veterans who have served there, I can tell you that “jungle rot” is real. In fact, these nasty infections of the skin and nail are the most common foot problems Vietnam veterans have suffered, and they still plague many veterans today. The good news is that with good self-care, there is no reason to prolong the suffering.

Skin infections

Why have so many Vietnam veterans suffered tinea pedis or athlete’s foot? The culprit is chronic exposure to water and moisture, often as a result of walking in rice paddies or rain-soaked jungles. Coupled with not being able to wash and change to dry socks and shoes, these conditions may have helped create the moist, dark, and warm environment that is perfect for feet to develop mold, yeast, and fungal infections. Once this “jungle rot” has a foothold in the skin, bacteria can invade the already infected skin to complicate an already bad situation.

“Jungle rot” is real.

The symptoms of skin infections include itching, swelling, redness, and skin breakdown – mostly between the toes and on the bottom and sides of the feet. Despite treatment with topical creams and lotions, too many veterans have had this infection linger on their feet for decades.

If you are suffering from “jungle rot,” here are some pointers that can help you fight the problem.

How to fight skin infections

Get a foot specialist to take a skin sample from the affected area and send it in for pathological analysis, checking for bacterial and fungal cultures.

Once the affecting organism(s) is identified, the infection can be treated with antibiotic and antifungal medications. The appropriate antibiotic to use will be determined by identifying the bacteria in the wound. A medication in pill form, Terbinifine (LAMISIL®) or Itraconizole (SPORANOX®) is the best oral medication to treat the mold, yeast, or fungal portion of the infection.

Before taking any antifungal medications, be sure to get a liver-function test. If you have a history of liver problems or hepatitis, you may not be able to take these medications.

In some cases, it’s better to replace your shoes and socks, as they can be the source of re-infection.

Nail infections

The same conditions that result in fungal skin infections can also cause fungal nail infections. In many cases, the skin infection starts first, and then infects the nails. Once infected, the nails typically change from their smooth, shiny, and pink condition to become thickened, or flaky – discolored to various shades of yellow, green, brown, or black. Sometimes just wearing shoes and walking can cause pain to the nails. The name of the problem that commonly affects the toenails of Vietnam veterans is onychomycosis (onycho = nail, mycosis = fungus).

How to fight nail infections

Have your foot-care specialist take a sample of your nail, and send it in for a pathology test called the Periodic Acid-Schiff test – a method of checking the anatomic pathology. This test will identify if the nail is infected with mold, yeast, or fungus.

Onychomycosis is best treated with an oral anti-fungal mediation such as Terbinifine (LAMISIL®) or Itraconizole (SPORANOX®). These medications are usually taken for 90 days. The same criteria for using these medications with a skin infection should be observed when treating a nail infection.

Nail problem not always an infection

A note of caution: In some cases, nails may appear to be infected, but you might actually have totally dystrophic nail syndrome or “blunt-force trauma.” Medications will not cure this syndrome. Treatment may include having a foot-care specialist debride (clean out) the nail, and reduce its thickness. The pathology test will show if the nail is, in fact, infected.

In any case, personal hygiene is an important part of the solution to clearing up foot infections. So you should bathe the affected area daily with soap and water, rinse and dry. Wash your socks with bleach, and use an ultraviolet sterilizing light inside your shoes to help to prevent re-infections.

Take care of your feet and they will take care of you.

 

Mark Hinkes, DPMMark Hinkes, DPM, is the Chief of the Podiatry Service and Director of Podiatric Medical Education for the VA medical centers in Nashville and Murfreesboro, Tennessee.