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INTRODUCTION

Acral surfaces, such as the feet, have unique characteristics that make them prone to certain dermatologic conditions. The plantar surface of the foot has the thickest keratin layer, a high concentration of eccrine sweat glands as well as sensory nerves, Pacinian corpuscles and other mechanoreceptors. The combination of abundant keratin and sweat creates an ideal environment for fungal infections. Friction and contact with footwear also make the feet susceptible to contact dermatitis. In addition, the feet are disproportionately affected by vascular disorders, due to their gravity-dependent anatomical location, and by peripheral small fiber sensory neuropathies. Since the feet are a site of frequent injury, vascular disorders and sensory neuropathies predispose this area to recurrent and difficult to manage wounds.

APPROACH TO DIAGNOSIS

Skin diseases involving the feet can be broadly placed into the following categories starting with the most common diseases (Table 40-1).

  • Inflammatory Dermatoses

  • Infectious Diseases

  • Ulcers

Table 40-1.Differential diagnosis for skin diseases of the feet

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