Foot Sweating / Plantar Hyperhidrosis

Also known in the medical field as plantar hyperhidrosis is a common form of localized excessive sweating. It may not have the same social impact on the patient as hand sweating but can be very bothersome to people. Over the last few years when more follow-up on patients who had ETS done it became obvious that excessive foot sweating (plantar hyperhidrosis) can pose the same social and functional difficulties that patients have with excessive hand sweating. We also noticed that the success rate for plantar hyperhidrosis after performing ETS is not more than 20%. Stories like severe embarrassment from the smell, necessity to change shoes and socks are a common problem. This can also affect intimate settings and create marital or relationship issues. Developmentally, the foot sweat glands, mature somewhat later in life than the hand sweating glands. Many patients state that their excessive foot sweating did not become apparent until after they had an excessive hand sweating problem.

Since Lumbar Sympathectomy was introduced there has been a smaller sub group of patients that have emerged who only suffer from excessive foot sweating (plantar hyperhidrosis). These patients do not have an associated hand sweating (palmar hyperhidrosis). There is genetic pattern that affects only the plantar area and so far lumbar sympathectomy has been a good option for these severe cases of excessive foot sweating.

Lumbar Sympathectomy - Proven Surgery Specifically for Excessive Foot Sweating
Now lumbar sympathectomy is offered as a surgical solution for those cases with severe plantar hyperhidrosis or plantar foot sweating. It should always be remembered that attempts should be carried out with some of the conservative measures that are available such as drysol, drionic or anti cholinergic agents. Recent evidence from different centers in the world showed that this operation is very effective to treat excessive foot sweating. This operation cannot be done at the same time as Thoracic Sympathectomy. An average of three to four months is needed to perform both operations. This is a cautious approach to ensure the body responds well to each operation. At present a good percentage of patients have the procedure done on an outpatient basis.

Updated Information:
This operation is done endoscopically and there are three small cuts made on the left and right side of the body (between the hip bone and the rib cage). In cases of technical difficulties, which is very rare, the surgery can be done in an open fashion through one incision and the difference in the amount of pain is minimal. At present not only is the operation done endoscopically but the operation can also be accomplished on an outpatient basis where the patient leaves the hospital on the same day.

One of the only doctors known to do this new approach in the U.S. is Dr. Reisfeld in Beverly Hills who is recognized as one of the leading authorities on this topic.

Sweaty feet as the sole presentation of hyperhidrosis appears in less than 5% of the patients. The majority of the patients will also have sweaty hands. As more time is gained more and more patients with only foot sweating (plantar) are coming for lumbar sympathectomy as their initial operation.

To see descriptions of various treatments click here.

The Success Rates for Different Types of Procedures:

ETS is very successful for those suffering from focal palmar hyperhidrosis (Sweaty Hands). With ETS those who also suffer from plantar hyperhidrosis (sweaty feet) the success rate is low. For those patients with remaining plantar hyperhidrosis the lumbar sympathectomy is now offered with a great deal of success. This is also true for people who suffer from isolated plantar hyperhidrosis and never had ETS done. The success rate of ELS is about 97 to 98%.

Additional Foot Sweating Resources:

  • Foot Sweating - Leading Los Angeles Surgeon Dr. Reisfeld and The Center for Hyperhidrosis. The only known doctor to perform both the ETS (hand sweating) and ELS (foot sweating) procedures.
  • Foot Sweating Treatment - Learn about the surgical treatment for foot sweating.
  • Plantar Hyperhidrosis


Can the hand and foot sweating surgeries be done at the same time?

Has it been proven if hyperhidrosis is hereditary?

Yes in a few studies that were published in peer review journals it has shown that more than 50% of the patients have some family history of hyperhidrosis. With the rest of the cases some families or individuals do not recall any relative with the illness but this could been a situation where it skipped a generation or simply not knowing all the family members. The location of the gene responsible for hyperhidrosis is known but the practical significance of what to do with that information is not yet developed.

I have both foot sweating and hand sweating. Should I do both procedures at the same time or separate them out?

Dear Seth,
With regard to your question the endoscopic thoracic sympathectomy (hand sweating) which mainly affects the hands and the endoscopic lumbar sympathectomy (foot sweating) which mainly affects the feet cannot be performed at the same time. There are some physiological reasons for this which should be discussed with a physician specializing in these procedures. One of the leading physicians performing this procedure in the US is Dr. Rafael Reisfeld. Visit his website at

I have been given a prescription for Ditropan today to combat excessive facial and head sweating what are your views?

Ditropan and other anticholinergic agents are medications that can be used and should be used for the treatment of facial hyperhidrosis. The scientific name for this clinical presentation is cranio-facial hyperhidrosis. I hope it will help you to a certain degree.

Is the ELS procedure safe and proven? How many procedures have been done? The website gives a success rate but not the number of cases.

The ELS procedure has been in practice since about 2006. The success rate for this procedure is about 97%. It is a safe procedure provided it is being done by an experienced surgeon. The reason we say this is because it is done only by very few surgeons who are experienced enough with this operation. Around the world there have been at least 1000 cases done as of now and information should be obtained from the surgeon before it is attempted.

I was given oxybutynin yesterday as a means to stop my excessive hand and foot sweating that I have had all of my life. I started it last night with little to no results, is this something that takes time to work.. most sites have said that it works instantly.

Thank you!

Oxybutynin, being an anticholinergic agent is one of the conservative oral medications used to treat hyperhidrosis. With this group of drugs there is an attempt to block a chemical which is released by the nerve ending and causing sweat. The success rate of this group of medications is relatively low if at all. There are patients who describe some success but usually to get a long lasting success one has to increase the dosage which later on will cause some side effects. It is a good attempt that you have done but any results could not be seen after one day. A blood level of the medication has to be built and then some response could be seen. I tell my patients to give it a try for at least 7-14 days and if there is no reduction in the excessive sweating of the hands and feet then most likely the response will be very limited.

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