Plantar Hyperhidrosis - Lumbar Sympathectomy

Plantar Hyperhidrosis

Excessive sweating of the feet can occur in isolation or in conjunction with palmar hyperhidrosis.

This leads to excessive wear and tear on conventional footwear, an inability to wear open footwear such as sandals, and an increased incidence of infection, particularly fungal infection affecting the sole of the foot. Many patients complain of an odour associated with constantly moist feet.

When it accompanies palmar (hand) hyperhidrosis, the most common approach is to deal with the hand sweating first by endoscopic thoracic sympathectomy (ETS), as this is usually the more dominant problem. Fortuitously, in 60% of patients, a reduction in the severity of foot sweating is noted, even though the sympathetic nerve supply to the foot remains intact.

In cases where excessive sweating of the feet is the sole or dominant problem, division of the sympathetic nerve supply to the lower extremities by a Lumbar Sympathectomy (LS) will dry the feet.

Lumbar Sympathectomy (LS)

This is performed as an open procedure under general anaesthesia. Two separate incisions are made on each side of the abdomen. The muscle fibres of the abdominal wall are split to gain access to the lumbar sympathetic nerve or chain. A short segment of the lumbar sympathetic nerve including the nerve cells (called ganglia) is excised.

Patients are required to stay in hospital for up to 72 hours, as the abdominal incision can be painful, and regular painkillers (analgesia) are required.

I recommend reduced activity for at least 4 weeks, and accordingly I would recommend at 3 weeks off work following this procedure.

The results following LS are outstanding, achieving the objective of dry feet in all cases.

Rebound sweating which can occur following ETS does not occur after LS, though some patients report an ache in the thigh in the first 6 weeks.