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Relief for Plantar Hyperhidrosis
A Lasting Solution For Sweaty Feet
Excessive foot sweating can interfere with daily life — from ruined shoes and limited footwear choices to discomfort, odor, and even relationship stress. These challenges often go beyond inconvenience, affecting both confidence and quality of life. Fortunately, there is finally an outpatient surgical solution to this problem with a 97-98% success rate.
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Results That Speak for Themselves
Surgery Success Rate
The proven surgical solution, specifically for excessive foot sweating, is now offered by Doctor Reisfeld. This procedure offers an amazing 97-98% success rate. Why not 100%? There are some rare cases in which anatomical abnormalities can be found, preventing the surgeon’s ability to complete the operation safely.
Also, in some rare cases severe scarring from previous unrecognized infections, previous chemical lumbar sympathectomies, or other surgeries can prevent the surgeon from completing the operation safely. Safety always comes first in these elective procedures.
The Truth Behind the Numbers
Why Is This Important?
Many hyperhidrosis surgeons will offer a completely different and much less effective surgical solution for excessive foot sweating called Endoscopic Thoracic Sympathectomy (ETS). The long term reduction rate of ETS for foot sweating is only 15-20%.
Patient Stories
More Stories of Hope and Healing
Hallie’s Story: The moment she found out about her excessive sweating.
Living with hyperhidrosis [excessive sweating] can be overwhelming…
We’re so excited for Nelly to step into this new chapter after surgery!
The Most Advanced Option for Lasting Relief
Dr. Reisfeld’s Expertise in Lumbar Sympathectomy (ELS)
Dr. Reisfeld performs the Lumbar Sympathectomy (ELS), which has a much higher success rate of 97-98%. A recent survey conducted by Dr. Reisfeld (3500 patients who had previous ETS) shows that some of the patients did see improvements after ETS for their foot sweating, but a great number of them still suffer from excessive foot sweating.
For these patients, the Lumbar Sympathectomy is offered as the most effective option with high success rates. Doctor Reisfeld is the only surgeon in the U.S. and one of only a handful of skilled doctors in the world that performs this highly specialized procedure. Technically this procedure is basically different from the thoracic sympathectomy in that the space to get to the lumbar sympathetic chain has to be created by the surgeon which makes the operation a bit longer. Compared to the Thoracic Sympathectomy which can take anywhere from 30-40 minutes, the lumbar sympathectomy is somewhat longer between 75 minutes to 90 minutes (just over an hour). Once the space is created a delicate process takes place in order to isolate the sympathetic chain from the surrounding structures. For more details on the procedure visit our details of hyperhidrosis surgery page.
What to Look For
Symptoms of Plantar Hyperhidrosis
As mentioned before, palmar hyperhidrosis (sweat hands) is one type of hyperhidrosis. There is a unique manifestation of sweat that is limited from the ankles to the toes. This particular anatomical distribution is missed by regular physicians who are looking for different causes to explain plantar hyperhidrosis.
Usually plantar hyperhidrosis is associated with palmar hyperhidrosis in more than 99% of the cases. Palmar hyperhidrosis is uniquely limited to the wrist and the fingers. When the patient has both excessive foot and hand sweating, this should direct the treating physicians to the diagnosis of focal hyperhidrosis.
As said before throughout this website, it is highly likely a genetically determined pathology (meaning someone in the family has or had it). A conservative treatment should be tried first, but keep in mind that the success rate is limited. Nevertheless, attempts should be carried out.
The Hidden Triggers
What Causes Excessive Foot Sweating?
As far as we know, the same gene that causes palmar hyperhidrosis (excessive hand sweating) is responsible for excessive foot sweating as well. The gene causes heightened activity in the sympathetic chain, which is part of the involuntary nervous system. The difference, is that clinical manifestation of palmar hyperhidrosis will show itself earlier in life than plantar hyperhidrosis.
This is to say that excessive hand sweating is usually a problem earlier in life than excessive foot sweating. In our estimates, the reason for that is the maturation process of plantar sweat glands takes longer than palmar sweat glands. Of interest is the fact that plantar hyperhidrosis (feet) as well as palmar hyperhidrosis (hands) are limited to a specific part of that organ.
In plantar hyperhidrosis, the excessive sweating appears from the ankles down. In the case of palmar hyperhidrosis, the excessive sweating appears from the wrist down to the hands.
Who Should Consider Surgery
How Do I Know If This Surgical Procedure Is Right For Me?
Plantar hyperhidrosis usually is associated with palmar hyperhidrosis. In about 5-10% of patients, plantar hyperhidrosis is the major symptom that requires attention. If a patient has to change their socks a few times a day, routinely has ruined shoes due to sweat, has macerated skin, and or recurrent infections that produce smell, these are all signs.
Any of the above or a combination of the above can be a reason to consult with a physician, and to try some conservative measures. This is a subjective issue that must be brought to the attention of a physician.
Relief Beyond ETS
For Former ETS Patients
Performing upper Thoracic Sympathectomy (ETS) for excessive hand sweating often times does not fully solve the problem of excessive foot sweating. Only a small percentage of patients had the desired improvement. Until recently, no specific operation was offered for patients suffering from excessive foot sweating.
Surgeons in other countries developed the Lumbar Sympathectomy, which is specifically targeted for excessive foot sweating. In this special approach, a specific segment of the sympathetic chain within the lumbar region is cut or clamped to relieve excessive foot sweating. The important difference between a Thoracic Sympathectomy and a Lumbar Sympathectomy, is that the Thoracic Sympathectomy helps specifically with excessive hand sweating, while Lumbar Sympathectomy helps specifically with excessive foot sweating.
It should be understood that even though patients who suffer from hand sweating also suffer from excessive foot sweating, the Thoracic Sympathectomy (ETS) helps mainly with excessive hand sweating. For those patients who underwent a Thoracic Sympathectomy and did not see improvements with their foot sweating they now have the new and proven option of Lumbar Sympathectomy to help with their symptoms. This is great news for anyone suffering from excessive foot sweating
Pioneering Treatments
Hyperhidrosis Expertise
Doctor Reisfeld is currently the only known surgeon who has the expertise to perform both the Endoscopic Thoracic Sympathectomy and the Endoscopic Lumbar Sympathectomy procedures. He has authored or co-authored multiple peer reviewed papers and studies on the topic. This speaks greatly to his years of dedication and practice as a pioneer in the field of hyperhidrosis. When it comes to selecting the very best hyperhidrosis surgeon in the world, Dr. Reisfeld tops most people’s lists.
Currently, Dr. Reisfeld performs unique procedures for each type of focal hyperhidrosis. To learn more about each procedure, please see our hyperhidrosis treatments page.
Important Consideration
How Plantar Treatment May Affect Palmar Hyperhidrosis
For patients who have plantar hyperhidrosis as well as mild palmar hyperhidrosis, there’s something to note. If you decide to do the ELS surgery first, you might experience an increase in palmar hyperhidrosis to a level that was not significant before. How long this increased level of palmar hyperhidrosis will occur is not yet known, but the patient should be aware of this possibility. Whether ETS will be necessary or not is still unknown.
Decades of Progress
History of Lumbar Sympathectomy
Since about 2005, a lot of information was obtained in regards to the performance of a lumbar sympathectomy for those patients who suffer from plantar hyperhidrosis. This new information also helped people who underwent an endoscopic thoracic sympathectomy and didn’t see improvements.
This information about lumbar sympathectomy was gathered initially in countries such as Brazil, France and Austria. The Lumbar sympathectomy became the operation of choice for those patients. It is done equally on female and male patients. The question of whether or not the operation will affect retrograde ejaculation in male patients was proven not to be a problem.
The solution was to adjust the level of the lumbar sympathectomy below lumbar vertebrae #2. This particular question should be discussed at length with the surgeon before any male patients proceed with lumbar sympathectomy regardless.
Percutaneous chemical denervation ( chemical lumbar sympathectomy) of the lumbar sympathetic chain is practiced in some places, but depending on the material used, the effect can be temporary or run the risk of associated injuries to nearby organs such as the ureters or blood vessels.
The reason for that risk is that when the chemical component is injected, it can progress to nearby structures without any ability to limit its spread. The benefit of surgical lumbar sympathectomy is that those organs nearby are recognized and protected throughout the procedure.
Pain after the operation is typically minimal and temporary. So far the pain after a lumbar sympathectomy is described as less than the pain experienced after ETS. A decision to go forward with this operation should be considered only after a detailed discussion with the surgeon to perform the procedure occurs. To learn more about the details of lumbar sympathectomy click the link. Most of the patients had a one night stay and occasionally some patients go home the same day.
In summary, as excessive hand and foot sweating becomes better understood in the medical field, we can now say that those problems are best helped with surgical approaches once the conservative measures have been used with no success. Excessive hand sweating (palmar hyperhidrosis) can be fixed in about 97-98% of the cases with an upper Thoracic Sympathectomy.
With this procedure, excessive foot sweating can only be partially healed. Now, thanks to extensive clinical work done in other countries such as Brazil and Europe, as well as with the United States, excessive foot sweating can be cured with a lumbar sympathectomy. For patients on whom Thoracic Sympathectomy did not help with their feet, the Lumbar Sympathectomy is a valuable and viable procedure.
New Insights for Patients
New Observations
For patients that have compensatory sweating in the groin/buttocks areas after having first done the ETS procedure, there is some observed improvement after performing the lumbar sympathectomy at a level of L2 or close to L2 as possible. This observation came about after Dr. Reisfeld performed a lumbar sympathectomy at this level for patients with foot sweating and they claimed that their groin/buttock sweating improved.
Learn more about the Lumbar Sympathectomy for foot sweating treatment.
99.2% Success Rate
Hyperhidrosis Testimonials:
Backed by Research
Doctor/Peer Reviewed Paper:
Dr. Reisfeld finished working on an important published paper regarding his experience with the initial 65 patients who underwent the lumbar sympathectomy. The paper is very significant because it adds further proof to the validity of performing endoscopic lumbar sympathectomies for patients who suffer from resistant plantar hyperhidrosis. The paper is available for review here:
Endoscopic Lumbar Sympathectomy for Focal Plantar Hyperhidrosis Using the Clamping Method – August 2010.
New Clinical Findings
Advancing the Science of Hyperhidrosis Treatment
A second paper, completely dedicated to the topic of lumbar sympathectomy, will appear soon in peer reviewed surgical journals. This paper deals with the issue of lumbar sympathectomies. The accumulative experience of about 154 patients is reviewed. The experience gained between the first paper (2010) and now is reflected and, as time goes by, the increased number of cases performed is going to shed more light into the problem. This will improve the technique, outcome, and satisfaction of patients involved.
Patient FAQs
Answers to Common Questions About Sweaty Feet
Is it normal to have sweaty feet?
Foot sweating can be a normal function of your body under certain circumstances, such as intense physical activity. Excessive foot sweating, however, is defined as sweating that goes beyond the normal physiological needs of your body.
This type of excessive foot sweating is known in the medical community as hyperhidrosis. If a person is sweating from his or her palms under normal conditions (non-active, no stress or excitement, normal temperature, social interaction), then they may have hyperhidrosis. Hyperhidrosis is a genetically inherited condition which causes social and functional problems in everyday life.
As a part of the hyperhidrosis symptoms, sweaty feet and sweaty hands are possible. For many patients, excessive hand sweating is the more bothersome issue. Excessive hand sweating appears earlier than excessive foot sweating in many cases.
This has to do with the maturation of the sweat glands in the feet which are fully developed later in life (mid 20’s). Patients with excessive foot sweating are suffering from it on the same level as those with excessive hand sweating.
As in the case as with excessive hand sweating, the usual conservative measures are not as viable. The lumbar sympathectomy procedure has been used since about 2006. With this operation, one can achieve elimination of excessive foot sweating in up to 98% of the cases.
This operation is not offered for patients who previously had an ETS procedure which was unsuccessful for the feet. It is also not offered for patients where excessive foot sweating is much more of a problem than hand sweating.
What is the best procedure for my excessive foot sweating?
Excessive foot sweating, or plantar hyperhidrosis, usually manifests together with palmar hyperhidrosis (excessive hand sweating). Solitary foot sweating without excessive hand sweating is also possible but in a very low percentage of cases.
We realized that the thoracic sympathectomy (ETS) doesn’t help with excessive foot sweating. Since 2004, the Lumbar Sympathectomy has proven to be the best option to treat patients with severe plantar hyperhidrosis (excessive foot sweating).
Continued refinements and improvements are constantly discovered. These include technical performance, as well as an understanding of the locations where a lumbar sympathectomy will help.
In some cases, post thoracic sympathectomy compensatory sweating in the buttocks area is also treatable with ELS. The performing surgeon can provide answers to additional questions.
It still behooves patients with foot sweating to try conservative measures before opting for a surgical solution. For more in-depth information please see our foot sweating section.
What is Lumbar Sympathectomy?
A Lumbar sympathectomy is done under general anesthesia. It involves 3 small cuts for the endoscopic approach into the retro-peritoneal area. Once the surgeon is there, a space is developed and the sympathetic chain at the lumbar region is located. At this point, it is either excised or clamped at the levels L3-L4. This particular procedure is done on both sides. The operation takes about an hour to perform and in contrast to the endoscopic thoracic sympathectomy, the patient should stay over at the hospital for one day.
What if my insurance says they do not cover this particular procedure?
Most insurance companies cover the procedure because it is seen as a medical necessity. We can help you with any insurance concerns. Our office, as a courtesy, will call your insurance carrier to verify benefits in the event that you choose to have the procedure.
Does Lumbar Sympathectomy affect pregnancy?
So far there is no known connection between lumbar sympathectomy and the ability to become pregnant. On the contrary, Dr. Reisfeld’s female patients who had this procedure have become pregnant without any issues.
What to expect after the Lumbar Procedure?
- Pain
You should expect a certain amount of pain. Generally speaking it is not that severe and is well controlled with oral medications that will be prescribed to you. Obviously the pain threshold is different between people but it is safe to say that tolerated well. One should expect the pain to decrease a few days after the operation.
- Activity
It is recommended that your physical activity be kept to a minimum for the first few days and then gradually increase to your normal day to day level. For strenuous physical activity (jogging, basketball, gym) one should listen to his/her body with regard to this type of activity. There are no rigid rules about it. No muscles have been cut in this operation so the healing process should be fast. For the first 2 to 3 days you should be careful in your movement from lying down to the standing position due to changes in the vascular bed which is the result of sympathectomy. It does not happen very often but one should be aware of it.
- Incisions
All incisions are closed with absorbable sutures. They are completely safe and have the benefit of the patient not having to see a doctor to take them out. They consist of chemical components that at times can cause some redness. This does not indicate an infection but merely the process in which the sutures are dissolved. At times the process of the sutures dissolving can bring a white spots on the incision which are not puss but instead the component of the suture. Simple cleaning with water is enough to clean the healing wound.
- Shower / bath
Shower or bath can be taken the day after the procedure. The band aids can be removed and new ones can be applied (your decision). Most of the time patients are comfortable with replacing their band aids for a few days. Use of soap or skin lotions are fine.
- Food
After Lumbar Sympathectomy normal food can be consumed. Regular heavy diet should be started after the patient is passing gas. Sometimes because of the fact that the operation is done in the proximity of the abdomen resumption of normal bowel activity might be delayed a day or two.
What if I have only plantar hyperhidrosis (foot sweating) without any palmar hyperhidrosis (hand sweating)?
We are seeing more cases where the patient’s only problem is plantar hyperhidrosis. It is a somewhat smaller group of patients, but their foot sweating is severe enough to pose as many problems as people with hand sweating. Dr. Reisfeld is happy to discuss your specific condition on a one-on-one basis to help you determine if surgery is the right option for you.
As more experience is gained over time a solitary presentation of plantar hyperhidrosis only is not a good indication to do ELS. For some unexplained reasons those patients with only plantar hyperhidrosis do not respond as well to lumbar sympathectomy. They might get some temporary relief of plantar hyperhidrosis but it is not a long lasting relief. The reason for that is not known however if more information becomes available in the future then the approach might be changed. It is imperative for the patient, who suffers only from excessive foot sweating, to talk with the doctor who understands the problem and is aware of the unique situation of plantar hyperhidrosis.
What is the truth about Subdermal Curettage as a treatment method for Plantar Hyperhidrosis?
You may have read that subdermal laser curettage is being used by some doctors as a treatment for plantar hyperhidrosis. This is a way to entice patients to go this route with no proven success rate or any value to it. Patients who chose this route describe total failure with this approach and a tremendous amount of pain and discomfort.
They also describe an inability to use their feet, which confines them to wheelchairs (temporarily). Laser suction curettage, or simply suction curettage, in the axillary area has some value in isolated cases of axillary hyperhidrosis.
These days, doctors could offer another approach for the treatment for axillary sweating (armpit sweating). The reason there is no value in this approach in cases of plantar hyperhidrosis, is because of the fact that there is almost no subcutaneous tissues in the plantar region.
Foot Sweating (Plantar Hyperhidrosis) Summary
Excessive foot sweating can be a serious problem, both in social settings and everyday functional activities. This can also affect intimacy between couples due to the smell, discomfort, and embarrassment it causes. This is especially true for women having difficulties wearing the appropriate footwear.
You may ask what should I do? Those affected should first discuss the matter with their doctor and then first try the conservative hyperhidrosis treatment measures available. If those measures do not give satisfactory relief, then consideration should be given to the hyperhidrosis surgical treatment options.
At present, the endoscopic lumbar sympathectomy procedure has been refined to the level that it can now be done on an outpatient basis. This allows patients to return home or to their hotel on the same day as the procedure. The success rate for the surgical procedure is excellent at 98%
Will I get more hand sweating after doing the lumbar sympathectomy procedure for my sweaty feet?
The answer is no. There are some instances in which patients describe a temporary increase in their hand sweating after a lumbar sympathectomy. These patients received the thoracic sympathectomy for their excessive hand sweating previously.
We do not know what causes this temporary increase in sweat. The length of time where more excessive hand sweating appears is a matter of days not weeks. The body’s nervous system needs time to adjust to the new signals that come after doing a lumbar sympathectomy.
Do you have any questions about foot sweating that were not answered here? Would you like to speak with Dr. Reisfeld to answer those questions? To learn more about what we can do for you, contact The Center for Hyperhidrosis by contacting our office.
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“May 11, 2021, changed my life—truly more than I could’ve ever imagined. The best way to describe life since ETS surgery is intentional and joyful. I feel like I can finally be present in every single moment because my mind isn’t constantly focused on my hands sweating.”
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Bri F.