MY FIRST BOTOX TREATMENT FOR FEET SWEATING

Background

In April 2010, I was traveling around the US west coast and by luck the International Hyperhidrosis Society was having its annual conference in Portland, Oregon on April 10th. They were looking for volunteers who would receive free Botox injections for excessive armpit (axillary) and hand (palmar) sweating from physicians who would be under training at the conference. I contacted the organization in early April to see if they could add me as a volunteer for feet (plantar) sweating treatment and the conference organizer, Lisa, managed to get this approved. The feet require the most (at least 100 per foot) injections and take the longest time to treat. So the conference organizers had initially decided to not include feet treatment due to time constraints.

I was not overly concerned about receiving hundreds of injections of a poison to disable nerves and overactive sweat glands. Millions of people around the world use Botox every year for cosmetic treatments such as wrinkle reduction. Most of these people get Botox injected into their facial areas, while I was getting it on my feet, which seemed far less dangerous. More importantly, I read that Botox does not penetrate the blood brain barrier, and it gets eliminated from the body over the course of a few months. Still, I would get far more injections in comparison to people who get Botox for any cosmetic or therapeutic reason, so I was expecting at least some mild side effects such as a headache or feet pain.

I had to stop treating my feet with Idromed iontophoresis around ten days before the conference so that they started sweating profusely again. This way, the physician could see what parts of my feet sweat excessively, prior to injecting Botox in them. Several days before attending this conference, my feet started sweating profusely again after the sweat blocking effects of iontophoresis had worn off.

2014 Update: According to the American Society of Plastic Surgeons, Botulinum Toxin Type A injections were by far and away the most popular minimally invasive cosmetic procedure performed in the US in 2013, with 6.3 million injections delivered. I suspect that this total is much higher in reality after accounting for unofficial back-of-the-alley type illegal procedures, and after including similar products to Botox such as Dysport and Xeomin.

At the Botox for Hyperhidrosis Volunteer Gathering

There were 22 patient volunteers at this conference at the Hotel Monaco in downtown Portland, a significant number of whom not surprisingly lived in the Pacific Northwest region. A few of the volunteers did fly in long distance to get their free Botox. Only three of the volunteers were male, including myself. Most of the volunteers seemed to be around the ages of 25 to 30. I was surprised that about half the volunteers only had armpit sweating. Axillary sweating doesn't bother me beyond the need to use high strength antiperspirants, but I suppose it is different for many women. At the time, MiraDry was not yet approved to treat excessive armpit sweating. Most of the remaining volunteers wanted to get rid of their hand sweating, while only two were getting injected on their feet if I remember correctly. Some had two areas of excessive sweating that they were hoping could be treated with Botox. After getting refreshments and free prescription strength hyperhidrosis products from sponsors such as Drysol, we were seated in one room and it was quite interesting to talk with some of the people who had a severe hand sweating problem. I was the only person in attendance who had already had ETS surgery, which cured my hand sweating, but worsened my feet sweating.

I was skeptical that Botox would work on my feet, especially since someone from the Whitley Clinic in the UK and several individuals have e-mailed me over the years to say that Botox does not work for excessive feet sweating. Renowned dermatologists Dr. David Pariser and Dr. Dee Anna Glaser were going to train all the physicians at this gathering. Prior to coming to Portland, I contacted the offices of Dr. Glaser to ask if they had success treating feet sweating with Botox. Her staff assured me that it worked.

I ended up sitting next to a girl at the conference volunteer gathering who had previously received Botox injections to stop her hand sweating, and she had tremendous success. Her palmar hyperhidrosis completely ceased for one year, and remained minimal for an additional six months. I did not know that Botox could stop hand sweating for more than six months, even though this length of success is not uncommon for armpit sweating. This also means that Botox can stay in your body for one and a half years. This girl did say that her hands hurt during the initial month after she got the injections in them, and even daily tasks such as buttoning a shirt were painful. However, one month of some pain is definitely worth one year of dry hands in my opinion. The fact that this girl flew across half the country to come to this volunteer gathering made me glad about taking this opportunity.

Receiving over 200 Botox Injections on my Feet

I was among the last few to get called from the volunteer gathering in the small room to a larger main hall next door where we received the Botox injections. It seemed like all of the volunteers called in the beginning had axillary sweating. This main hall was full of people, including those volunteers already getting injected, representative(s) from Allergen, physicians training to give the injections, nurses, and several women who seemed to be mixing or just bringing out the Botox from the freezers. My doctor was Dr. Howard Green (a foot doctor from Canada) who I had already contacted prior to coming down to the conference since the International Hyperhidrosis Society had him listed on the conference section of their website as one of the possible doctors to contact. He had me sign some documents and fax them to him prior to this conference. Dr. Green had treated a few people with plantar hyperhidrosis with Botox prior to attending this conference, so he wasn't a true trainee.

Dr. Green and his assistant told me to lie down face down on a type of table that you often see at doctors' offices. Then they started making green marks underneath my feet (see pictures at bottom of this page), with the marks placed fairly close to each other. Dr. Green had a template for this, but the template did not extend beyond the soles of my feet to the sides, even though he did end up giving me injections on the sides of my feet. The injections were a bit painful at the beginning, especially since they started giving them to me in my sensitive toes area first. Thereafter, it was mostly smooth sailing. I never had pain that was severe enough to make me cry out and I did not get any pain killers injected into my feet. I had physicians come and talk to me all the time I was getting injected, so my mind was a bit distracted from what was happening to my feet too, which also meant that I did not even realize that I got some injections on the upper sides of my feet. The physicians talking to me asked me about what I was feeling and about my hyperhidrosis in general. I was surprised to see at the end that I had bleeding on my feet despite the lack of any major pain sensation.

The "hyperhidrosis superstars" (as deemed by the International Hyperhidrosis Society) Dr. Dee Anna Glaser and Dr. David Pariser were both in the hall and monitoring things, as was Lisa the organizer of the event. I did get a chance to speak with Dr. Glaser who came across as an excellent and sincere doctor/person. Unfortunately, she could not inject me even a few times because of federal regulations requiring her only being able to give injections to people in states where she is registered to do so (and Oregon wasn't one of those states). Dr. Green said I got around 100 injections into each foot, more than is typical since my feet are larger than the average man's feet. The pictures at the bottom of this page show around 90 marks on the soles of each foot, so I probably got only a little over 10 injections on the sides of each foot (where there are no green marks to make it possible to count the total). At the end of my treatment with Dr. Green, Dr Pariser happened to be watching us and he told me that I received $2,000 worth of Botox. Add to that what I would have had to pay in doctor fees before getting the injections, and I was quite glad I took this opportunity to get free treatment under the eyes of the "hyperhidrosis superstars". Health insurance companies nowadays cover all types of hand and feet hyperhidrosis treatments (most still classify underarm or armpit sweating as a cosmetic problem), but you would still need to pay a deductible and copay: so getting Botoxed every six months or so can become expensive.

My Results from Botox for Sweating

My results were excellent and way beyond my expectations during the first few months after getting injected ( see further below for monthly updates ). I got instantaneous dryness in my feet after they were injected on April 10, 2010, and this is very unusual. Everyone I talked to and everything I have read seems to suggest that dryness only starts several days after being injected. Perhaps I was lucky in that my feet were sweating profusely right before I was about to get injected (see photos below that show some sweat) so that could have impacted the results favorably. I didn't seem to get any side effects except minor pain in my feet while walking during the first couple of days after getting the injections, minor headache on the first night after treatment and a burning sensation under one toe now and again for the first week and a half post-treatment.

I was on vacation for the remainder of April 2010 and probably walked at least 50 miles during that time, with absolutely no evident feet pain. The feet have been bone dry all the time except when I was walking in 85 degree weather in Texas when parts of the upper sides of my feet (say the area up to one-third of the way up to my ankles in the rear areas of my feet) became slightly wet. Perhaps the number of injections I received on the upper sides of my feet were spread out at greater distances than the number of injections I got on my soles. Dr. Green said that most of the sweat glands in the feet are at the bottom sole area, but I seem to have a large number on the sides of my feet too and maybe he is mistaken. This amount of minimal sweating on very hot days on the upper sides of my feet is easily bearable for me, and probably happens to most people who do not even have hyperhidrosis. The unseemly green marker dots on my feet went away a few days after treatment (it helps if you shower daily)!

If these great results last for close to a year, I will seriously consider having Botox injected into my feet every alternate year. I will continue with iontophoresis therapy during the in-between years, since that has also given me great success as long as I use the right type of water it seems. If the results from Botox only last for 3-4 months, I will not risk the regular injection of a toxin into my body.

My Recommendations

I would recommend trying out Botox for your hand or feet excessive sweating problems. The International Hyperhidrosis Society has several free volunteer sessions each year, and you should sign up right away before they get full. If you can't get in for this free session, I would recommend you going to a physician who has a lot of experience doing this, since a lot of people have complained about lack of success on the feet and even hands, and this could be due to being injected by an inexperienced person. Even better would be someone who has been trained at these International Hyperhidrosis Society conferences. Clinics and patients who have reported failure in the past were clearly doing something wrong (e.g., misjudging the number of injections required, misjudging the depth of injections or maybe even using an incorrect Botox formulation).

If you do get good results, but if the results only last for 3-4 months or so, I would suggest trying Hidrex or Idromed iontophoresis instead. I am wary of potential side effects of Botox in the long-term if you get 100s of injections every few months. I am also curious about whether the Botox stays in the area it is injected in, or whether it spreads to other areas of your body. Also, how does it get eliminated from the body (via your urine)? Why did that one girl I mentioned earlier get results lasting over one year? Does that mean none of the toxin moved from her hand area for that long a duration of time? Since Botox has only become so popular over the past two decades, I think being wary of how frequently you get injected is justifiable.

Update: As of May 20 2010, 40 days after getting injected, I still have completely dry feet almost all the time. Very pleasantly surprised!

Update: As of July 5 2010, I have completely dry feet most of the time, although on several days with 85 degree and above temperatures, my feet did sweat (generally from the sides, where I did not get a significant quantity of Botox injected).

Update: As of August 8 2010, I am still happy with the results. The only time my feet sweat is when the temperature is above 80 degrees. Even in 90 degree weather, my socks never get anywhere near as wet as they used to. Most likely, this is because the soles of my feet hardly sweat at all. The thing I am most pleased about is that my feet do not sweat at all when the temperature is around 70F to 80F. Next time I get Botox injections, I will try to get them at the end of summer, and hopefully have completely dry feet during all of fall and winter.

Update: As of September 10 2010, things have not changed much from my previous update, although on some days, the top sides of my feet have been sweating really badly even when the weather has been cooler. Overall, the sweating is still not as frequent on cooler days as it was prior to my getting injected in April. When I am wearing socks and shoes, the feet sweating is still usually zero -- which was not the case before I got injected. When I am barefoot, the feet do sweat significantly sometimes, but not as frequently as before.

Update: As of October 9 2010, I am fairly certain that the effects of Botox are wearing off. On some of the cooler fall days, I don't sweat at all from my feet for the whole day, but I think that this was true even before I began this whole odyssey with iontophoresis and then Botox. If there are a few cool days in a row, I will sweat on some of them just like I did before getting injected. Most likely, I will restart iontophoresis therapy before the end of the year and might not post any more updates hereon.

Update: As of November 11 2010, I seem to have had very little sweating from my feet over the past month. It seems like colder weather must have made a positive difference, even though localized hyperhidrosis is not usually related to temperature. In the past, before I started all these treatments, I have noticed that my feet sweat very little on a 60F day if it follows a 70F day. However, if there are a few 60F days in a row, the feet usually start sweating profusely again for around half the day. I get a feeling that there is still some Botox remaining in my feet area, and the colder weather has helped improve the efficacy of the remaining Botox. It should be noted that for the past few days I have taken some Robinul Forte tablets I had remaining from a 2009 prescription, and the effect of these has been very positive on my feet sweating, albeit with some side effects.

Botox for feet sweating: Blood stains and a little bit of sweat are visible in photo closeup. The marker dots go away in a few days.

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Botox and hyperhidrosis forum

Patient recommendations of clinics and physicians that offer Botox to treat hyperhidrosis

Locations where you can get Botox injections for hyperhidrosis

Botox and hyperhidrosis general information