Hand, Foot, and Mouth Disease (HFMD) is a common viral illness, most frequently seen in infants and young children, though it can affect people of any age. The infection is typically caused by the Coxsackievirus A16, which belongs to the larger group of nonpolio enteroviruses. HFMD is a highly contagious condition that generally remains mild and self-limiting, resolving within seven to ten days. The virus spreads easily through close personal contact, respiratory droplets, and contact with contaminated surfaces or stool.
Symptom Presentation on the Feet
The characteristic rash of HFMD often appears as small, flat red spots that evolve into tiny, fluid-filled blisters on the palms of the hands and the soles of the feet. These lesions can also appear on the sides of the feet, the toes, and sometimes on other areas like the buttocks. The lesions on the feet are frequently tender, causing discomfort that makes walking and standing painful.
The blisters on the soles and palms typically present as small, oval-shaped bumps that are red or grayish in color. They are filled with a clear fluid that contains the contagious virus. The physical presence of these spots often makes wearing shoes or tight footwear difficult due to the pressure and friction exerted on the sensitive skin.
Guidance on Covering or Leaving Feet Bare
The general recommendation for managing the skin lesions of HFMD is to allow them to remain uncovered and air-dry naturally. Exposing the blisters to the air facilitates the drying process necessary for the sores to scab and heal properly. Applying occlusive ointments or keeping the feet covered constantly can trap moisture, potentially hindering the natural healing progression of the blisters.
In circumstances where covering the feet is unavoidable, such as when a child must wear shoes or if the skin is weeping, a careful choice of covering material is advised. Loose-fitting socks made from soft, breathable fabrics like cotton or Merino wool are preferable. Materials with moisture-wicking properties, such as Merino wool or certain synthetic blends, can help manage perspiration, reducing the risk of the blisters remaining overly moist.
The primary benefit of wearing socks is the physical protection they offer against friction from footwear or accidental scraping that could cause a blister to rupture. If a blister bursts, the fluid is highly contagious, so a sock can act as a temporary barrier to contain the viral fluid. If a blister breaks open, the area should be gently cleaned, and a small, non-stick bandage can be applied with a topical antibiotic ointment to prevent secondary bacterial infection. The sock should then be changed immediately, and the contaminated item should be washed thoroughly.
Limiting Contagion and Spread
The fluid within the blisters of HFMD is a direct source of the virus, making the rash on the feet a point of contagion. The virus can be shed from these lesions until they have fully dried and crusted over, which usually takes about seven to ten days. Therefore, hygiene practices focused on the lower extremities and surrounding environment are important to prevent transmission.
Any clothing or linen that comes into direct contact with the blisters, including socks, should be washed separately and thoroughly. Caregivers must practice hand hygiene, washing hands with soap and water for at least twenty seconds after touching the feet, changing socks, or handling contaminated items. This prevents accidental transfer of the virus to the face or to other household surfaces.
The virus can survive on inanimate objects, necessitating frequent disinfection of floors, toys, and any surface where the infected person walks barefoot. Using a household disinfectant that is effective against enteroviruses on high-touch areas helps to break the chain of transmission from the feet to the hands and subsequently to the mouth. Avoiding the sharing of towels, bedding, or other personal items further reduces the risk of cross-contamination.