Trick of the Trade: Toxic sock syndrome

The olfactory nerve of an emergency physician is exposed to a broad range of smells in the Emergency Department. I've learned that the stinky-feet problem is a commonality amongst ED's around the world! I call it the "toxic sock syndrome". There are two remedies which I've been told of:

• Nebulized oil of wintergreen
• Placing a open canister of coffee grounds next to the feet (I've never understood this. I would imagine it would smell like stinky feet in a cafe. Plus, what a waste of coffee!)

One trick which I learned at SF General is the antacid booties trick. The premise of the trick falls back on basic chemistry. Feet with poor hygiene and trapped perspiration within socks are the perfect environment for moisture-loving bacteria to produce isovaleric acid. Isovaleric acid is the culprit behind the foul smell.

To combat the acidic environment, adding a base will neutralize the pH and thus the odor. A readily-available basic product that most ED's have are antacid liquids, such as Maalox or Mylanta.

Start by pooring about 30 mL of antacid into each disposable paper boot.

Apply the boot to the patient's feet so that the antacid contacts the skin.

And like magic, the odor almost completely disappears!