Sweaty Feet Treatment (Surgical)

Description:Sweaty Feet Treatment
Excessive Foot sweating is almost always accompanied by excessive hand sweating. Even though foot sweating does not have the social significance like hands do it still poses a severe impact both socially and physiologically for those who suffer from excessive foot sweating. The notion that ETS can help with excessive foot sweating (plantar hyperhidrosis) faded as more experience was gained since 1990. For many years ETS was the procedure performed by most surgeons to eliminate hand sweating with the hope it would also help with excessive foot sweating. This was not the case and most of the patients, after ETS, still had excessive foot sweating. The medical community then discovered that lumbar sympathectomy was the best and most effective surgical treatment for excessive foot sweating with a much higher degree of success (98%). In a higher percentage of patients the severity of plantar hyperhidrosis (foot sweating) is not being manifested in the early to late teens like is the case with palmar hyperhidrosis (hand sweating). The physiological explanation for that is the fact that the maturation of the sweat glands in the feet occurs slightly later in life.

Basically with this procedure the lumbar sympathetic chain is approached endoscopically through small cuts in the side of the abdomen. The sympathetic chain in the lumbar region is exposed and clamped or divided as per the surgeons choice.

Effectiveness of Sweaty Feet treatment:
The success rate is about 97% to 98% and the operation can be accomplished on an outpatient (return home the same day) basis with a low amount of pain. A return to normal life can also be obtained within a short time (2-3 days). Most of the patients who had Endoscopic Thoracic Sympathectomy as well as Endoscopic Lumbar Sympathectomy claim that the amount of pain after Endoscopic Lumbar Sympathectomy is less than the pain from Thoracic Sympathectomy. The ELS procedure is done through three relatively small cuts on each side of the abdominal cavity. With this lateral approach the abdominal cavity is not entered. Also the clamping method that is being used, enables exact verification where the lumbar sympathectomy was done. It is very important to stay below the level of the second lumbar vertebra.

In about 10% of the cases patients may experience a short lived recurrence which occurs about 3 ½ days after the operation. This is only temporary and will go away, as long as the first 3 ½ days were totally dry. A true recurrence which means the operation was not successful, will become within a few hours to a day after the operation. Success rates are high however there is a small possibility of recurrence. So far no reversal surgeries have been done.

Endoscopic Thoracic Sympathectomy (ETS) and Endoscopic Lumbar Sympathectomy (ELS):
Even though both ETS and ELS are very effective in treating palmar and plantar hyperhidrosis cannot be performed at the same time. At present Dr. Reisfeld recommends patients wait at least 4 months between ETS and ELS. Which procedure is done first really depends on the patients preference. So far the majority of patients that can benefit from both procedures choose ETS first but the reverse can be done as well. Over time an interesting finding has emerged. Patients with mild palmar hyperhidrosis (sweaty hands) but with severe plantar hyperhidrosis (sweaty feet) who have the ELS procedure done may experience an increase in their palmar hyperhidrosis. The level of which and length of time that this occurs is to yet to be determined. It may be that these patients could benefit from ETS as well but it is still too early to tell.

Another observation that came about is the fact that patients who have groin and buttocks compensatory sweating after the ETS procedure get some improvement with their excessive compensatory sweating of those sites when the level of the ELS is kept at L2 or as close to L2 as possible. This observation will need many more cases to confirm in the future but so far it’s an encouraging finding.

Dr. Reisfeld Publishes Important Paper
As more experience has been gained Dr. Reisfeld published two peer reviewed papers with regard to this subject. Again it showed that lumbar sympathectomy for the treatment of severe plantar hyperhidrosis (foot sweating) can be accomplished but it should be done by highly experienced and knowledgeable surgeons. There are some very delicate technical aspects to the surgery and also the level of the lumbar sympathectomy is important. If a patient had a previous thoracic sympathectomy the level of compensatory sweating which came after the ETS will stay basically the same. Again it was proven that patients tolerate the procedure well and the amount of discomfort/side effects are kept to a minimum.

Dr. Reisfeld published a paper detailing the treatment and the success rate via lumbar sympathectomy for patients who suffer from plantar hyperhidrosis (feet sweating). In his paper he demonstrates that with lumbar sympathectomy feet sweating is eliminated with a success rate of about 96 to 97%.
Lumbar sympathectomy for excessive foot sweating is a very viable option. Again this should be discussed with an experienced surgeon after local conservative methods have been tried and failed.

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Hi I'm from the Philippines

Hi I'm from the Philippines and would like to know if there are qualified surgeons who can perform ETS here. I've tried all conservative approach recommended by my doctor, but I still have a severe case of hand and feet hyperhydrosis. It's very embarrassing and really affects my daily activities. Hope to hear from you the soonest. Thank you!

from philippines

I have been reading regarding iontophoresis. Has there been any luck looking for this treatment in Manila? or buying online from germany or usa shipping to Philippines. I am considering this. I am kind of scared of surgery.

re: iontophoresis

One of the treatment modalities for excessive hand and feet sweating is the usage of iontophoretic machines. With these machines there is an emission of low electrical impulses (shock waves) into the skin of the affected area (palms or feet). The success rate is extremely limited but if you want to try it is not going to harm you. The two models are either the Drionic machine of Fisher MD iontophoresis machine. Instructions on how to use those machines is included with the information you will get when receiving the machine. Best of luck to you.

re: Hi I'm from the Philippines

To be honest I am not familiar with anyone in your country whom I know and can recommend him / her to you. I'm sure if you check with a reputable center in one of the big cities of the Philippines hopefully you will find one.

Feet and hands are sweaty

Hi I'm in South-Africa and my hands and feet sweats a lot permanently and I have an hobby of ice skating but I get blisters on my feet because its always wet ,what can I do to stop the blisters and I do wear one pair of socks,please help.

Re: Feet and hands are sweaty

As you by now know that excessive hand sweating and excessive feet sweating are usually the manifestation of palmar and plantar hyperhidrosis. If the excessive sweating affects the person on a daily basis then attempts should be carried out with conservative treatment modalities such as Drysol, anticholinergic agents and iontophoresis machines. The success rate of those conservative treatments with a severe case of hyperhidrosis is minimal, but every patient should try those for a short time. If those fail then the alternative of surgery is always there and a careful discussion should be carried out between the patient and the surgeon with regard to those operations. As a general recommendation Dr. Reisfeld suggests to do the ETS procedure first because it can have some success with excessive feet sweating. If no resolution of the foot sweating happens after the ETS procedure then ELS is still a possibility to eliminate excessive foot sweating. Before any decision is made a careful discussion should be carried out between the patient and his/her surgeon.

What do you see in the future for the treatment of foot sweating

In the next 10 to 20 years what major developments would you envision for the surgical treatment of excessive foot sweating? Should I wait to have the surgery to allow more time for the treatments to advance?

Re: What do you see in the future for foot sweating

Thank you very much for this interesting and well thought question. Since hyperhidrosis is a genetically based problem, which means that a certain gene is responsible for this clinical manifestation. It has been shown in different studies that more than 50% of the patients will have some information about other family members, close or remote, suffering from the same problem. The location of the gene is also known but unfortunately genetic treatment is yet a futuristic possibility. With more money and effort that are being poured into research there will be a possibility of helping those suffering with a non invasive / non surgical methods treating hyperhidrosis. Treatment with different medications so far has not proven to be effective so the only solution at this point is the surgical approach. The endoscopic approach (ELS) so far has proven itself to be very effective, with a minimal amount of short term discomfort or disability after the surgery. One has to bear in mind that before any decision is made a thorough discussion about the operation, timing and possible side effects should be carried out between the patient and a well qualified surgeon.


Hi which hospital in south africa durban does els bcause after my op for my hands my feet got worse and it unbearable.please find me a sugeon in durban who can perform els for my sweaty feet.I heard that els causes high blood pressure and fainting.please tell me if this is true.thanks alot

re: els


Unfortunately I am not familiar with surgeons in South Africa and more than that there are very few surgeons in the world that are trained and capable performing endoscopic lumbar sympathectomy (els). With regard to the issue of blood pressure the opposite is true because sympathectomy especially thoracic is known to reduce blood pressure. Sympathectomy as a whole has beneficial effects when it comes to high blood pressure. Hopefully this helps you with your question.

Where to get ELS

What hospitals/surgeons perform ELS?

re: Where to get ELS

Endoscopic Lumbar Sympathectomy (ELS) is a surgical procedure not done by too many surgeons. There are a few reasons for this and the main one is that the surgeon who does it has to be familiar with the anatomical location of the procedure which is a domain that is not easily mastered any surgeon. To better answer your question I would have to know where you reside and then give you the appropriate details. Your more than welcome to call or get in touch with us at (310) 557-3037 or fill out our contact form.


I have had a procedure for ETS approx 8 years ago. I've tried all other avenues for treatment in regards to my feet. I would like to look into ELS - can you recommend any surgeons in Australia, I live in Adelaide South Australia.

re: ELS Australia

The ELS procedure is a new surgical treatment for the sweaty feet. The ETS procedure has a longer history, success rate and efficacy and the ELS follows the same pathway. The development of ELS came about 10 years ago when we realized that ETS helps only with a small percentage of patients who suffer from excessive hand sweating and excessive feet sweating. With the ELS operations the sympathectomy is done in the lumbar region which eliminates the sympathetic nerve fibers which are responsible for sweaty feet. As of today there are not too many surgeons around the world who perform this unique operation. The reason being is that lies in the fact that the lumbar region of the body is an area that a regular thoracic surgeon or general surgeon are not familiar with and it takes special knowledge experience and training to become familiar with performing this operation. If you are looking for a surgeon to do the ELS procedure make sure you talk with a surgeon who is very much familiar and experienced with the operation. We do not of any surgeon presently in Australia who performs this procedure.

Severe case of hyperhidrosis with hands and feet

Dr. Reinsfeld,
My 17 yr. old son suffers severely from sweating to the point of dripping on his hands and feet. We went to Emory University in Atl. where the doctor stated that his was one of the most severe cases she had seen. We tried botox injections to hands, the dry area on his hands after treatment was the size of a quarter that only lasted a couple of days. She has said that she wants to try it again. He has taken meds and has tried the drysol as well, the only thing we haven't tried is the iontophoresis treatment. This condition has affected him to the point of causing extreme depression/anxiety and loss of self confidence. He now wants to join the national guard and scheduled to go to MEPS (medical portion) next week!! He is not planning on telling them of his condition because he is afraid it will disqualify him for the military. My questions are: 1. do you think he should try iontophoresis 2. Is there a doctor that you can recommend that is somewhere in GA./FLA where we can get some advice and treatment. 3. Do you think that hyperhidrosis would make him more susceptible to dehydration during military drills? Thank you for your help, this is a very debilitation disorder for anyone to experience.

re: Severe case of hyperhidrosis with hands and feet

The case you are describing is a typical case of severe hyperhidrosis where the hands and the feet are the most affected. It happens to about 1.7% of the population. The approach you have already adopted and tried is the right approach where conservative measures are tried first. If you did not yet try the drionic machine (which can be rented) you can do so but I do not believe it will be a long term solution. The fact that he tried Botox injections is against my belief because I do not do it nor recommend it because it provides very short relief if at all, painful, costly and can cause some muscular weakness. In your son's case I think that the surgical option is a valid one and should be considered strongly. With regard to your question about dehydration, generally speaking it does not happen and his physical performance should be the same. At present I do not know anyone in your geographical location. Please feel free to call me to discuss the matter further.

How much?

How much does the Lumbar Sympathectomy treatment cost me? Thank you.

RE: How much?

First and foremost is a discussion with a doctor to see if you are eligible or qualified for the operation. After that is determined you can discuss with the surgeon or the office staff with regard to payment. You are more than welcome to contact us at (310) 557-3037 to discuss further.

Had surgery for palms, armpits

Hi Dr.,

In 2000 or so, I had the surgery for hyperhydrosis for palms/armpits. It worked great! Although my level of compensatory sweating in the groin area is awful, it is a better trade off for the palms. My feet also sweat so bad, I am very limited as to what shoes I can wear as they will slip and slid around in the summer in most shoes without something to soak up the sweat. I read that you now have surgery for the feet. And that it may help with that compensatory sweating! Could you please tell me more? Where are you located? Do most insurances cover the lumbar surgery?


Re: Had surgery for palms, armpits

Hello Kristin,

Thank you for the message. There is in fact now a procedure called lumbar sympathectomy specifically for this purpose. We have seen very good success rates with this procedure for people who had ETS and now suffer from severe foot sweating. The operation is carried out under general anesthesia and takes about an hour and a half. It is done on an outpatient basis (You can go home the same day) with a success rate for foot sweating of about 98%. It will not change the level of compensatory sweating in other areas which you had from the ETS but, you might get some relief with your groin sweating which can be helped by lumbar sympathectomy. For more precise information please call us at 310 557 3037. We are located in Los Angeles. Most insurance companies do cover the procedure now. When you call, you can provide us with your insurance information and our expert staff will check it for you.

Dr. Reisfeld

Very interesting

I was at wikipedia and webmd, but only here did I find the most detailed information on hyperhidrosis. Thank you.


Hello! I've heard special cedarsoles are another option to get rid of sweaty feet. Is it right? These cedarsoles are made from antifungal and absorbable cedar wood. A natural product? Maybe it's an option...

About Cedarsoles

If a patient finds any help from these type of conservative measures they should continue as long as they continue to get benefits from this. On the hand, in my opinion, if those conservative measures are not helpful the surgical option is always available for more of a permanent solution.