ArcaMax

DEAR DR. ROACH: I was gardening and stabbed myself in the arm with pruning shears over the weekend. It just occurred to me yesterday that I'm not sure how long it's been since I got my booster shot for tetatnus. So, I checked, and I last had a booster shot nine years ago. Do I need a booster now? -- M.M.

ANSWER: For adults who have had the primary series of the tetanus vaccine (three or more doses), a dirty wound (potentially covered with spores from garden soil) would be cause for recommendation in people who have not had a tetanus vaccine within the past five years.

You should get the vaccine as soon as possible but can still get it up to 21 days later. People who have had less than three tetanus vaccines or whose immunization status is uncertain should receive tetanus immune globulin and a tetanus vaccine after any wound that is not clean and minor.

Although cleaning the wound is critical, it does not replace the need for specific tetanus treatment.

DEAR DR. ROACH: I've been a reader of your column for quite some time, so I don't have a reason for waiting as long as I have to ask this question, especially since none of my doctors have been able to come up with an answer.

I'm approaching 78 and have an extensive medical history. This includes a heart attack that happened 13 years ago, which resulted in quadruple bypass heart surgery. Then I underwent kidney removal in 2000 due to cancer and three surgeries on my right knee, including a total knee replacement surgery three years ago. Two years ago, I had my left knee totally replaced.

It was after the left knee replacement that I noticed the bottoms of both of my feet starting to sweat, sometimes so profusely that I was literally slipping when I wore flip-flops (still do).

I also have an edema condition below both knees, so I don't know if this is a contributing factor. In addition, the sweating is more prevalent in warmer (and hotter) weather. Again, none of my doctors have an answer or even a thought as to why this is happening. -- E.B.

ANSWER: The condition you have is called secondary focal hyperhidrosis. It is "secondary" because it happened after an inciting event -- probably your knee surgery. (Primary hyperhidrosis usually starts by age 18.) It is considered "focal" because it only occurs in the soles of your feet, not in your whole body, and "hyperhidrosis" literally means "too much sweat."

Knee surgery is not a common cause of secondary focal hyperhidrosis, but I did find case reports of this happening. However, in these cases, the sweating is usually on the side of the surgery, not both sides as in your case.

I did wonder about the leg edema (swelling) affecting the sweating, but I did not find any evidence of this in the literature.

Treatment for focal hyperhidrosis in the feet includes prescription antiperspirants, iontophoresis (electrical movement of ionized substances, usually water, through intact skin), and botulinum toxin (Botox). Oxybutynin, which is usually used to treat an overactive bladder, is sometimes useful.

You can read more about hyperhidrosis at SweatHelp.org, the website of the International Hyperhidrosis Society.

========

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

(c) 2025 North America Syndicate Inc.

All Rights Reserved