By Keith Roach, M.D.

DEAR DR. ROACH: My nephew has foot odor. Even after showering, his feet have a bad odor. His shoes smell bad and have to be replaced often. What is the remedy for this problem? -- B.C.

ANSWER: Foot odor is caused mostly by bacteria living on your feet. Bacteria thrive in warm and moist environments, so people who sweat a lot from their feet are at high risk. Some people are also colonized with particularly bad bacteria, such as Kytococcus (formerly Micrococcus), Corynebacterium or Dermatophilus. These bacteria do not cause disease, but they break down dead skin cells into unpleasantly smelly chemicals. A careful look at the skin on his feet may reveal small pits in the skin, especially around the heel, after a long day in socks and shoes.

Treatment may include disinfecting skin solutions (such as chlorhexidine), antibiotics (topical erythromycin or clindamycin) and keeping the feet as dry as possible. This may require application of antiperspirants to the feet, either regular over-the-counter or prescription varieties. He also should wear lighter, more breathable footwear. Washing (and then drying) the feet several times daily and putting on new socks each time may also help during the treatment phase.

Although ultraviolet-light shoe sanitizers exist, I’d recommend getting new footwear while trying to get rid of as much of the bacteria as possible.

Blood pressure levels

DEAR DR. ROACH: My husband is 75. I am 68. Our family doctor says that our blood pressure average is fine at 140/80 with no medicine. We thought it should be 120/70, but he says the limit is higher for seniors in order to decrease falls. This is pretty confusing. Do you think it’s OK? -- S.M.

ANSWER: The best goal for blood pressure has been the subject of controversy. For the overall population, a level of 120/80, slightly less than the average blood pressure in the U.S. and Canada, is associated with a lower risk of heart disease, stroke and death than a blood pressure of 140/80. But the difference is pretty small. A blood pressure of 160/90 has a significantly higher risk, and at blood pressures above 160 systolic (that’s the first or “top” number), the risk for stroke and heart disease rises steeply.

A recent trial (the SPRINT trial) showed that among older people with high blood pressure who had increased risk for heart attack, a systolic blood pressure goal of 120 was better at reducing risk than a blood pressure goal of 140. Both groups had a diastolic (the second or “bottom” number) goal of less than 90. However, the goal among people at lower risk is not as clear.

Most experts would not treat people with medication unless their average blood pressure is over 140 systolic or over 90 diastolic. In people treated with medication, some experts prefer a goal of less than 130/less than 90, while others would treat to less than 120/less than 90. It is true that more blood pressure medication and more intensive goals can lead to greater side effects, including falls. However, in the SPRINT trial, there was NO increase in fall risk and a slight 0.6 percent increase in the risk of fainting.

Nondrug therapy, which includes modest salt restriction, regular exercise and stress reduction, can lower the blood pressure enough that people do not need medication.

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Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. (c) 2021 North America Synd., In