eISSN 1307-394X Research An Investigation on the Prevalence of Different Foot Skin Diseases and Their Risk Factors Among University Students Yeşim Kaymak,1* MD, Ercan Göçgeldi,2 MD, Işıl Şimşek,3 MD Address: 1Dermatologist, Gazi University, Medical Health Center, Ankara, Turkey; 2Assistant Professor, Gülhane Military Medical Academy, Department of Public Health, Ankara, Turkey; 3Professor, Gazi University, Vocational Educa- tion Faculty, Ankara, Turkey. E-mail: [email protected] * Corresponding author: Yeşim Kaymak, MD, Hoşdere Cad. Şair Baki Sok. 2/5 Yukarı Ayrancı, Ankara 06540 Turkey Published: J Turk Acad Dermatol 2007;1 (2): 71202a This article is available from: http://www.jtad.org/2007/2/jtad71202a.pdf Key Words: Skin diseases, foot health, university students Abstract Objectives: Skin diseases seen on the feet increase in the university environment due to factors such as shared living conditions, failing to provide adequate hygiene, lower economic status, length of daily walking and wearing shoes continuously. Our aim in this study was to determine the skin dis- eases seen on the feet of university students, to specify the students' knowledge, attitudes and be- haviors regarding foot health and foot care, and to reveal the risk factors playing a role in the de- velopment of these diseases. Methods: A total of 302 university students who consulted the dermatology specialist in the Medico– Social Health Center due to any disease on their feet and agreed to participate in the research were included in the study. Subjects were requested to respond to a questionnaire. Results: The most common foot diseases of the participants were tinea pedis (24.8%), sweaty feet (24.2%), and foot callosities (23.2%). The rates of being male gender, age 23 and above, low fa- ther’s education level (primary school or lower), living in a rural area, failing to dry the feet properly and adequately after washing, and cutting the toenails improperly were found at a significantly higher rate in patients with fungal disease. Conclusion: Educational activities regarding the protection of foot health and using healthy shoes should therefore be carried out in this age group. Introduction traumas and effects related to the weight of the body [4]. Feet are organs carrying the weight of the Skin diseases seen on the feet are, accord- body and are subject to various environ- ing to the order of their frequency, fungus mental factors. Foot pathologies, mainly infections, bacterial infections, toenail pa- fungus diseases, generally start with pu- thologies, hyperkeratotic lesions, and ec- berty and increase as we get older. Almost zematous lesions [4, 5]. While tinea pedis is 70% of adults have various foot problems frequently encountered in the summer due [1, 2, 3]. Foot health is affected by factors to hot and humid environmental conditions, such as mechanical effects originating from complaints related to corns increase in the the shoes, personal hygiene, the environ- winter as a result of using tight and closed ment we live in, seasonal characteristics, shoes. Shared living conditions such as education, and economic status as well as military schools, boarding schools, and dor- Page 1 of 7 (page number not for citation purposes) J Turk Acad Dermatol 2007; 1 (2): 71202a. http://www.jtad.org/2007/2/jtad71202a.pdf mitories also increase the frequency of some were significant or not. Values with alpha error dermatological problems that are seen on margins lower than 0.05 were considered statis- the feet [5]. tically significant. We think that skin diseases seen on the feet Results increase in the university environment due to factors such as shared living conditions, A total of 302 students, 52.6% (n=159) male failing to provide adequate hygiene, lower and 47.4% (n=143) female, participated in economic status, length of daily walking the study and the mean age was 21.8 ± 2.6 and wearing shoes continuously. However, (range 18 to 28). The average monthly in- studies aiming to detect the skin diseases come of the families was 863.5 ± 509.7 YTL. seen on the feet of university students and Some demographic characteristics of the to determine the students' knowledge, atti- participants are shown in Table 1. tudes and behaviors related to foot health The first five most common foot diseases of and foot care are almost nonexistent both the participants were tinea pedis (24.8 %), in our country and other countries. hyperhidrosis (24.2 %), foot callosities (23.2 %), unguim incarnatus (14.5 %), and ver- Our aim in this study was to detect the skin diseases seen on the feet of university stu- dents, to determine the students' knowl- Table 1. Some Socio-demographic Characteristics edge, attitudes and behaviors regarding foot of the Participants health and foot care, and to reveal the risk Characteristics (n=302) N % factors playing a role in the development of Gender these diseases. Male 159 52.6 Female 143 47.4 Materials and Methods Age This study was planned as a descriptive study 22 and under 202 66.9 and carried out at Gazi University Medico-Social 23 and over 100 33.1 Health Center between March and September Class 2006. A total of 302 university students who 1-2 148 49.0 consulted the dermatology specialist in the Med- ico-Social Health Center due to any disease on 3-4 154 51.0 their feet and agreed to participate in the re- Monthly income of the family search were included in the study. Students 500 and under 60 19.9 found not to have any dermatological problem by 501-1000 195 64.6 the dermatology specialist were referred to the relevant specialist. 1001-1500 32 10.6 1501 and over 15 5.0 Preliminary tests of the survey form to determine Mother’s education level the socio-demographic characteristics, knowl- edge, attitudes, and behaviors of all students re- Not literate 33 10.9 garding foot health and foot care prepared ac- Literate 23 7.6 cording to the medical literature and specialist Primary school 175 57.9 views and consisting of multiple choice and fill- Secondary school in-the-blank type of questions were carried out 32 10.6 on the students who would not be included in High school 29 9.6 the study. College/University 10 3.3 All subjects were required to sign an informed Father’s education level consent to be involved in the study. The data Not literate 8 2.6 were transferred to the computer environment Literate 23 7.6 using the SPSS for Windows 11.0 package soft- Primary school 138 45.7 ware and statistical analyses were carried out. Descriptive statistics were stated using percent- Secondary school 29 9.6 ages. In addition, each of the five most frequently High school 71 23.5 observed diseases were considered a single case College/University 33 10.9 group and the students within or outside this Longest place of residence subject group were compared according to their various demographic characteristics and habits Rural (village/town) 112 37.1 related to foot care. The chi-square test was used Urban (big city) 190 62.9 to determine whether the observed differences Total 302 100.0 Page 2 of 7 (page number not for citation purposes) J Turk Acad Dermatol 2007; 1 (2): 71202a. http://www.jtad.org/2007/2/jtad71202a.pdf Table 2. Diseases Detected on the Feet Table 3a. Practices of the Participants of the Participants Regarding Foot Health and Foot Care Diseases n* % Practices (n=302) n % Frequency of washing the feet Tinea pedis 75 24.8 Once daily or more 257 85.1 Hyperhidrosis 73 24.2 Less frequent than once daily 45 14.9 Existence of personal foot towel Foot callosities 70 23.2 Yes 177 58.6 Unguim incarnatus 44 14.5 No 125 41.4 Verruca vulgaris 30 9.9 Status of drying feet after washing Dryness and cracking of the Yes 186 61.6 28 9.3 heels No 116 38.4 Flatfeet 19 6.3 Drying feet properly Calcaneal spur 6 2.0 Yes 155 51.3 No 147 48.7 Onychomycosis 3 1.0 Frequency of changing socks Shoe sores 3 1.0 Everyday 202 66.9 Hallux valgus 1 0.3 Less frequent than once daily 100 33.1 Healthy sock usage (cotton, mercerized) * More than one disease was detected in some students Yes 243 80.5 Others 59 19.5 ruca vulgaris (9.9 %). The diagnosis of ti- Cutting toenails properly nea pedis and onychomycoses were made Right 125 41.4 clinically and microscopically. These dis- Wrong 177 58.6 eases are shown in Table 2. Having personal nail scissors The practices of the participants regarding Yes 264 87.4 foot health and foot care are presented in No 38 12.6 Status of having special toenail care Table 3. Those washing their feet one or (pedicure) more times a day constituted 85.1%, those Yes 18 6.0 with separate foot towels constituted 58.6%, No 284 94.0 and those drying their feet properly after Status of having a personal set for pedi- washing constituted 51.3% of all the par- cure (n=18) ticipants. Yes 14 4.7 No 4 1.3 Socks were changed daily by 66.9%, and Most important factors for selecting 80.5% stated that they used healthy socks shoes* (cotton, etc.). Those cutting their toenails Fit the feet well 240 79.5 properly constituted 41.4%, those with per- Economical 55 18.2 sonal nail scissors 87.4%, those who had Fashionable (color/form) 44 14.6 pedicure 6.0%, and those with their per- Made of natural leather 23 7.6 sonal set while having pedicure 4.6%.