CONDITIONS

Athlete’s Foot

What Is Athlete’s Foot

Athlete’s foot (tinea pedis) is a common, highly contagious fungal infection that is characterized by itching, flaking and cracking of the skin. The infection typically develops on the skin between the toes or on the sole of the foot, though the fungi that cause the infection can travel to the rest of the foot or body if left untreated. Athlete’s foot is a superficial fungal infection, meaning it affects a specific area on the external surface of the skin, making it easier to treat than a more widespread systemic infection. Athlete’s foot is a common, highly contagious fungal infection that is characterized by itching, flaking and cracking of the skin. The infection typically develops on the skin between the toes or on the sole of the foot, though the fungi that cause the infection can travel to the rest of the foot or body if left untreated. Athlete’s foot is a superficial fungal infection, meaning it affects a specific area on the external surface of the skin, making it easier to treat than a more widespread systemic infection.

What Causes Athlete’s Foot

Most athlete’s foot infections are caused by two types of fungi: Trichophyton mentagrophytes and Trichophyton rubrum.

Trichophyton mentagrophytes is responsible for the first two forms of athletes foot:

  • Toe web infection, which causes dry, itchy, and flaking skin in between the toes
  • Vesicular infection, which causes blister-like sores most typically on the soles of the feet

The symptoms of these two types of athlete’s foot typically are severe and fast in onset, but they can be treated easily.

Trichophyton rubrum is responsible for the third type of athlete’s foot:

  • Moccasin-type infection, which begins as only minor discomfort, itching, and dryness on the bottom of the foot and later develops to the thickening and cracking of the skin and toenails.

Moccasin-type infections are harder to treat because many topical medications cannot penetrate the thick layer of skin to eliminate the fungus.

Athlete’s foot is highly contagious and can be spread by contact with an infected person or by touching contaminated surfaces such as showers, pools, rugs, shoes, towels, and bed linens. Public pools and showers are an especially common source of infection, as the moist environment and heavy foot traffic make an excellent breeding ground for the moisture-seeking fungi.

Risk Factors For Athlete’s Foot

Around 70% of the population will be infected with athlete’s foot at some point in their lifetime, and about 15% of the population is infected with it at any given time. Men are much more likely than women to get athlete’s foot, especially adolescent males.

You may be at higher risk of contracting athlete’s foot if you:

  • Have a history of fungal infections
  • Walk barefoot in locker rooms or other public places
  • Shower in a communal area
  • Are not keeping your feet clean and dry
  • Get a pedicure with contaminated instruments
  • Wear air-tight or poorly ventilated shoes or boots
  • Have excessively sweaty feet
  • Live where the weather is hot and humid
  • Have immune system disorders, particularly HIV/AIDS.
  • Come into contact with an animal (even a domestic dog or cat) that may be carrying the fungus. Signs could include patchy fur. Make sure you have your animal checked regularly by a vet.

Diagnosing Athlete’s Foot

Your primary care physician can usually diagnose athlete’s foot by asking about your symptoms and looking at your skin. But because infections can be caused by bacteria other than the athlete’s foot fungi, a definitive diagnosis is important for successful treatment. If tests are needed, they may include:

  • A simple office test called a KOH, or potassium hydroxide, exam. In a KOH exam, the doctor scrapes a small skin sample from the affected area, mixes it with a liquid containing KOH, and examines the liquid under a microscope. The KOH destroys all cells that are not fungi, and the doctor can determine whether or not the athlete’s foot-causing fungi are present.
  • Viewing the feet under a “Wood’s light,” a black light that detects color changes in the skin as a result of the fungal infection.
  • Further skin sample tests performed at an external lab.

Symptoms of Athlete’s Foot

The following are symptoms of athlete’s foot, typically found in between the toes or on the bottoms of the feet:

  • Dry skin
  • Itching, which gets worse as the infection spreads
  • Scaling
  • Cracking
  • Redness, usually all over the feet
  • A white, wet surface, especially on the skin between the toes
  • Blisters, which may open and become painful

Prognosis

Mild to moderate cases of athlete’s foot almost always respond well to an over-the-counter anti-fungal treatment. More severe cases, such as advanced moccasin-type athlete’s foot, or persistent infections might require prescription anti-fungal treatment. Preventative measures can be taken to decrease the risk of reoccurring athlete’s foot infections.

Most cases of athlete’s foot are cured without difficulty as long as the condition is diagnosed and treated early. Rare complications include:

  • Fungal nail infection (onychomycosis), This can cause the nail to become thick, discolored, and crumbly, and the skin beneath to become painful and inflamed. Effective treatment is available, but it may take several weeks to rid the nail of the infection.
  • Cellulitis and other bacterial infections. Cracked skin on your feet or toes may allow bacteria to enter your body, making you vulnerable to possibly serious infections that can spread to rest of the body. In the most serious cases, infections like Cellulitis can spread to the bone and result in blood poisoning (septicemia). Symptoms of bacterial infection include fever, chills, patches of warm, red and painful skin, and general feelings of illness.
  • Jock itch. This can happen when the fungal infection is spread from the feet to the groin, often by your hands or on a towel, and is characterized by an itchy, burning rash.

If you experience symptoms of any of the above, or symptoms of athlete’s foot, please get checked by a doctor as soon as possible.

Living With Athlete’s Foot

The American Academy of Dermatology (AAD) offers these tips to help you be more comfortable and prevent further infections:

  • Keep your feet clean and dry by wearing absorbent socks made of natural fibers, such as cotton. Avoid synthetic fibers like nylon. Change your socks
    during the day if your feet become moist or sweaty.
  • If you can, remove the insoles of your shoes and sneakers and allow them to dry out overnight.
  • Dust the inside of your shoes with talcum powder or a medicated powder such as Desenex to help decrease the moisture level.
  • Alternate wearing different pairs of shoes to allow them to dry out for a day or two at a time.
  • Wear shower sandals at public pools and in showers.

Additionally,

  • Dry your groin area before your feet after bathing, and put your socks on before your underwear. This prevents the fungus from travelling and developing into jock itch.
  • Wear socks without shoes when indoors to give your feet and shoes time to air out.
  • Wash your hands after touching your shoes or feet.

Screening

Because athlete’s foot is an acute or temporary infection, doctors do not regularly screen for it. Make sure to get regular checkups, and mention any problems you have to your doctor. Take the preventative measures against athlete’s foot listed here.

If you experience any of the symptoms of athlete’s foot, schedule an appointment with your doctor.

Prevention

Athlete’s foot is highly contagious, but there are ways to cut down your chances of getting it.

The Harvard Medical School recommends the following to prevent athlete’s foot:

  • Wearing sandals or shower shoes when walking around a locker room, pool or any other open, wet surface, even the “splash zone” in a playground fountain.
  • Making sure your feet are clean by washing them with soap and water at least once a day, and keeping them dry the rest of the time. Don’t forget to dry between your toes.
  • Maintaining clipped and clean nails, since your nails can house and spread the infection.
  • Wearing clean socks every day, and changing them more often if you sweat a lot or get them wet.
  • Using foot powder to reduce friction between your toes and between your feet and socks. Less friction means less sweat and a drier, less fungus-friendly environment.

Medication And Treatment

Several over-the-counter (OTC) topical anti-fungal medications are available, and are typically effective modes of treatment. These include:

  • Clotrimazole OTC (Lotrimin OTC)
  • Miconazole (Micatin)
  • Terbinafine OTC (Lamasil OTC)

If you don’t see any improvement within two weeks of starting the OTC treatment, speak with your doctor. He or she may prescribe you a topical anti-fungal medication such as:

  • Miconazole econazole nitrate (Spectazole)
  • Butenafine (Mentax)
  • Terbinafine (Lamasil)
  • Clotrimazole (Lotrimin)

If these fail, your doctor might prescribe you an oral anti-fungal, such as:

  • Fluconazole (Diflucan)
  • Itraconazole (Sporanox)

Make sure to wash your hands before and after applying any topical medications.

Complementary and Alternative Treatment

Many people with athlete’s foot have found alternative treatments helpful. These include:

  • Tea tree oil. The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institute of Health, cites two clinical trials that suggest tea tree oil can help heal athlete’s foot. Tea tree oil, which can be rubbed on the feet, acts as a natural antiseptic and can be found at health food stores.
  • Sosa. New York University Langone Medical Center reports two preliminary studies pointing to the herb sosa’s ability to keep feet dry. This is important, since sweating leads to the spread of the fungus.
  • Garlic. A small number of studies support garlic’s antimicrobial properties. In particular, studies have looked at a compound in garlic known as “ajoene” which appears to be especially effective against athlete’s foot fungus as reported in The New York Times.
  • Vinegar. A homemade remedy of one part vinegar and roughly four parts water, once or twice a day for 10-minute foot soaks, may aid in treatment.

Care Guide

Although athlete’s foot can be uncomfortable, it’s usually not serious. The American College of Foot and Ankle Surgeons suggests you do the following to help your athlete’s foot heal:

  • Avoid walking barefoot to reduce the spread of the fungus,
  • Wash your feet daily with soap and water and thoroughly dry them, including your toes.
  • If your feet sweat a lot, change your socks during the day.
  • Use talcum or antifungal powder on your feet.
  • Take antifungal medication, either OTC or prescription.
  • Allow your shoes to air for at least 24 hours before you wear them again.
  • Don’t wear tight hosiery and shoes. Instead choose light and airy socks and footwear,

Dry your groin area before you dry your feet. Also, put on your socks before your underwear. Both these strategies can keep the fungus from spreading to your groin and causing jock itch.

When To Contact A Doctor

With the right care, it’s likely your athlete’s foot will clear up without any complications. However, don’t hesitate to contact your doctor if you notice any of the following:

  • Your foot is swollen and warm to the touch, especially if there are red streaks, as this may indicate a bacterial and/or more extensive fungal infection. Other signs include pus, drainage, and fever of 100 F (37.8) or higher.
  • The infection appears to be spreading.
  • You think you have athletes foot and you have diabetes or diseases associated with poor circulation. Poor circulation caused by diabetes and other conditions may increase your chance of a bacterial infection complication.
  • Your symptoms don’t improve after two weeks taking an antifungal medication

Questions For Your Doctor

Health professionals who are qualified to diagnose and treat athlete’s foot include:

  • Family and internal medicine doctors
  • Dermatologists
  • Podiatrists
  • Physician assistants
  • Nurse practitioners

Questions For A Doctor

These are questions you may want to ask your doctor about athlete’s foot:

  • What medications do you recommend to treat this?
  • What are the side effects of the medicine I’ll be taking?
  • Which over-the-counter antifungal powder do you recommend?
  • What lifestyle changes can I make to avoid this happening again?

Resources

April is National Foot Care Month as designated by the American Podiatric Medical Association (APMA). The purpose is to increase public awareness about foot health.

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