Athlete’s Foot

Infection

Athlete’s foot (tinea pedis) is a fungal infection that comes from a family of fungi known as dermatophytes – a group of organisms that can break down the protein in skin, hair, and nails. These fungal pathogens also cause ringworm and nail infections. Athlete’s foot usually begins between the toes, causing a red, scaly rash that is very itchy. The fungus prefers to grow in moist environments and proliferates in crowded places. It is common in athletes, diabetics, people with lowered immune systems, and people who frequent public places involved with water (like public showers and nail salons). The infection can be short-lived or persist for months to years.

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Symptoms

Symptoms can affect the entire foot, but sometimes start between the toes and spread to the soles and top of the foot. One or both feet can be affected.

  • Itchy feet and toes
  • Burning sensation
  • Stinging
  • Loose toenails
  • Thickened, yellow toenails
  • Cracked skin
  • Dry skin
  • Itchy blisters
  • Redness
  • Oozing

Risk Factors

Everyone is at risk for athlete’s foot. However, people with impaired immune systems or with pre-existing conditions (like diabetes or eczema) are at a higher risk. Risk factors include:

People with weakened or impaired immune systems. Athlete’s foot is very common among diabetics, people with autoimmune disease, HIV, and cancer patients.

Males and teenage boys. Male hormones tend to make the sweat glands more active.

Wearing damp socks. Wearing damp socks or tight-fitting shoes creates the ideal environment for fungi to grow and thrive.

Sharing linens and towels. Sharing linens and towels with others can transfer the fungi from one person to another. Athlete’s foot can be very contagious.

Bare feet in public places. Walking barefoot in public areas that are near water or steam can put you at risk.

Minor skin or nail injuries. Existing injuries can increase your risk of infection.

Nail salons. Pedicure and manicure spaces can be contaminated with dermatophytes.

Diagnosis

Athlete’s foot is easily diagnosed upon examination of the skin and medical history. The doctor may ask you about recent activities and if you have a history of infections like these. Infections that are hard to cure may require further testing, but this is unlikely. Tests for Athlete’s foot include:

Skin scraping. The doctor may take skin scrapings of the affected skin to look at it more closely under the microscope. It may even be sent off to the lab for further testing.

KOH prep. The doctor may take small skin scrapings, or some of the drainage, and place it on a slide with a chemical that stains the fungi and makes it visible.

Fungal cultures. The doctor may take a swipe of the drainage and affected skin with a swab (much like the ones used to check for strep throat). They send it into the lab to be cultured and see what grows. This is also useful when fungi are resistant to treatment because the lab can perform a sensitivity test on the culture to see which medications it responds to. Believe it or not, fungal infections are now showing the same resistance to antifungal medications as bacteria are to antibiotics. This is why prevention tips should be followed as shown below.

Treatments

Over the counter antifungals. These can be purchased without a prescription. Common OTC antifungals are Lotrimin© (clotrimazole), Lamisil© (terinafine), and Tinactin© (tolnaftate).

Prescription antifungals. If you do not respond to OTC medications, or if your infection is too severe, your doctor may prescribe creams or pills such as Mentax© (butenafine) or Naftin© (naftifine), or oral medications such as Diflucan© (fluconazole) and Sporanox© (itraconazole). Doctors may wait to prescribe oral antifungals only in more severe cases because the potential risk of side effects may outweigh the benefits.

For any of these medications, treatment must be completed and results may take time. If a full course of treatment is not finished, the infection could return or worsen.

Alternative Treatments and Home Remedies

Tea tree oil. After your shower or bath, rub a few drops of tea tree oil onto the affected area. Tea tree oil is a known natural antifungal and is helpful with long-term use.

Apple cider vinegar. Vinegar changes the pH of your skin, making it unfavorable for fungal growth. Mix ½ cup with water in a spray bottle and use it to spray your feet after your shower.

Oregano soak. Oregano is a natural antifungal. Make an oregano tea with warm water and 4 ounces of oregano. Soak your feet in the solution 2 to 3 times a day.

Essential oils. A current research study examined the activity of several essential oils against dermatophytes fungi that cause athlete’s foot. The study showed that rose, litsea, and lemon myrtle essential oils completely inhibited the growth of the bacteria. Practice care when applying essential oils and always dilute in a carrier oil.

Prevention

  • Keep feet clean and dry
  • Use waterproof sandals when frequenting pools, saunas, and public showers
  • Do not share towels
  • Do not wear damp socks
  • Go barefoot at home and give your feet a chance to breathe
  • Use a good foot powder
  • Practice good blood sugar control if you are a diabetic

References

AAD. How to prevent athlete’s foot. Retrieved from American Academy of Dermatology Association: https://www.aad.org/public/diseases/a-z/athletes-foot-prevent

Achterman, R. R., & White, T. C. (2013, July 08). Dermatophytes. Current Biology, 23(13), 1145-1268). Retrieved from https://www.cell.com/current-biology/pdf/S0960-9822(13)00292-3.pdf

CDC. (2017, February 6). Hygiene-related diseases – Athlete’s foot (tineas pedis). Retrieved from Centers for Disease Control: https://www.cdc.gov/healthywater/hygiene/disease/athletes_foot.html

Healthline. (2018, September, 27). Athlete’s foot (tineas pedis). Retrieved from Healthline: https://www.healthline.com/health/athletes-foot

Mayo Clinic. (2019, September, 04). Athlete’s foot. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/athletes-foot/symptoms-causes/syc-20353841

Parrish, N., Fisher, S. L., Gartling, A., Craig, D., Boire, N., Khuvis, J., Riedel, S., Zhang, S. (2020, October 16). Activity of various essential oils against dermatophytes of Microsporum and Trichophyton. Frontiers in Cellular and Infection Microbiology, 10. Retrieved from: https://www.frontiersin.org/articles/10.3389/fcimb.2020.545913/full

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