What is athlete’s foot?
Tinea pedis, more commonly known as athlete’s foot, is characterised as an inflammatory fungal infection of the skin between the toes (toe webs), the soles of the feet, as well as the heels. The condition causes red (inflamed), raw and cracked skin eruptions or blisters. Skin may become itchy (or have sensations of burning or stinging), scaly and occasionally ooze or weep. An infection can spread to the toenails, and sometimes the hands too.
Feet that are exposed to warmth and moisture provide an ideal environment for fungal growth. As many as 70% of the world’s population may develop athlete’s foot at some time or another during their lives.
Athlete’s foot is not classified as a serious condition, but must be treated so as to prevent spreading of the fungus to other parts of the body or to another person. It can be easily picked up from contaminated surfaces such as flooring, shared clothes or towels which have been in contact with infected feet.
Athlete’s foot can be difficult to ‘cure’ as it is common to experience recurring infections. Anyone is vulnerable to contracting this fungal infection, irrespective of age or gender.
The condition is also often called ‘jungle rot’ by armed forces serving in areas with tropical climates, and is closely related to other fungus causing infections such as jock itch and ringworm.
Fact versus fiction
Athlete’s foot, although not a serious condition, is often misunderstood. Understanding the nature of the fungus which causes an infection can help to better understand how it occurs and why it can happen multiple times.
- Myth – athlete’s foot only happens to professional sports men and women: The name by which this condition is most well-known does have something to do with professional athletes, but not exclusively. A fungal infection can happen to anyone exposed to the contaminating cause. The condition became well-known as it appeared to affect many athletes in places that they frequent – gyms, showers and locker rooms (shared environments which are primed for fungal growth).
- Myth – Athlete’s foot is different from jock itch infections: Both infections are caused by the same fungus. The difference in name merely refers to the specific parts of the body in which an infection typically occurs. Jock itch refers to an infection of the groin area and is known as tinea cruris. Athlete’s foot doesn’t just affect the feet either. Scratching or touching infected feet, and then touching other areas of the body can spread infection, such as the groin area or armpits. Spreading is also possible through contact with contaminated clothing or bed linens.
- Myth – A person with generally poor hygiene habits will likely get athlete’s foot: Adopting good washing habits won’t necessarily prevent a bout of athlete’s foot. If feet aren’t properly dried after washing, this is what creates an ideal breeding ground for fungus. Showering is not likely to clear an infection either, even if feet are well washed with soap and water. Cleanliness, however, is important for preventing a recurrence, as long as feet are well dried after each wash.
- Myth – Those who wear socks and shoes all day are more prone to athlete’s foot: Yes, and no. If shoes and socks are dry, chances are your feet will be just fine. Dark, damp environments are where fungus thrive the best. If shoes and socks are not clean and dry when worn, risk for fungal infection increases.
- Myth – Socks made of natural fibres (e.g. cotton) can prevent athlete’s foot: Many natural fibres can hold moisture, so a pair of cotton or wool socks is not likely to prevent a fungal infection, but may not hold as much moisture near the foot. Natural fibres are more porous materials, so are better to wear than synthetic ones which are water resistant.
- Myth – If skin on the foot isn’t peeling, it’s not an athlete’s foot infection: Not everyone will necessarily experience cracking or peeling of the skin. There is likely to be dryness and signs of inflammation (redness) however, all of which are symptoms of athlete’s foot.
- Myth – athlete’s foot can clear up on its own: This fungal infection doesn’t resolve itself. It can worsen without treatment and sometimes result in more serious complications. Antifungal medications are recommended for the full length of time stipulated, even if symptoms begin to clear beforehand. This can help to prevent a recurrence.
What causes athlete’s foot?
Dermatophytes are the group of fungi (tinea fungus) that causes athlete’s foot. The fungus grows on (or inside) the top layer of skin (epidermis) and multiplies, thriving on warmth and moisture. The webbing between the toes is usually where an infection first occurs as a result. An environment which is closed, dark, lacking airflow, moist and warm (humid), offers fungi the opportunity to feed on keratin (the protein which is found in the skin, nails and hair) and then multiply.
Athlete’s foot is easily spread by an infected person walking around barefoot or having touched their infected feet, followed by other surfaces. It is common for infection to spread through skin particles left on the floors of public gyms, showers, lockers rooms, spa facilities, nail salons or swimming pools.
Infection can also spread with the sharing of socks, shoes (the fungus can grow in shoes as well) or other clothing and towels, which has been in contact with the fungus. Simply touching the feet or toes of an infected person (direct contact) can also spread the fungus.
It is possible to spread an infection as a result of fungi exposure without having contracted athlete’s foot yourself. Some people appear to be a little more resistant to such infections than others who may have impaired immune systems (such as those with diabetes).
Signs and symptoms of athlete’s foot
General signs which are most common in athlete’s foot infections include:
- Skin which is red (rash-like and raw), dry or moist and / or flaky, cracked (fissuring) and scaly lesions (peeling) – especially in the toe webbing and / or soles
- Soggy skin
- Itching skin (or varying degrees of stinging or burning sensations) – that often worsens when shoes and socks are removed
- Small blisters (which may be painful) or ulcers (which leak fluid)
Athletes foot may affect one or both feet at one time. A ‘two feet, one hand’ pattern is fairly common with fungal growth spreading to the hands via direct contact (i.e. scratching or picking) with infected feet. Hand fungal infections are known as tinea manuum. Infection can spread to the toenails as well.
The type of athlete’s foot can also be determined from the collection of symptoms present. Some fungal infection result in rash-like, red, raw and blistery symptoms, while others produce thick, dry and scaly types of effects.
The different types of athlete’s foot are:
- Toe web infections: Infections are initially seen between the fourth and fifth toes, which appear scaly (or peeling) and cracked. Infection can spread to the rest of the foot, particularly the soles. Also known as an interdigital infection, the skin becomes red (inflamed), rash-like, scaly or peeling and may give off a smelly discharge. In severe instances, the skin may turn green in colour.
- Moccasin infections: The first signs of infection may be a little soreness on the sole of the foot, and skin along the heel may become thick, itchy and cracked (dry). Dryness and scaling (which can resemble eczema) can extend from the soles up the sides of the feet. Toenails can also discolour and thicken when infected, and begin to crumble. Toenails may also pull away from the nail bed, and in some cases, loosen and fall out. If toenails are infected, combination treatment may be required (toenails are required to be treated separately).
- Vesicular infections: This type of infection may begin with an outbreak of tiny fluid-filled blisters (which may be itchy and / or painful), usually along the soles of the feet. Blisters can surface anywhere on the foot, however, and can sometimes be accompanied by a bacterial infection as well (if blisters burst open). Open sores or ulcers can also develop causing a bacterial ulcerative infection. These can become inflamed, painful and ooze discharge. Signs of a bacterial infection include a honey-yellow crust on the foot, redness, swelling, warmth and pain.
How to tell the difference between psoriasis and athlete’s foot
Psoriasis is a genetic autoimmune condition which is not as a result of a fungal infection, and is not contagious. In the case of psoriasis, skin cells are produced at a faster rate than is normal, accumulating on the surface of the skin. The skin cells do not fall off naturally and instead develop into thick scales and / or white/silver patches. The result is dry and itchy skin which can also be painful. The condition can either affect just a small area of the body or cover larger portions, occurring in flares.
Symptoms between the two skin conditions are a little similar, but there are a few differences:
- Psoriasis: Skin is covered by scales and red patches, which may be painful. Dry cracked skin may also bleed. Joints may also become swollen and painful, and nails may thicken or become pitted.
- Athlete’s foot: Skin may be red and scaly (peeling).
- Both: Itching or burning sensations on or around red, rash-like areas of skin.
Location on the body may also be a tell-tale sign
The feet are the main area of the body affected by athlete’s foot, with the potential for the infection to spread elsewhere. Patches of skin irritation that occur around the knees, elbows, back, trunk etc. are more typical of psoriasis than a fungal infection (athlete’s foot).
Athlete’s foot may be easily treated with anti-fungal ointments and creams which can be bought over-the-counter. Psoriasis is not likely to clear with the use of the same ointments and works better with the use of systemic medications which slow down the production of skin cells.
When in doubt, a consultation with a medical doctor can help to clarify which of the two conditions a person may have. This can be done with a physical inspection of the affected areas of the body (physical examination) and a laboratory test (using a sample).
When to call the doctor
If unsure of symptoms, or an infection does not clear up with over-the-counter anti-fungal ointments, it is best to consult with a healthcare professional. This is especially necessary if redness, and swelling increases and affected areas begin to bleed, leak discharge (fluid) and become painful (signs of a bacterial infection). Those with affected nails, or who have a compromised immune system or diabetes should also consult their doctor for a thorough check. If symptoms ae suddenly accompanied by a fever, a consultation with a medical professional should be booked as soon as possible.
Whom should you see?
As athlete’s foot is a fungal infection affecting the skin, a specialist in the treatment of skin disorders (dermatologist) is best to consult with. Other medical professionals who can all diagnose and treat such infections include podiatrists, internal medicine physicians, paediatricians and general practitioners (GPs).
Diagnosing and treating athlete’s foot
How is a diagnosis made?
Athlete’s foot is a relatively straightforward condition to diagnose and treat. A doctor can easily identify athlete’s foot by sight, but may require skin scrapings, using a skin lesion potassium hydroxide (KOH) exam, in order to accurately diagnose the root cause (fungus).
A collection of skin scrapings (sometimes the nails as well) is relatively painless and may be necessary in order to identify the type of fungus causing the irritation. Scrapings are then sent to a laboratory where the sample is placed in a solution of potassium hydroxide (KOH) to be assessed under a microscope. The potassium hydroxide effectively destroys any normal cells, leaving behind those infected by fungi. From there the type of fungus can be identified. Results of the analysis are quick and can be ready in minutes. In rare instances, a biopsy of skin may be required for testing (a small sample is carefully removed). A fungal culture can also be used to make a diagnosis.
Generally, if a case of athlete’s foot presents anything unusual, scrapings may be requested. For the most part, athlete’s foot may be diagnosed just by a physical examination of the affected areas. A doctor will discuss all symptoms and assess if there have been any other fungal infections in the past.
The type of questions that may come up include:
- How long ago did you start experiencing symptoms?
- How would you describe the first signs of skin irritation?
- Are you experiencing any itchiness or burning sensations?
- Are you experiencing any degree of pain?
- Have you tried treating the skin? Have your efforts made symptoms worse or better?
- Are you aware of having been around anyone with athlete’s foot? (i.e. a family member or friend)
- Have you recently spent time in communal areas such as gyms, swimming pools, a sauna or spa?
Treatment for athlete’s foot
Fungal infections such as athlete’s foot do not generally clear up on their own. It is best to begin treating infection as soon as minor symptoms appear. Antifungal treatments are usually recommended, much of which are available over-the-counter. If these do not show signs of improvement, it is best to consult a doctor for further assessment – not all foot irritation is as a result of a fungal infection. If there are signs of a bacterial infection, for instance, antibiotics will be prescribed to clear irritation and discomfort.
Antifungal treatments work to prevent the fungus that is causing infection from spreading or multiplying any further (hindering growth). Treatments are available in cream / lotion, spray, powder or liquid forms. A doctor or pharmacist will recommend an antifungal treatment that is most suitable for a person’s age (child, adult or senior). Pregnant or breastfeeding women and children may not be able to use certain products. Pregnant women will also not likely be prescribed oral medications due to risk to an unborn baby.
A doctor or pharmacist will recommend that they be used in the following way:
- Affected areas should be washed and dried thoroughly (including between the toes).
- Hands should be washed and dried thoroughly after touching affected skin.
- Antifungal treatment (i.e. cream, powder, spray or liquid) can then be directly applied to the affected skin. A small amount is mostly all that is needed for at least one application a day.
- Hands should be thoroughly washed again once treatment has been applied.
Itchiness and pain may be alleviated with the use of a mild steroid cream for a short period of time as well. These creams can generally be used at the same time as antifungal treatment products.
Treatment should be continued even when symptoms begin to clear (usually within a week), as recommended in the leaflet accompanying the product (at least one week after symptoms clear and up to 4 weeks). This is to ensure that the fungus clears completely and has little chance of recurring. If symptoms do not appear to be clearing and are still highly uncomfortable after about a week, antifungal medications of prescription strength may be recommended by a doctor. He or she may also request blood tests to ensure sufficient liver function before prescribing medications which may be stronger in order to combat more resistant instances of athlete’s foot.
A doctor or pharmacist may also recommend antiperspirant sprays containing aluminium chloride (Drysol) for those who tend to sweat a lot. Powders may also be recommended to alleviate moisture on the feet as.
If an infection has spread to the toenails, this must be treated as well so as to avoid potential reinfection. Treatment for infected toenails may require separate treatment products but should be administered at the same time as treatment for the remainder of the foot. Nail treatment may require recommended oral antifungal medications for between 3 and 4 months.
A doctor or pharmacist is not likely to recommend topical corticosteroid creams and lotions as these do not help to clear fungal infections.
Along with the application of antifungal treatments, a doctor will recommend good foot hygiene habits, as well as adjustments which promote a clean, dry (moisture-free) and friction-free environment. It may be recommended that vinyl shoe materials be avoided as these promote moisture when worn, which does not help to keep potential fungal infections at bay. Wearing sandals in communal areas where fungi are likely to thrive is also recommended.
Clean, absorbent socks (leggings or stockings) are best to wear, and should be changed if feet become sweaty or moist. The insoles of shoes can also be removed from shoes, so as to allow them to dry out when not worn. Shoes and socks can also be dusted with powder (medicated antifungal powder or even talcum powder) to help decrease moisture when worn. It can also help to alternate pairs of shoes, and not wear the same pair every day. This can help to allow for time to dry out a pair of shoes for a day or two before being worn again.
A doctor or pharmacist will also recommend that skin not be torn, picked at or scraped off during treatment as this can result in healthy skin cells becoming infected (and spreading the fungi).
Mild cases of athlete’s foot typically respond well to antifungal treatments, but can recur. Severe cases must be seen, diagnosed and treated by a medical doctor.
Can a vinegar foot soak alleviate athlete’s foot?
Studies have looked into whether foot baths containing vinegar may have healing properties. Vinegar is effectively a diluted form of acetic acid, which may have antifungal healing properties. Vinegar is capable of working as a disinfectant which can also reduce bad odours.
Mild cases of athlete’s foot may benefit from a vinegar based solution foot soak, especially if toenails have become infected as well. Those who are diabetic should not use this foot soak solution and rather consult their healthcare provider for treatment.
To make a foot bath solution, use 1-part vinegar to 2 parts water. Before submerging feet into the solution, they should be thoroughly washed with soap and water. Feet can be soaked in a solution at night, cleaned, moisturised or treated with antifungal products before bed.
A 10 to 15-minute daily soak for several weeks (or until signs of infection subside) is a relatively inexpensive way to help alleviate symptoms of fungal infection. The vinegar odour is a strong one but does tend to subside once feet are dry.
There’s little harm in giving feet a vinegar bath, but if dryness and cracking appear to increase, bath frequency can be reduced to alternate days. If dryness is a problem, using cool water (not hot) may be more effective.
What about using Listerine?
A bold mouthwash product that is formulated to kill up to 99% of bad breath germs that cause gingivitis and cavities, has been used by some in a similar foot soak bath for the treatment of athlete’s foot. Some have been known to use Listerine on their feet for the removal of dead skin cells, as well for treating fungal (including those of the toenails) infections. The thinking in using this product is associated with known antifungal properties in thymol and menthol – two ingredients in Listerine.
Does it work?
Studies have not been able to clinically prove that Listerine use is an effective antifungal treatment. Some studies have only focussed on fungal infections in the mouth, however, and not the feet. As yet, it has not been clinically proven that the antifungal properties in the mouthwash are in fact an effective treatment for fungi affecting the feet and nails. As a mouthwash, however, antibacterial and antifungal properties are proven to be effective. A foot bath with this ingredient may not necessarily cause any further harm or side-effects, but may not be the most effective means to clear an infection. It is advisable to seek treatment from a medical doctor or pharmacist instead.
Alternative natural remedies
There are several other alternative means that have been tried for treating fungal infections. Some may provide relief, such as alleviating inflammation, but as yet, have not yet been entirely clinically proven to treat infections such as athlete’s foot any more effectively than over-the-counter and prescription medications.
Before trying any home or natural remedy it is best to talk to a pharmacist or medical doctor.
Some natural alternatives which have been tried include:
- Tea tree oil: Oil produced from the leaves of the tea tree (also known as melaleuca) is known to have antiseptic properties which can kill off certain types of fungi and bacteria. Tea tree oil is an ingredient in many home treatment products on the market. Tea tree oil rubbed into the skin may help reduce swelling, itching and burning sensations associated with athlete’s foot, but is not a proven remedy for everyone who uses it. For some people, it can cause side-effects of skin irritation, such as rash or trigger an allergy. Sometimes dilution of a product can alleviate side-effects. Tea tree oil should never be taken orally as it can be toxic to the body’s system.
- Bitter orange: Some studies have found that watered down (diluted) bitter orange oil with regular applications can help to alleviate symptoms of athlete’s foot. Undiluted, bitter orange oil can cause skin irritation and inflammation, and can also make the skin more vulnerable to sunburn if not protected with a sun exposure cream.
- Ajoene: A natural chemical found in garlic, ajoene has been tested in studies to see the effects on athlete’s foot symptoms. Taken in a gel form or orally, symptoms in at least one study showed relief within a week.
- Green tea: Polyphenols in green tea are known to help with alleviating redness (or inflammation) and have also been used to determine if these nutrients can also help with peeling. Studies have not yet determined whether the antifungal properties in green tea can actually cure athlete’s foot, killing off the fungi causing the condition. It may be that a good, regular soak in green tea simply makes feet feel a little better.
Risk factors and complications
What risk factors are associated with athlete’s foot?
Anyone is vulnerable to a fungal infection such as athlete’s foot. Certain behaviours can increase risk. These include:
- Walking barefoot in communal areas where dermatophytes (pathogenic fungi) thrive.
- Damp socks, stockings or leggings, as well as tightfitting closed-toe shoes are frequently worn.
- Wearing the same shoes and socks for extended periods of time.
- Contact is made with surfaces that have been touched by a person with a fungal infection, such as rugs or mats, clothing, shoes, towels or bed linen.
- Feet are hot, wet or sweaty for long periods of time.
Other potential risk factors include:
- Minor nail or skin injuries on the feet can increase risk for infections.
- Weakened or impaired immune systems, such as those with HIV-AIDS infections.
- Pre-existing conditions such as diabetes or eczema may be more prone to fungal infections with increased risk of ulcers.
- Pedicure environments which may be contaminated can spread infection.
The biggest complication associated with athlete’s foot relates to poor treatment or lack of treatment. Left on its own, fungi can spread to other parts of the body, including the hands, legs, toenails and fingernails, as well as other people.
Fungi does not typically spread too deeply within the body (i.e. it is not likely to affect the body’s internal organs or bloodstream). It does, however thrive in skin, nails and hair (keratin). Spreading can result in the following:
- Onychomycosis or tinea unquium (infection of the nails)
- Tinea cruris or ‘jock itch’ (infection of the groin area – genitals, buttocks and inner thighs)
- Tinea corporis (infection of the skin in other areas of the body)
- Secondary bacterial infections (as a result of bacteria and yeast causing inflammation, fever, pus drainage, swelling and pain)
It can also happen that an infection with athlete’s foot can result in an allergic reaction. This can lead to blisters forming on the feet (sometimes the hands too).
How to prevent athlete’s foot
‘Clean and dry’ is best when it comes to foot care. The practice of such hygiene habits can help to significantly reduce occurrences and / or recurrences of athlete’s foot.
Preventative behaviours can include:
- Allowing the feet (skin) to ‘breathe’ by removing shoes daily or wearing ‘roomy’ (well-ventilated) footwear
- Avoiding exposure to moist environments for prolonged periods of time
- Taking care when walking barefoot in public or communal environments – rather wear sandals
- Taking precautions when it becomes known that another person has an active infection and frequents the same environments
- Drying feet completely (but gently) after washing, especially between the toes
- Wearing clean socks, stocking, tights or leggings daily (i.e. alternate pairs of shoes)
- Socks, leggings or tights should be changed more than once a day if feet are prone to sweating
- Avoiding sharing footwear, leggings or tights, and towels with others
- Washing towels, showers and floors frequently (if an infection is active, use hot water to wash clothing and towels).
- Avoiding the use of moisturiser between the toes to alleviate dryness (this can promote fungal growth)
Those who are more prone to fungal infections may find that weekly applications of antifungal creams or foot powders in footwear may help to prevent recurrences. Those who experience infections repeatedly can also take their own nail instruments to salons for use, instead of making use of theirs (unless disposable supplies are preferably used).
Outlook for athlete’s foot
Mild infections typically clear up within a few weeks, responding well to antifungal treatments. Severe cases may take a month or longer. Recurrences are common, but if treated when symptoms first begin, infection spreading can be better prevented. For some who are more prone to infections, long-term treatment may be necessary.