Athlete’s foot is one of the most common fungal infections of the skin affecting 70% of the global population at some time in their life. It is more common in males and occurs more frequently after puberty, with the prevalence increasing as a person gets older. Athlete’s foot is not a severe or serious condition unless the damaged skin becomes infected with bacteria. Overall this complication is uncommon in most people. There is a range of effective treatments to eradicate the infection and prevention often involves simple lifestyle measures.
What is athlete’s foot?
Athlete’s foot is the common term for a fungal infection of the skin on the feet. It may sometimes also extend to the nails of the toes (toenail fungus). The medical term for this condition is tinea pedis. Most of the infections are caused by a type of fungi known as dermatophytes. It usually begins between the toes but can affect the skin anywhere on the feet. Although wearing closed shoes and having sweaty feet increases the chance of developing athlete’s foot, it can affect any person irrespective of sweat volume or type of shoes worn.
The fungi can be spread from person to person with direct contact or through inanimate objects like rugs and towels. Fungal spores can also be found in soil and walking barefoot may increase the chance of contracting the infection especially if there are breaks in the skin. Athlete’s foot may require a combination of topical agents (creams and ointments) and oral agents (pills). Effective treatment does not mean that the condition will not recur and ongoing preventative measures should be implemented for the long term.
Causes of Athlete’s Foot
There are different species of dermatophytes that infect the skin of the foot. Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton tonsurans and Epidermophyton floccosum are the more common species to cause athlete’s foot. The prevalence may vary from among different regions and Trichophyton rubrum is the most common species worldwide. Dermatophytes differ from yeasts, which is another type of fungus. Yeasts like Candida albicans can infect the feet but is more likely to occur when there is breaks in the skin like with open wounds.
Dermatophytes tend to cause superficial infections since it contains enzymes (keratinases) that can digest the skin protein keratin. Fungi tend to thrive in environments that are moist, dark and warm. The feet are the ideal environment since closed shoes create the ideal micro-environment. People who wear closed shoes for long periods of time in a day are naturally at a greater risk. The shoes trap the body heat, prevent sweat from evaporating and shield the fungi from sunlight.
Some people are more inclined to develop athlete’s foot than others, although the condition can affect any person of any age or gender. High risk factors include:
- Being a male, and adult males in particular.
- Living in the same house with somebody with a fungal infection, especially when there is common points of contact like rugs.
- Sharing clothing with a person with a fungal infection, especially socks and shoes.
- Using public places, especially damp areas, like at public pools or communal showers while barefoot.
- Having sweaty feet or a weakened immune system.
- Wearing damp or wet socks, or not removing it once wet, and using tight-fitting shoes.
- Genetic predisposition to developing fungal infections of the skin.
- Living in hot and humid tropical environments.
Signs and Symptoms
The presentation of athlete’s foot can vary depending on the duration and severity of the infection. Typically dermatophytes cause round ring-like lesions and is therefore often referred to as ringworm. However, this characteristic presentation may not always be as clearly visible on the feet. Some of the signs and symptoms of athlete’s foot include:
- Itchy feet
- Dry scaly skin
- Peeling or cracked skin
- White to red lesion between toes
- Tiny blisters
In many instances athlete’s foot may occur concomitantly with fungal skin infections elsewhere in the. Athlete’s foot with jock itch (groin fungus, tinea cruris) is common, as is a fungal infection of the hands and fingers (tinea manuum). The fungus may have spread from the feet to these sites, usually when scratching the area. If left untreated and the infection persists for a long period of time the skin may become thick and dark, with or without any itching.
Pictures of Athlete’s Foot
Images sourced from Dermatology Atlas Brazil
Athlete’s foot can be effectively treated with medication, both topical and oral. Topical applications are effective for most cases but persistent infections will also require oral treatment. There are a range of drugs that can be used and the choice of drug is dependent on a number of factors. Many topical applications can be purchased over-the-counter while some may require a prescription after a diagnosis of athlete’s foot (tinea pedis) is confirmed.
Topical agents include miconazole, clotrimazole, terbinafine or tolnaftate. It should be used for a period of 6 weeks to completely eradicate the fungus and may have to be continued for a period of time thereafter to prevent recurrence. Oral agents include fluconazole, itraconazole and terbinafine. If there is a superimposed bacterial infection of the skin then antibiotics may first be required. Oral antifungal agents may not have an immediate effect and the prescribed course needs to be completed as indicated.
Tea tree oil, Melaleuca alternifolia, has been shown to be effective in the treatment of athlete’s food in various clinical trials.
Preventative measures after successful treatment involves the use of both medicated powders and lifestyle changes.
- Medicated powders can help the area dry if sweaty feet is a problem and it has anti-fungal agents that prevent the fungi from infecting the skin of the feet.
- The feet should be kept dry and damp footwear (socks and shoes) should not be worn. In addition socks and shoes that were previously used should be discarded as it may contain fungal spores that can cause another infection.
- Well ventilated footwear is equally important. Tight shoes and closed shoes should be avoided during the treatment period and sandals may be a better option when it suitable to wear informal attire.
- Never share footwear (socks and shoes) with any other person. There is no certainty whether another person has a fungal infection or not even if there is no obvious symptoms.