Summary

• Athlete's foot is a common fungal infection


• Athlete's foot refers to a dermatophyte infection of the spaces between the toes, usually between the fourth and fifth toes


• It may occur in association with other fungal skin infections, such as fungal infection of the toenails, feet or groin


• The condition usually responds to self-care


• If the infection persists, long-term medication and preventive measures may be needed

Alternative names

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Tinea of the foot; Ringworm - foot

What is athlete’s foot?

Athlete's foot is an extremely common skin disorder and is the most common and most persistent of the fungal (tinea) infections.

The dermatophytes that cause athlete's foot and similar infections, called tinea infections, live on the dead tissues of the hair, nails, and outer skin layers.

Athlete's foot may occur in association with other fungal skin infections such as jock itch. Jock itch is a dermatophyte infection of the groin area. It occurs most frequently in adults.

What causes athlete’s foot?

The body normally hosts a variety of microorganisms, including bacteria, dermatophytes, and yeast-like fungi (such as Candida). Some of these are useful to the body. Others may, under proper conditions, multiply rapidly and cause infections.

The fungi that cause athlete's foot thrive in warm, moist areas. Susceptibility to this infection is increased by poor hygiene, occlusive (closed-up, such as tennis shoes) footwear, prolonged moist skin, and minor skin or nail injuries.

Tinea infections are contagious, and can be passed through direct contact, or contact with items such as shoes, stockings, and shower or pool surfaces. They also can be transmitted from contact with pets that carry the fungus. Athlete's foot may be brief or long-term and may recur after treatment.

What are the symptoms of athlete’s foot?

Athlete's foot may be symptomless. Itching and burning may be present. On examination, the affected area appears red and scaly. The scaling is often whitish due to maceration of the skin caused by the moist environment.

Tinea infection may also involve the nails and the rest of the foot. These lesions are red and scaly, or vesiculopustular and crusted.

The nails are discoloured, thickened and crumbly.

How is a diagnosis made?

The diagnosis is based primarily on the appearance of the skin. A diagnosis can also be made by means of a:

• Skin culture (fungi from flecks of skin are allowed to grow on special material)


• Skin lesion biopsy (examination may show dermatophyte)


• Skin lesion KOH exam (skin scrapings in KOH show dermatophyte)

Athlete's foot usually responds to self-care:

Keep the skin clean and dry. Wash thoroughly with soap and water and dry the area carefully and completely. Blow-drying the feet with a hair dryer removes excess water from the outer layers of skin and is more effective than drying with a towel. Wear clean socks and change socks and shoes as often as necessary to keep the feet dry. Topical over-the-counter antifungal powders or creams, such as those that contain miconazole or clotrimazole, may be used to control the infection.

Severe or chronic infection may require further treatment by the health care provider. Oral antifungal medications may be given. Other topical antifungal medications, such as ketoconazole or terbinafine, may be needed. Antibiotics may be needed to treat secondary bacterial infections.

Wet dressings or medicated soaks are used to clean raw, wet or weeping lesions. Dry, scaly lesions may respond to topical creams or lotions.

What is the prognosis?

Athlete's foot infections range from mild to severe. They may persist or recur, but they generally respond to treatment. Long-term medication and preventive measures may be needed.

Complications

• Recurrence of athlete's foot


• Secondary bacterial skin infections such as impetigo, ecthyma and cellulitis


• Lymphangitis, lymphadenitis


• Systemic side effects of medications (see the specific medication)

When to call your doctor

Call for an appointment with your health care provider if athlete's foot symptoms do not respond to self-care measures.

How can it be prevented?

Good personal hygiene helps prevent and treat athlete's foot. Antifungal or drying powders may be used as a preventive measure if a person is susceptible to athlete's foot, or if exposed frequently to areas where athlete's foot fungus is suspected (public showers, etc.).

Wearing sandals at a public shower or pool may help prevent athlete's foot, but these measures have not been shown to be of definite benefit. Drying the feet thoroughly after bathing or swimming has been shown to be the best means to prevent the disorder.

Wool socks allow moisture to be drawn away from the feet. Change the socks as frequently as needed to keep feet dry and, at a minimum, on a daily basis. Shoes should be well ventilated and preferably of natural material such as leather. It may be helpful to alternate shoes daily, so each pair can dry completely between wearings.

Information supplied by the National Institutes of Health.

Reviewed by Prof H.F. Jordaan, MBChB, Mmed (Derm).

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