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Athlete's foot

Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 2003.


Athlete's foot — codes and concepts
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What is athlete's foot?

Athlete's foot is a term often used to describe a fungal infection (or dermatophytosis) of the foot (tinea pedis).

It most often results in peeling skin and fissuring between the toes (the toe clefts). The cleft between the fourth and fifth toes is the most frequently affected. 

Fungal infection is not the only reason for peeling and fissuring between the toes, and the term athlete's foot is sometimes used to refer to any condition where the toe clefts are inflamed.

Athlete's foot

What causes athlete's foot?

Athlete's foot is generally due to proliferation of dermatophyte fungi of the genera Trichophyton rubrum, Trichophyton interdigitale, and Epidermophyton floccosum.

Predisposing factors

Athlete's foot is more common in those who participate in sports because:

  • They may wear occlusive footwear
  • They sweat heavily
  • They may fail to dry their feet carefully after showering
  • They are exposed to fungal spores on the surfaces of communal areas.

What are the clinical features of athlete's foot?

The clinical features of athlete's foot may include:

  • Moist, peeling skin between the toes
  • White, yellow, or greenish discolouration 
  • Sometimes, thickened skin
  • Painful fissures
  • Unpleasant smell. 

Athlet's foot is generally mild; very inflamed athlete's foot is generally due to secondary bacterial infection.

How is athlete's foot diagnosed?

The diagnosis is usually clinical, as athlete's foot has a characteristic appearance. If resistant to treatment, investigations are undertaken to identify a specific infection.

What is the differential diagnosis of athlete's foot?

Athlete's foot is a localised interdigital form of intertrigo.   

Apart from tinea pedis, peeling and fissuring between the toes can be due to:

Non-fungal causes of athlete's foot

What is the treatment of athlete's foot?

Treatment for athlete's foot should begin with general measures.

  • Dry carefully between the toes.
  • Use a dusting powder to keep the affected area dry.
  • Keep toes apart using a cotton or foam wedge.
  • Wear shoes that are loose around the toes or go bare foot.
  • Apply a topical antifungal agent. These may also control many of the bacteria that live in the moist skin between the toes.

Whitfield ointment (3% salicylic acid, 6% benzoic acid in petrolatum) is particularly useful, as it removes the surface layer of moist peeling skin (ie, it is keratolytic), and it eliminates bacteria and fungi.

Make sure that other sites of fungal infection are also treated effectively.

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Patient information summary

Athlete's foot is a contagious fungal skin infection of the foot (tinea pedis) that is not often serious but can be difficult to get rid of completely.

  • Symptoms: Common symptoms include itching, moist, peeling skin between the toes - most often between the smallest and second smallest toe; this can cause itchy skin. Other symptoms may include itchy skin, scaly skin, dry skin
  • Causes: Athlete's foot occurs when the tinea fungus grows on your feet; the fungus grows best in moist, warm environments. This may be seen frequently in athletes that wear sports shoes for long periods of time and often have sweaty feet.
  • Transmission: This foot infection can also be passed through direct contact or contact with contaminated surfaces from an infected person; care should be taken in swimming pools, public pools, public showers/communal showers, and on locker room floors.
  • Prevention: To help prevent athlete's foot, strategies such as keeping feet clean and dry, using shower shoes, avoiding closed shoes, and avoidance of a moist environment in general should be used.
  • Treatment: There are a number of over-the-counter antifungal creams and powders available to treat this fungal foot infection eg, terbinafine, miconazole, clotrimazole. There may be other combination options available containing steroids to treat any inflammation. Other sites of fungal infection should also be treated. Oral medications are not often needed but may be used in some cases.
  • Seeking medical help: You should see the doctor if over-the-counter treatment has not worked, you have a compromised immune system, it spreads to the nails, or a bacterial infection may be suspected. A skin sample (flakes of skin) may be taken to be examined more closely and the correct treatment can be given. 

 

 

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