Athlete's Foot

What are the symptoms of this condition?

In a patient with athlete's foot, there may be itching, scaling, inflammation or blistering of the skin, usually between the toes, although the infection may also be seen on the sole and side of the foot as well. Burning and itching may increase as the infection develops and blistering may expose raw areas underneath the skin. With time, the fungus may infect other parts of the foot and become resident in the soles or the toenails.

Similar symptoms are sometimes experienced in other body areas, notably the groin and under the arms, as the infection can spread beyond the toes.

What is the cause of the condition?

Athlete's foot is a fungal infection usually caused by the fungus tinea pedis. It is now one of the commonest fungal skin disorders in the world, with an estimated 70% of the population likely to get it at some point in their lives. Despite its name, it is not confined to sporting or athletic persons, as the incidence of infection rises with age and it is frequently found in the elderly. However, it rarely affects young children.

Fungi thrive in places that are damp, warm and dark. Since our feet spend many hours a day enclosed in shoes where the atmosphere is damp, warm and dark, organisms such as this will readily flourish.

The source of the infection may be found in swimming baths, changing rooms and shower areas which are commonly warm and damp. But, as the fungus is often found on the skin of people who do not show any active infection, it has also been suggested that some individuals are simply less resistant to the fungus than others. There may be a genetic factor involved, and it is possible that diabetes may increase the risk.

The symptoms of itching, burning, small blisters and general discomfort can result from other conditions apart from tinea pedis. Sensitivities and allergic reactions to components in the shoe material or the socks, and other skin conditions like eczema and psoriasis, may cause symptoms and signs that are very similar to those of athlete's foot. Other symptoms such as weeping, pus, or yellow crusts, would indicate a bacterial infection, which should be treated by the doctor.

What complications might occur?

If the athlete's foot infection is left untreated, it can spread to different areas of the foot apart from the toe spaces. The upper and lower foot surfaces can become infected; extensive blistering can take place; secondary bacterial infections may develop if the skin is broken; and the whole foot may become very sore and painful.

What can I do to treat myself?

An important strategy for both prevention and cure is to eliminate the environment that the fungi prefer. As these organisms thrive in warm and damp conditions, it makes sense to keep the feet cool and dry. Pay particular attention to drying well between the toes after washing the feet, showering or bathing; and wear shoes and socks that allow the feet to ?breathe' to prevent the build up of moisture in and around the toes. Nylon socks and rubber or plastic shoes will encourage the feet to sweat and should be avoided; open shoes or sandals made of leather and cotton socks would be preferable.

Another method of keeping the feet dry is to dust them well with talcum powder several times a day. The talc will absorb perspiration from the feet and promote dryness. Change the socks twice a day if possible, and dry carefully between the toes each time. Use a separate towel from the rest of the family to prevent the infection spreading to them. Try to change your footwear every day, as moisture and perspiration can build up inside the shoes and will take time to evaporate.

If you are using sports facilities or swimming baths, shower shoes will protect your feet from potentially contaminated surfaces.

Many antifungal treatments are available without a prescription - these are detailed below.

What treatments are available for me to purchase?

A large range of ointments, creams and sprays are available for treating this condition. Dusting powders may be used as a preventative as they absorb sweat and so help to keep the feet dry. Advice on the most appropriate medication can be obtained from the Pharmacy2U pharmacist.

It's important to carry on treating athlete's foot for 2 weeks after the symptoms have cleared, to make sure the infection is completely eradicated; however, if you have been treating the condition for 2 weeks without any reduction in the symptoms, you should see your doctor.

The main active ingredients found in these products are as follows:

Imidazole anti-fungals

The imidazoles are the most effective anti-fungals available to buy and include clotrimazole (included in Canesten) and miconazole (included in Daktarin).

Other anti-fungals

These include tolnaftate (Tinaderm and Mycil), benzoic acid (Toepedo) and zinc undecenoate (Mycota).

Anti-fungal plus hydrocortisone

Canesten Hydrocortisone Cream, as well as being an anti-fungal, contains hydrocortisone which reduces skin inflammation and irritation. It is effective when the skin is particularly red and inflamed. However, normal hydrocortisone cream (without an anti-fungal) should not be used to treat athlete's foot as it is likely to make the infection worse. Canesten Hydrocortisone should not be used for more than 7 days, or by children under 10, or pregnant or breastfeeding women.

Diabetics should consult their chiropodist or doctor if they believe they have athlete's foot.

To view the full range of athlete's foot treatments available from Pharmacy2U Click here.

What treatments are available from my doctor?

If the athlete's foot has not responded to treatment after 2 weeks, you should see your doctor for more advice. He or she may wish to conduct investigations to determine which fungus is causing the infection, and prescribe stronger antifungal drugs to fight it.

It is possible that the infection may affect the nails. Nails can become infected as a result of an injury to the nail itself, which allows the fungus to gain entry, or the fungus might travel from an adjacent area and move to the skin under the nail at the free end.

If it is a proven nail infection a possible remedy would be the antifungal agent terbinafine, to be taken as a six week course for fingernail infections and a twelve week course for toenail infections, assuming the organism is sensitive to that drug. As it is not uncommon for relapses to occur the infection may flare up again, and the drug only destroys the fungus; it does not restore the nail. Antifungal nail paints are also available on prescription to treat fungal nail infections ? these usually require application for many months to be successful.

What additional investigations might be needed?

In particularly difficult cases, investigations will be needed to isolate the organism that is causing the problem; this will determine whether or not there is a secondary bacterial infection. Swabs would be taken from the affected parts of the feet and sent for laboratory examination.

It's important to note that diabetics should always talk to their doctor or chiropodist if they have any problems with their feet, including athlete's foot. One long term complication of diabetes is that the circulation to the feet can become impaired, reducing the body's ability to fight infection and heal open wounds.

If prescription treatments for athlete's foot do not help, you may be referred to a skin specialist.

Any other information I should have?

This is a common problem among those who use sports facilities and swimming baths. While it may not be possible to completely avoid athlete's foot, following the measures suggested in the self-treatment section should help to reduce the likelihood of infection.