Athlete's Foot

Topic Overview

What is athlete's foot?

Athlete's foot is a rash on the skin of the foot. It is the most common fungal skin infection. There are three main types of athlete's foot. Each type affects different parts of the foot and may look different.

What causes athlete's foot?

Athlete's foot is caused by a fungus that grows on or in the top layer of skin. Fungi (plural of fungus) grow best in warm, wet places, such as the area between the toes.

Athlete's foot spreads easily. You can get it by touching the toes or feet of a person who has it. But most often, people get it by walking barefoot on contaminated surfaces near swimming pools or in locker rooms. The fungi then grow in your shoes, especially if your shoes are so tight that air cannot move around your feet.

If you touch something that has fungi on it, you can spread athlete's foot to other people-even if you don't get the infection yourself. Some people are more likely than others to get athlete's foot. Experts don't know why this is. After you have had athlete's foot, you are more likely to get it again.

What are the symptoms?

Athlete's foot can make your feet and the skin between your toes burn and itch. The skin may peel and crack. Your symptoms can depend on the type of athlete's foot you have.

Toe web infection usually occurs between the fourth and fifth toes. The skin becomes scaly, peels, and cracks. Some people also may have an infection with bacteria. This can make the skin break down even more.
Moccasin type infection may start with a little soreness on your foot. Then the skin on the bottom or heel of your foot can become thick and crack. In bad cases, the toenails get infected and can thicken, crumble, and even fall out. Fungal infection in toenails needs separate treatment.
Vesicular type infection usually begins with a sudden outbreak of fluid-filled blisters under the skin. The blisters are usually on the bottom of the foot. But they can appear anywhere on your foot. You also can get a bacterial infection with this type of athlete's foot.

How is athlete's foot diagnosed?

Most of the time, a doctor can tell that you have athlete's foot by looking at your feet. He or she will also ask about your symptoms and any past fungal infections you may have had. If your athlete's foot looks unusual, or if treatment did not help you before, your doctor may take a skin or nail sample to test for fungi.

Not all skin problems on the foot are athlete's foot. If you think you have athlete's foot but have never had it before, it's a good idea to have your doctor look at it.

How is it treated?

You can treat most cases of athlete's foot at home with over-the-counter lotion, cream, or spray. For bad cases, your doctor may give you a prescription for pills or for medicine you put on your skin. Use the medicine for as long as your doctor tells you to. This will help make sure that you get rid of the infection. You also need to keep your feet clean and dry. Fungi need wet, warm places to grow.

You can do some things so you don't get athlete's foot again. Wear shower sandals in shared areas like locker rooms, and use talcum powder to help keep your feet dry. Wear sandals or roomy shoes made of materials that allow moisture to escape.

Cause

Athlete's foot (tinea pedis) is a fungal infection of the skin of the foot. You get athlete's foot when you come in contact with the fungus and it begins to grow on your skin.

Fungi commonly grow on or in the top layer of human skin and may or may not cause infections. Fungi grow best in warm, moist areas, such as the area between the toes.

Athlete's foot is easily spread (contagious). You can get it by touching the affected area of a person who has it. More commonly, you pick up the fungi from damp, contaminated surfaces, such as the floors in public showers or locker rooms.

Although athlete's foot is contagious, some people are more likely to get it (susceptible) than others. Susceptibility may increase with age. Experts don't know why some people are more likely to get it. After you have had athlete's foot, you are more likely to get it again.

If you come in contact with the fungi that cause athlete's foot, you can spread the fungi to others, whether you get the infection or not.

Symptoms

Athlete's foot (tinea pedis) symptoms vary from person to person. Although some people have severe discomfort, others have few or no symptoms. Common symptoms include:

Peeling, cracking, and scaling of the feet.
Redness, blisters, or softening and breaking down (maceration) of the skin.
Itching, burning, or both.

Toe web infection

Toe web infection(interdigital) is the most common type of athlete's foot. It usually occurs between the two smallest toes. This type of infection:

Often begins with skin that seems soft and moist and pale white.
May cause itching, burning, and a slight odor.
May get worse. The skin between the toes becomes scaly, peels, and cracks. If the infection becomes severe, a bacterial infection is usually present, which causes further skin breakdown and a foul odor.

Moccasin-type infection

A moccasin-type infection is a long-lasting (chronic) infection. This type of infection:

May begin with minor irritation, dryness, itching, burning, or scaly skin.
Progresses to thickened, scaling, cracked, and peeling skin on the sole or heel. In severe cases, the toenails become infected and can thicken, crumble, and even fall out. For more information, see the topic Fungal Nail Infections.
May appear on the palm of the hand (symptoms commonly affect one hand and both feet).

Vesicular infection

A vesicular infection is the least common type of infection. This type:

Usually begins with a sudden outbreak of fluid-filled blisters under the skin. The blisters most often develop on the skin of the instep but may also develop between the toes, on the heel, or on the sole or top of the foot.
Sometimes occurs again after the first infection. Infections may occur in the same area or in another area such as the arms, chest, or fingers. You may have scaly skin between eruptions.
May also be accompanied by a bacterial infection.

Athlete's foot is sometimes confused with pitted keratolysis. In this health problem, the skin looks like a "moist honeycomb." It most often occurs where the foot carries weight, such as on the heel and the ball of the foot. Symptoms include feet that are very sweaty and smell bad.

What Happens

How athlete's foot (tinea pedis) develops and how well it responds to treatment depends on the type of athlete's foot you have.

Toe web infection

Toe web infections(interdigital) often begin with skin that seems moist and pale white. You may notice itching, burning, and a slight odor. As the infection gets worse, the skin between the toes becomes scaly, peels, and cracks. If the fungal infection becomes severe, a bacterial infection also may develop. This can cause further skin breakdown. The bacterial infection may also infect the lower leg (cellulitis of the lower leg). Toe web infections often result in a sudden vesicular (blister) infection.

Toe web infections respond well to treatment.

Moccasin-type infection

Moccasin-type infections may begin with minor irritation, dryness, itching, burning, or scaly skin and progress to thickened, cracked skin on the sole or heel. In severe cases, the toenails become infected and can thicken, crumble, and even fall out. If you do not take preventive measures, this infection often returns. You may also develop an infection on the palm of the hand (symptoms commonly affect one hand and both feet).

Moccasin-type infections may be long-lasting.

Vesicular infection

Vesicular infections(blisters) usually begin with a sudden outbreak of blisters that become red and inflamed. Blisters sometimes erupt again after the first infection. A bacterial infection may also be present. A vesicular infection often develops from a long-lasting toe web infection. Blisters may also appear on palms, the side of the fingers, and other areas (dermatophytid or id reaction).

Vesicular infections usually respond well to treatment.

Complications

If untreated, skin blisters and cracks caused by athlete's foot can lead to severe bacterial infections. In some types of athlete's foot, the toenails may be infected. For more information, see the topic Fungal Nail Infections.

All types of athlete's foot can be treated, but symptoms often return after treatment. Athlete's foot is most likely to return if:

You don't take preventive measures and are again exposed to fungi that cause athlete's foot.
You don't use antifungal medicine for the prescribed length of time and the fungi are not completely killed.
The fungi are not completely killed even after the full course of medicine.

Severe infections that appear suddenly, and keep returning, can lead to long-lasting infection.

What Increases Your Risk

Athlete's foot is contagious, but some people are more likely to get it (susceptible) than others. Susceptibility may increase with age. Experts don't know why some people are more likely to get it. After you have had athlete's foot, you are more likely to get it again.

If you aren't susceptible to athlete's foot, you may come in contact with the fungi that cause athlete's foot yet not get an infection. But you can still spread the fungi to others.

Risk factors you cannot change

Risk factors you cannot change include:

Being male. Men are more susceptible than women.
Having a history of being susceptible to fungal infections.
Having an impaired immune system (due to conditions such as diabetes or cancer).
Living in a warm, damp climate.
Aging. Athlete's foot is more common in older adults. Children rarely get it.

Risk factors you can change

Risk factors you can change include:

Allowing your feet to remain damp.
Wearing tight, poorly ventilated shoes.
Using public or shared showers or locker rooms without wearing shower shoes.
Doing activities that involve being in the water for long periods of time.

When To Call a Doctor

Call your doctor about a skin infection on your feet if:

Your feet have severe cracking, scaling, or peeling skin.
You have blisters on your feet.
You notice signs of bacterial infection, including:
- Increased pain, swelling, redness, tenderness, or heat.
- Red streaks extending from the affected area.
- Discharge of pus.
- Fever of 100.4°F (38°C) or higher with no other cause.
The infection appears to be spreading.
You have diabetes or diseases associated with poor circulation and you get athlete's foot. People who have diabetes are at increased risk of a severe bacterial infection of the foot and leg if they have athlete's foot.
Your symptoms do not improve after 2 weeks of treatment or are not gone after 4 weeks of treatment with a nonprescription antifungal medicine.

Watchful waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. You can usually treat athlete's foot yourself at home. But any persistent, severe, or recurrent infections should be evaluated by your doctor.

When athlete's foot symptoms appear, you can first use a nonprescription product. If your symptoms do not improve after 2 weeks of treatment or have not gone away after 4 weeks of treatment, call your doctor.

Who to see

Health professionals who can diagnose or treat athlete's foot include:

Exams and Tests

In most cases, your doctor can diagnose athlete's foot (tinea pedis) by looking at your foot. He or she will also ask about your symptoms and any previous fungal infections you have had.

If your symptoms look unusual or if a previous infection has not responded well to treatment, your doctor may collect a skin or nail sample by lightly scratching the skin with a blade or the edge of a microscope slide, or by trimming a nail. He or she will examine the skin and nail samples using laboratory tests including:

KOH (potassium hydroxide) preparation, to confirm the presence of fungi.
Fungal culture, to identify the type of fungus present.

In rare cases, a skin biopsy will be done by removing a small piece of skin that will be looked at under a microscope.

Treatment Overview

How you treat athlete's foot (tinea pedis) depends on its type and severity. Most cases of athlete's foot can be treated at home using an antifungal medicine to kill the fungus or slow its growth.

Nonprescription antifungals usually are used first. These include clotrimazole (Lotrimin), miconazole (Micatin), terbinafine (Lamisil), and tolnaftate (Tinactin). Nonprescription antifungals are applied to the skin (topical medicines).
Prescription antifungals may be tried if nonprescription medicines are not successful or if you have a severe infection. Some of these medicines are topical antifungals, which are put directly on the skin. Examples include butenafine (Mentax), clotrimazole, and naftifine (Naftin). Prescription antifungals can also be taken as a pill, which are called oral antifungals. Examples of oral antifungals include fluconazole (Diflucan), itraconazole (Sporanox), and terbinafine (Lamisil).

For severe athlete's foot that doesn't improve, your doctor may prescribe oral antifungal medicine (pills). Oral antifungal pills are used only for severe cases, because they are expensive and require periodic testing for dangerous side effects. Athlete's foot can return even after antifungal pill treatment.

Even if your symptoms improve or stop shortly after you begin using antifungal medicine, it is important that you complete the full course of medicine. This increases the chance that athlete's foot will not return. Reinfection is common, and athlete's foot needs to be fully treated each time symptoms develop.

Toe web infections

Toe web(interdigital) infections occur between the toes, especially between the fourth and fifth toes. This is the most common type of athlete's foot infection.

Treat mild to moderate toe web infections by keeping your feet clean and dry and using nonprescription antifungal creams or lotions.
If a severe infection develops, your doctor may prescribe a combination of topical antifungal creams plus either oral or topical antibiotic medicines.

Moccasin-type infections

Moccasin-type athlete's foot causes scaly, thickened skin on the sole and heel of the foot. Often the toenails become infected (onychomycosis). A moccasin-type infection can be more difficult to treat, because the skin on the sole of the foot is very thick.

Nonprescription medicines may not penetrate the thick skin of the sole well enough to cure moccasin-type athlete's foot. In this case, a prescription topical antifungal medicine that penetrates the sole, such as ketoconazole, may be used.
Prescription oral antifungal medicines are sometimes needed to cure moccasin-type athlete's foot.

Vesicular infections

Vesicular infections, or blisters, usually appear on the foot instep but can also develop between the toes, on the sole of the foot, on the top of the foot, or on the heel. This type of fungal infection may be accompanied by a bacterial infection. This is the least common type of infection.

Treatment of vesicular infections may be done at your doctor's office or at home.

You can dry out the blisters at home by soaking your foot in nonprescription Burow's solution several times a day for 3 or more days until the blister area is dried out. After the area is dried out, use a topical antifungal cream as directed. You can also apply compresses using Burow's solution.
If you also have a bacterial infection, you will most likely need an oral antibiotic.

Even when treated, athlete's foot often returns. This is likely to happen if:

You don't take preventive measures and are again exposed to the fungi that cause athlete's foot.
You don't use antifungal medicine for the specified length of time and the fungi are not completely killed.
The fungi are not completely killed even after the full course of medicine.

You can prevent athlete's foot by:

Keeping your feet clean and dry.
- Dry between your toes after swimming or bathing.
- Wear shoes or sandals that allow your feet to breathe.
- When indoors, wear socks without shoes.
- Wear socks to absorb sweat. Change your socks twice a day.
- Use talcum or antifungal powder on your feet.
- Allow your shoes to air for at least 24 hours before you wear them again.
Wearing shower sandals in public pools and showers.

What to think about

You may choose not to treat athlete's foot if your symptoms don't bother you and you have no health problems that increase your chance of severe foot infection, such as diabetes. But untreated athlete's foot that causes skin blisters or cracks can lead to severe bacterial infection. Also, if you don't treat athlete's foot, you can spread it to other people.

Severe infections that appear suddenly (acute) usually respond well to treatment. Long-lasting (chronic) infections can be more difficult to cure.

Toenail infections (onychomycosis) that can develop with athlete's foot tend to be more difficult to cure than fungal skin infections. For more information, see the topic Fungal Nail Infections.

Prevention

You can prevent athlete's foot (tinea pedis) by:

Keeping your feet clean and dry.
- Dry between your toes after swimming or bathing.
- Wear shoes or sandals that allow your feet to breathe.
- When indoors, wear socks without shoes.
- Wear socks to absorb sweat. Change your socks twice a day.
- Use talcum or antifungal powder on your feet.
- Allow your shoes to air for at least 24 hours before you wear them again.
Wearing shower sandals in public pools and showers.

If you have athlete's foot, dry your groin area before your feet after bathing. Also, put on your socks before your underwear. This can prevent fungi from spreading from your feet to your groin, which may cause jock itch. For more information about jock itch, see the topic Ringworm of the Skin.

Tips to prevent athlete's foot recurrence

Always finish the full course of any antifungal medicine (cream or pills). Live fungi remain on your skin for days after your symptoms have disappeared. The chances of killing athlete's foot are greatest when you treat it for the prescribed period of time.
Washing clothes in soapy, warm water may not kill the fungi that cause athlete's foot. Use hot water and bleach to increase the chance of killing fungi on your clothes.
You can help prevent recurrence of a toe web infection by using powder to keep your feet dry, using lamb's wool between the toes (to separate them), and wearing wider, roomier shoes that have not been infected by fungi. Lamb's wool is available at most pharmacies or foot care stores.

Home Treatment

You can usually treat athlete's foot (tinea pedis) yourself at home by using nonprescription medicines and taking care of your feet. But if you have diabetes and develop athlete's foot, or have persistent, severe, or recurrent infections, see your doctor.

Nonprescription medicines

Nonprescription antifungals include clotrimazole (Lotrimin), miconazole (Micatin), terbinafine (Lamisil), and tolnaftate (Tinactin). These medicines are creams, lotions, solutions, gels, sprays, ointments, swabs, or powders that are applied to the skin (topical medicine). Treatment will last from 1 to 6 weeks.

If you have a vesicular (blister) infection, soak your foot in Burow's solution several times a day for 3 or more days until the blister fluid is gone. After the fluid is gone, use an antifungal cream as directed. You can also apply compresses using Burow's solution.

To prevent athlete's foot from returning, use the full course of all medicine as directed, even after symptoms have gone away.

Avoid using hydrocortisone cream on a fungal infection, unless your doctor prescribes it.

Foot care

Good foot care helps treat and prevent athlete's foot.

Keep your feet clean and dry.
- Dry between your toes after swimming or bathing.
- Wear shoes or sandals that allow your feet to breathe.
- When indoors, wear socks without shoes.
- Wear socks to absorb sweat. Change your socks twice a day.
- Use talcum or antifungal powder on your feet.
- Allow your shoes to air for at least 24 hours before you wear them again.
Wear shower sandals in public pools and showers.

You may choose not to treat athlete's foot if your symptoms don't bother you and you have no health problems that increase your risk of severe foot infection, such as diabetes. But an untreated athlete's foot infection causing skin blisters or cracks can lead to severe bacterial infection. Also, if you don't treat athlete's foot infection, you can spread it to other people.

Medications

Antifungal medicines that are used on the skin (topical) are usually the first choice for treating athlete's foot (tinea pedis). They are available in prescription or nonprescription forms. Nonprescription medicines are usually tried first.

For severe cases of athlete's foot, your doctor may prescribe oral antifungals (pills). But treatment with this medicine is expensive, requires periodic testing for dangerous side effects, and does not guarantee a cure.

When you are treating athlete's foot, it is important that you use the full course of the medicine. Using it as directed, even after the symptoms go away, increases the likelihood that you will kill the fungi and that the infection will not return.

Medicine choices

Nonprescription antifungals are usually tried first. These include clotrimazole (Lotrimin), miconazole (Micatin), terbinafine (Lamisil), and tolnaftate (Tinactin).

Prescription antifungals may be tried if nonprescription medicines do not help or if you have a severe infection. Some of these medicines are topical antifungals, which are put directly on the skin. Examples include butenafine (Mentax), clotrimazole, and naftifine (Naftin). Prescription antifungals can also be taken as a pill, which are called oral antifungals. Examples of oral antifungals include fluconazole (Diflucan), itraconazole (Sporanox), and terbinafine (Lamisil).

What to think about

If your symptoms do not improve after 2 weeks of treatment or have not gone away after 4 weeks of treatment, call your doctor.

Some topical antifungal medicines work faster (1 to 2 weeks) than other topical medicines (4 to 8 weeks). All of the faster-acting medicines have similar cure rates.^{footnote 1} The fast-acting medicines may cost more than the slower-acting ones, but you use less of these medicines to fully treat a fungal infection. Oral antifungal medicines are typically taken for 2 to 8 weeks.

Other Treatment

Tea tree oil or garlic (ajoene) may help prevent or treat athlete's foot (tinea pedis) fungi. Burow's solution is helpful for treating blisterlike (vesicular) infection.

Tea tree oil is an antifungal and antibacterial agent derived from the Australian Melaleuca alternifolia tree. Although it reduces fungi and resulting symptoms, tea tree oil may not completely kill off the infection.^{footnote 2}
Ajoene is an antifungal compound found in garlic. It is sometimes used to treat athlete's foot.
Compresses or foot soaks using nonprescription Burow's solution can help soothe and dry out blisterlike (vesicular) athlete's foot. After the blister fluid is gone, you can use antifungal creams or prescription antifungal pills.

Related Information

References

Citations

Crawford F (2009). Athlete's foot, search date July 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Murray MT, Pizzorno JE Jr (2006). Melaleuca alternifolia (Tea Tree). In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, vol. 1, chap. 104, pp. 1053-1056. St. Louis: Churchill Livingstone Elsevier.

Other Works Consulted

Habif TP (2010). Tinea of the foot section of Superficial fungal infections. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 495-497. Edinburgh: Mosby Elsevier.

Habif TP, et al. (2011). Tinea of the foot (tinea pedis). In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 269-272. Edinburgh: Saunders.

Wolff K, Johnson RA. (2009). Tinea pedis section of Fungal infections of the skin and hair. In Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 692-701. New York: McGraw-Hill.

Credits

ByHealthwise Staff
Primary Medical Reviewer Patrice Burgess, MD, FAAFP - Family Medicine
Adam Husney, MD - Family Medicine
Martin J. Gabica, MD - Family Medicine
Elizabeth T. Russo, MD - Internal Medicine
Ellen K. Roh, MD - Dermatology

Current as ofOctober 5, 2017

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Current as of: October 5, 2017

Author: Healthwise Staff

Medical Review: Patrice Burgess, MD, FAAFP - Family Medicine & Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Elizabeth T. Russo, MD - Internal Medicine & Ellen K. Roh, MD - Dermatology