The Cause and Treatment of Athletes Foot and Nail Fungus

Athlete’s foot is the common term for a fungal infection of the skin on the feet. It is caused by a group of fungal organisms called dermatophytes, which can infect our skin, nails, or hair. Fungal organisms are hard to avoid as they not only infect a human or animal host, but an live in a spore or resting state in our environment waiting for the opportunity to infect the next susceptible host.

Dermatophytes love to infect our feet because it is a warm and moist environment made possible by sock and shoe use. Small cracks in callus or around the nail allow the fungal organisms the entrance to set up shop and cause infection. The classic athlete’s foot or Tinea pedis is the skin infection caused by fungus. This can involve a large or small area of the foot. When on the bottom surface of the foot it may appear as an inflamed rash. With possibly small white scales. It may also present with small red or white bumps, some may be filled with fluid. It could appear dry or moist. If infection occurs between the toes (which is common) it may appear wet and with a foul odor. The increased moisture is caused by the toes rubbing together, and the odor due to bacteria that normally live in the area. A frequent itch may be present. The treatment for Tinea pedis consists of topical antifungal creams or lotions, proper foot hygiene, complete drying of the foot including between the toes after bathing, applying antifungal powders inside shoes to decrease moisture, frequent sock changes, and rotating shoes to allow complete drying of perspiration. In advanced cases a short course of an oral antifungal may be necessary. There are numerous topical creams available with and without prescription. 

Onychomycosis is the term used for fungal infection of the nail. This condition is more frequently seen in the toenails due to warm, moist environment in shoes and repetitive trauma. This condition presents with a thick, deformed nail, usually with a white, yellow, or dark discoloration. There usually is a thickening of soft debris under the nail. The nail can become either very hard or brittle, with cracks and irregularities within it. The entire nail or only a portion maybe in infected. A single nail or multiple nails may be involved, and an athlete’s foot infection may occur at the same time. The treatment of onychomycosis is more difficult than Tinea pedis due to the nail anatomy and the barrier effect of the nail plate itself. Prescriptive and non-prescriptive topical medications are available and have been shown to be effective in 30%-40% or infections, depending on extent. Oral antifungal medications are effective in 60%-70% of cases and are typically used for 3 – 12 months. They are relatively safe drugs but need to be monitored closely, which may include blood testing. 

A final alternative for onychomycosis is either temporary or permanent removal of portion or the entire nail. This treatment is usually reserved for painful conditions that have not responded to other therapy.