Athlete's Foot

Causes and Symptoms:

Athlete's foot is a common fungal infection of the feet, usually occurring between the toes. Fungal infection of the feet is called tinea pedis (tinea is the medical word for fungus, and pedis means feet), and the specific fungus that causes athlete's foot is called trichophyton. When the feet, or other areas of the body, stay moist, warm and irritated, this fungus can thrive and infect the outer layers of the skin. The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages the growth of fungi.

The warmth and dampness of areas around swimming pools, showers, and locker rooms, are breeding grounds for fungi. Because the infection is common among athletes who use these facilities frequently, the term "athlete's foot" has became the popular colloquial name for this condition.

Trichophyton fungi are living germs, like small plants, that grow and multiply on humans. Some people may actually have the fungus on their skin, but unless the conditions are conducive to fungal growth and nourishment, athlete's foot will not develop. Why some people develop athlete's foot and others don't is not clearly known, but up to 70% of the population will have athlete's foot at some time during their lives. It occurs mostly among teenage and adult males and is uncommon, though not unheard of, in women and in children under the age of 12. If a child displays what appear to be the symptoms of athlete's foot, chances are it's another skin condition.

Athlete's foot tends not to occur among people who spend much of their time barefoot, as it is moisture, sweating and lack of ventilation of the feet that present the perfect setting for trichophyton fungus to grow.

The presence of the fungus can be accompanied by a feeling of itching and burning. The skin frequently peels, and, in particularly severe cases, there may be some cracking, pain and bleeding as well.

When the skin is injured by the fungus, bacteria can also invade the skin. Bacterial infection of the skin, and the resulting inflammation, is known as cellulitis. These bacteria can cause a bad smell, similar to standard foot odor, but greater in severity, which is another common symptom of athlete's foot. Cellulitis is especially likely to occur in the elderly, individuals with diabetes, people with chronic leg swelling, or those who have had veins removed, such as for heart bypass surgery. Patients with impaired immune systems are also more susceptible to bacterial infection.

Athlete's foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, if the patient scratches or otherwise aggravates the infection and then touches other parts of the body. The organisms causing athlete's foot may persist for long periods; consequently, the infection may also be spread to other areas of the body by contaminated bed sheets or clothing.

It's commonly believed that athlete's foot is highly contagious -- that it is easily contracted by walking barefoot in a locker room, for example. This is not true. Medical experiments, in which the objective has been to infect healthy skin with athlete's foot, have failed; often one may have it without infecting others in the same living space.

It is also important to note that not all fungal conditions are athlete's foot. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, also may mimic athlete's foot. An accurate diagnosis is best provided by a medical professional.

Diagnosis:

The signs of athlete's foot, any or all of which may be detected, are drying skin, itching, scaling, inflammation, and blisters. Blisters often lead to cracking of the skin, wherein small raw areas of tissue are exposed, causing pain and swelling. Itching and burning may increase as the infection spreads. In diagnosing a patient with athlete's foot, the healthcare provider will be particularly attuned to the possibility of spreading infection.

Tinea pedis can take different forms. In some instances, it will manifest itself as a scaly dry rash on the bottom and sides of feet. This type of athlete's foot is said to occur in a "moccasin" pattern. In other cases, cracks or fissures between the toes, sometimes with soft white scaling, will be the deciding symptom, as they are more common to athlete's foot than to other varieties of fungal infection.

The healthcare provider will look for open sores, blisters or ulcers of the feet; blackened or otherwise discolored toenails or moles, growths on the feet or nails, oozing or weeping from the areas between the toes (known as toe webs). It will also be useful to determine if there is any pain present in the patient's feet or nails. Many people with athlete's foot also have a fungal infection of the toenails called onychomycosis.

Diagnosis is somewhat complicated by the fact that toenail fungal infections can look different in different people. Many people with no fungal or bacterial infection do have a white or yellow thickening under the nail. Moreover, onychomycosis itself is quite common in moderate amounts; many adults have some fungus of the toenails. However, onychomycosis can make the toenails difficult to cut, and in some cases can make the patient predisposed to ingrown toenails. The fungus can also provide openings or cracks in the skin that may allow easier access for bacterial infections of the feet and legs.

In some, the skin between the toes, especially the last two toes, may peel, crack, and scale. In others, there is redness, scaling, and perhaps blisters on the soles and along the sides of the feet. These skin changes may be accompanied by itching. Medical attention is important, as toenail infections can be very stubborn to treat, and may result in scaling, crumbling and thickening of the nails. Even nail loss is a possibility in severe cases.

It must be taken into account that not every thick, discolored toenail is infected with fungus. Other conditions, including psoriasis and circulatory problems, can mimic onychomycosis. Conversely, not all rashes on the feet are athlete's foot. Before treating a foot rash yourself, check with a healthcare provider who can diagnose the condition and prescribe the correct medication. Using over-the-counter preparations on a rash that is not athlete's foot may make your condition worse. Before you begin treatment, make sure a healthcare provider helps you make the correct diagnosis. It is advisable to seek medical attention soon after symptoms develop, as timely attention can prevent the development of a bacterial infection.

Following a thorough foot examination, the healthcare provider who suspects athlete's foot may take a scraping of the skin on the patient's feet. The skin scales are then examined under a microscope, or placed in special substances to look for growth of the fungus.

Treatment:

Although athlete's foot can be easily treated, it also can be very resistant to treatment.

Once the fungus is diagnosed, treatment should begin immediately. For simple cases, anti-fungal creams may be prescribed. The creams can relieve the symptoms fairly quickly.. In more severe cases, the healthcare provider may prescribe foot soaks before applying antifungal creams. If a case of athlete's foot is particularly stubborn, antifungal pills may be prescribed. Toenail infections are very difficult to treat, and ongoing research try to find additional effective treatment continues.

It is not easy to prevent athlete's foot, because it is usually contracted in dressing rooms, showers, and swimming pool locker rooms, where bare feet commonly come in contact with the fungus. However, you can do much to prevent infection by practicing good foot hygiene. Daily washing of the feet with soap and water, drying carefully between the toes; and changing shoes and socks regularly to decrease moisture, are all effective measures toward preventing the fungus from infecting the feet. Also helpful is the daily use of a quality foot powder. It is advisable to wear light and airy shoes, and keep the socks dry, changing them frequently in instances of heavy perspiration.

Beyond prevention, fungicidal and fungistatic chemicals used for athlete's foot treatment frequently fail to contact the fungi in the outer layers of the skin. Therefore, topical or oral antifungal drugs are prescribed with growing frequency.

If the infection is bacterial, antibiotics that are effective against a broad spectrum of bacteria may be prescribed. It is also important to continue treatment even after symptoms and discomfort have subsided, as the infection can remain for some time afterwards, and could recur.