Athlete's Foot (Tinea Pedis): Symptoms and Treatment

What is athlete's foot?

Athlete's foot, medically known as tinea pedis, is a dermatophyte infection affecting the skin of the feet. It most commonly occurs between the toes; however, it can also spread to the soles of the feet, heels, and the sides of the feet.

The most common causative agents include Trichophyton rubrum and Trichophyton interdigitale.

Briefly, what you need to know

Not every itchy foot is a fungal infection.

Whitening, cracking, and flaking between the toes are common.

It can also manifest as dry, widespread scaling on the soles of the feet.

It can occur together with nail fungus.

It can be contagious.

Cortisone cream can temporarily improve the appearance, but it may mask the infection.

Limited disease can often be treated with topical antifungals.

In widespread or resistant disease, reconfirmation of the diagnosis may be necessary.

What does athlete's foot look like?

Three main clinical presentations are important.

thong type

This is the most common form.

Especially between the fourth and fifth fingers:

bleaching/maceration,

flaking,

cracking,

itching,

combustion

visible.

Advanced maceration and fissures can also create entry points for secondary bacterial infection.

Moccasin type

It appears as widespread dry and thick scaling on the soles, heels, and sides of the feet.

Patients sometimes say:

“"My feet are very dry."”

He describes it as follows.

Therefore, it can be confused with eczema or xerosis.

Vesiculobullous/inflammatory type

It can manifest particularly as small vesicles or larger, fluid-filled blisters on the soles and sides of the feet.

It can be confused with conditions such as dyshidrotic eczema.

What causes athlete's foot?

Dermatophytes proliferate in the superficial skin layer, which contains keratin.

Factors that facilitate a favorable environment for infection include:

moisture,

sweating,

closed shoes,

shared shower/changing areas,

accompanying nail fungus,

personal predisposition

It can be found.

Large real-world data also show that tinea pedis and onychomycosis frequently coexist, and that age, foot condition, and certain comorbidities influence the risk.

Is athlete's foot contagious?

Yes.

It can be transmitted through direct skin contact or through contaminated surfaces.

However:

“"You definitely caught it from the pool."”

It is often not possible to specify a definitive source.

Wearing slippers in shared shower areas, not sharing towels, and keeping feet dry can help reduce the risk of infection.

Can athlete's foot spread to the nails?

Yes.

Tinea pedis can be found in conjunction with onychomycosis, especially when it persists for a long time.

The opposite is also possible: an infected nail can create a permanent reservoir of dermatophytes for the skin of the foot.

Therefore, during the examination:

spaces between the toes + soles of the feet + nails

They should be evaluated together.

How to differentiate between athlete's foot and eczema?

It's not always easy with just appearances.

Flaking on the soles of the feet:

tinea pedis,

contact dermatitis,

dyshidrotic eczema,

psoriasis

It may be associated with various diseases such as these.

A 2024 dermatology study shows that dermoscopy can help differentiate these acral squamous cell diseases; however, direct visualization of the fungus is more important when needed.

How is the diagnosis made?

In typical cases, the clinical presentation is quite instructive.

However, recent reviews have shown that the sensitivity of clinical diagnosis alone may be low. Therefore, direct examination of KOH is valuable, especially in atypical or treatment-resistant cases.

If necessary:

KOH microscopy,

fungal culture,

molecular methods

available.

How is athlete's foot treated?

Topical antifungals

It is the primary treatment for limited and superficial tinea pedis.

Among the agents that can be used are:

terbinafin,

azole group antifungals,

ciclopirox

and other suitable topical agents are available.

Treatment duration can vary depending on the medication used and the type of disease. A current review emphasizes that topical treatments are the primary approach for superficial/localized disease.

Systemic antifungals

Oral treatment is mostly:

common disease,

lack of response to topical treatment,

accompanying onychomycosis,

immunosuppression

It is evaluated in situations such as these.

Should cortisone cream be used?

It is not advisable to use it uncontrollably without a diagnosis.

Corticosteroids can reduce redness and itching, but they do not eliminate the dermatophyte. Moreover, they can alter the appearance of the infection, leading to tinea incognito.

Because:

“"It's itchy and red; let's apply some cortisone cream."”

The approach can be quite misleading when standing up.

Why does athlete's foot recur?

Common causes:

premature discontinuation of treatment,

keeping your feet constantly moist,

accompanying nail fungus,

reinfection,

misdiagnosis,

less frequently, antifungal resistance.

In cases that persist and do not improve despite appropriate treatment, especially due to the increase in resistant dermatophytes, the diagnosis and causative agent should be re-evaluated.

What precautions should be taken at home?

The spaces between the toes should be dried thoroughly.

Socks should be changed regularly.

Shoes should not be worn for extended periods while damp.

Shoes should be used alternately and left to dry.

Shared towels and foot care products should be avoided.

If there is accompanying nail fungus, it should not be ignored.

When should you consult a dermatologist?

Especially:

if it repeats,

If it does not respond to topical treatment,

if the nails are also affected,

If widespread redness/swelling develops on the foot,

If cracks and pain are pronounced,

if there is diabetes or immunosuppression,

If you are not sure that the diagnosis is really a fungal infection

Dermatological evaluation is appropriate.

Frequently Asked Questions

Is athlete's foot contagious? Yes.

Does athlete's foot smell? Odor can accompany it; however, dermatophyte infection isn't the only cause of bad odor. Bacterial colonization, sweating, and the footwear environment can also play a role.

Is the whitening between your toes a fungal infection? It could be, but it's not always the case. Maceration can have various causes.

Can athlete's foot spread to the nails? Yes. Tinea pedis and onychomycosis can frequently occur together.

How many days should antifungal cream be used? The duration varies depending on the medication used and the type of disease. Stopping treatment randomly as soon as symptoms disappear can increase the risk of recurrence.

Does soaking your feet in vinegar help? There is no strong evidence that it can replace standard antifungal treatments.

Can athlete's foot completely disappear? With proper treatment, it can be cleared up; however, it can recur due to predisposition and reinfection.

Clinical Note by Dr. Utkan Kızıltaç

The two most common problems I see with athlete's foot are the prolonged use of combination corticosteroid creams without a diagnosis, and treating only the areas between the toes even when nail fungus is present. In recurring cases, instead of simply seeking a stronger cream, it's necessary to evaluate the diagnosis, the nails, and potential sources of reinfection together.

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