If the skin in the foot area is infected with disease-causing fungal pathogens, this is known as athlete's foot.
Athlete's foot is one of the dermatomycoses (skin fungal infections). Dermatomycoses are localized or superficial fungal infections of the skin and its appendages. Various fungi can cause dermatomycoses.
Athlete's foot often occurs on both feet at the same time. Athlete's foot can generally occur
- in the spaces between the toes and/or on the toes,
- the soles of the feet,
- on the edge of the foot and
- on the back of the foot
occur. In around 80 percent of cases, the spaces between the toes are affected. The toes themselves as well as the soles and the edge of the foot are less frequently affected, accounting for around 28 percent of cases. Athlete's foot is most rarely found on the back of the foot (approx. 6 percent).
A fungal infection of the feet is typically accompanied by a number of easily recognizable symptoms. These include wetness, scaling, itching and an unpleasant odor.
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Athlete's foot is one of the most common fungal skin diseases in western industrialized countries. It is also one of the most common infectious diseases of all.
An estimated one third of the population in this country suffer from a fungal infection in the area of the feet. Up to 70 percent of all Germans are affected by athlete's foot at least once in their lives.
The disease is slightly more common in men than in women. The number of fungal infections in the foot area increases with age. Children are rarely affected.
The typical symptoms of a athlete's foot infection include
- whitish, swollen or weeping foot skin,
- redness and scaling of the infected skin areas,
- the formation of blisters or pustules and small cracks in the skin,
- itching and burning,
- pain and
- an unpleasant odor.
These athlete's foot symptoms do not always occur at the same time and vary in severity.
A distinction is made between three forms of athlete's foot depending on the location and type of symptoms:
- the interdigital form(tinea pedis interdigitalis),
- the squamous-hyperkeratotic form(tinea pedis plantaris) and
- the vesicular-dyshidrotic form(tinea pedis interdigitalis).
Athlete's foot continues to spread if it is not treated © chaipanya | AdobeStock
Interdigital athlete's foot
The interdigital form is the most common form of athlete's foot. It occurs in the spaces between the toes.
The first symptoms of this form of athlete's foot usually appear between the fourth and fifth toe. In the early stages, the infection usually manifests itself as moist and softened skin (maceration). This is accompanied by unpleasant itching between the toes.
As the infection progresses, the affected areas of skin can become scaly and peel off. A reddened layer of skin becomes visible underneath. In addition, small blisters or pustules often form, as well as deep, painful cracks in the skin. These cracks in the skin facilitate the penetration of other pathogens, such as bacteria. In addition, athlete's foot is often accompanied by an unpleasant odor.
Interdigital athlete's foot can sometimes remain undetected for years . If left untreated, athlete's foot can spread from between the toes to the rest of the foot.
For this reason, you should not ignore even mild symptoms in the early stages, but consult a doctor.
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Squamous-hyperkeratotic athlete's foot
The squamous-hyperkeratotic form of athlete's foot, also known as moccasin mycosis, develops on the soles of the feet. From here, it slowly spreads to the edges and back of the foot.
The typical symptoms of this form of athlete's foot include increased dryness and scaling of the skin in the initial stages.
As the disease progresses, excessive keratinization (hyperkeratosis) of the scaly (squamous) skin occurs. Thick corneal layers and painful skin cracks form. These skin cracks, also known as rhagades, mainly develop on the heels, which are particularly exposed to stress.
Those affected often mistake the squamous-hyperkeratotic form of athlete's foot for dry skin and therefore do not go to the doctor. Here too, it is better to see a doctor sooner before the athlete's foot can spread!
Vesicular dyshidrotic athlete's foot
The vesicular-dyshidrotic form of athlete's foot usually starts in the area of the arch of the foot and the edges of the foot.
The main symptom here is the formation of small, fluid-filled blisters. Due to the thick horny layer on the soles of the feet, they do not burst spontaneously but dry up.
As a result, those affected often suffer from a feeling of tightness and itching of the skin on their feet.
Athlete's foot must always be treated, as it does not heal on its own.
If it is treated too late or inconsistently, there is a risk of further spread or even serious complications.
For example, athlete's foot in the spaces between the toes can spread to the entire foot or to the toenails. Nail fungus can also develop.
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Other areas of the skin and body are also at risk. The armpits or groin have a warm and moist environment, which means that the fungal infection can spread there.
Infection of other parts of the body can occur, for example
- by scratching your itchy feet with your bare hands, or
- using a single towel to dry the feet and other parts of the body.
can occur.
Another possible complication is the additional development of a bacterial infection, such aserysipelas. Fungal colonization damages the skin's natural defences. This makes it easier for bacteria and viruses to penetrate the skin and cause serious inflammation.
In most cases, dermatophytes are responsible for athlete's foot. These fungal pathogens, also known as filamentous fungi, specifically attack the skin and its appendages (nails and hair). They only lead to superficial mycoses.
In rare cases, however, athlete's foot can also be caused by yeasts and molds.
Infection with these pathogens usually occurs either through direct or indirect smear infection.
Which pathogens are responsible for athlete's foot?
Fungal diseases caused by dermatophytes are also known as dermatophytoses or tinea. In medicine, the term tinea pedis is therefore usually used for athlete's foot. The most important representatives of the dermatophyte group include the genera
- Trichophyton, in particular Trichophyton rubrum and Trichophyton interdigitale,
- Microsporum and
- Epidermophyton.
Yeast fungi reproduce by sprouting or splitting and are therefore also referred to as sprouting fungi. Important representatives of the group of yeasts are the genera
- Candida,
- Cryptococcus and
- Pityrosporum.
A athlete's foot infection caused by yeasts is usually caused by Candida species, in particular the pathogen Candida albicans. Athlete's foot caused by Candida usually affects the spaces between the toes and is therefore also known as interdigital candidiasis.
Molds usually cause systemic mycoses inside the body. However, they can also be the cause of superficial mycoses such as athlete's foot.
Scopulariopsis brevicaulis, for example, is a mold that can be responsible for a athlete's foot infection.
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How are the pathogens that cause athlete's foot transmitted?
Transmission usually occurs from person to person through a so-called smear or contact infection. Two different transmission routes are possible: direct and indirect smear infection.
In the case of direct smear infection, the pathogens are transmitted through direct skin contact with the infected foot of another person. This can happen in contact sports such as judo.
With indirect smear infection, on the other hand, infection occurs indirectly through skin contact with contaminated surfaces. The disease can be transmitted by touching used shoes or socks, for example, or even floors or carpets. This form of infection is by far the more common transmission route.
In most cases, transmission occurs through flakes of skin secreted by infected people that come into contact with healthy people. Infected people shed these flakes of skin, particularly when walking barefoot, and then spread them invisibly on the floor. From there, they get onto the skin of other barefoot people's feet and can cause athlete's foot there.
Athlete's foot is also known as athlete's foot. This term is due to the fact that athletes in particular often suffer from athlete's foot. Athletes particularly often use
- Communal showers,
- changing rooms,
- public swimming pools and
- saunas and
- often wear shoes that promote perspiration.
The fungal pathogens that cause the disease thrive particularly well in a warm and humid environment. This is why athletes have a higher risk of contracting athlete's foot. Of course, the risk also applies to other people who like to visit such facilities.
Hotel rooms, vacation resorts and campsites also pose a higher risk, as many people walk barefoot here too.
However, whether a person becomes infected through contact with athlete's foot pathogens depends on so-called predisposing factors.
Weakened immune system
Normally, the body's own immune system can cope with athlete's foot pathogens without any problems.
The risk group of people who are particularly susceptible to athlete's foot includes
In addition, people who have
are particularly susceptible to athlete's foot.
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Warm and humid climate
In addition to communal showers, changing rooms and swimming pools, the risk factor "warm and humid climate" also affects other areas of life. People have a higher risk of infection with athlete's foot pathogens,
- who wear shoes or socks that are too tight or not air-permeable enough, which impede blood circulation and ventilation of the feet,
- who tend to sweat more, i.e. have sweaty feet, and
- have inadequate foot hygiene or do not dry their feet properly after showering.
Entry points in the skin
In order to cause a athlete's foot infection, the pathogen must first penetrate the natural protective layer of the skin. To do this, the athlete's foot pathogens use small skin tears and injuries on the feet in particular.
These skin injuries can be caused by shoes that are too tight, for example. Foot malpositions such as
which promote the development of pressure sores and wounds on the feet, also increase the risk.
In addition, the skin on the feet can also be damaged by frequent cleaning with aggressive soaps, shower gels or sprays.
A athlete's foot infection is diagnosed by
- a medical history interview,
- a clinical inspection of the affected areas of the foot and
- a microscopic examination of a tissue sample in the laboratory.
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Clinical inspection and medical history
A suspected diagnosis of athlete's foot can usually be made by clinically inspecting the feet and taking a medical history.
For this purpose, the attending physician - usually a dermatologist - examines the affected areas of skin on the feet. Based on the characteristic symptoms, he can usually already recognize whether it is a case of athlete's foot.
The doctor obtains further clues as to whether the skin changes are athlete's foot during a medical history interview. He will ask the patient whether they suffer from other symptoms such as itching, burning or pain on their feet.
The doctor also tries to identify possible risk factors and causes for the athlete's foot infection. For example, he will ask whether the patient
- tends to sweat on the feet,
- frequently uses public showers and swimming pools or
- often wears shoes that are impermeable to air or too tight.
As part of the athlete's foot diagnosis, the doctor looks for typical symptoms © Alexander Raths | AdobeStock
Detection of the athlete's foot pathogen in a native preparation
For a clear diagnosis of athlete's foot, microscopic evidence of the pathogen in the so-called native preparation is necessary. In this case, a native preparation is a skin or scale sample of the infected skin of the foot. The doctor can easily scrape it off with a spatula.
This sample material is examined under a microscope with 25 to 400x magnification. If athlete's foot pathogens are found, the diagnosis of athlete's foot is established.
However, it is usually not possible to determine the exact type of athlete's foot pathogen under the microscope. To identify the exact pathogen, the next step is often to create a so-called fungal culture.
Determination of the athlete's foot pathogen with a fungal culture
For targeted treatment, the doctor must identify which pathogen is responsible. The fungal culture is used for this purpose.
With the help of the tissue sample taken, the fungus is cultivated on a suitable culture medium in the laboratory. The specific type of fungus can then be identified from the fungal colonies that have grown.
It can take up to three or four weeks before the result is available.
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Differential diagnosis for athlete's foot
Other diseases can also be accompanied by symptoms similar to athlete's foot. The doctor must rule out other diseases as part of the diagnosis. Diseases with symptoms similar to athlete's foot include
Athlete's foot should always be treated medically, even if it is only mild and causes only minor symptoms. If left untreated, athlete's foot can spread and sufferers can also infect other people.
So-called antifungals are generally used to treat athlete's foot. These are antifungal medications that are administered externally on the skin or internally in the form of tablets.
Depending on the mode of action of the antifungals, two different types of antifungals can be distinguished.
Fungistatic antifungals contain active ingredients such as clotrimazole, which primarily inhibit the reproduction of athlete's foot pathogens. They prevent the athlete's foot infection from spreading further.
Fungistatic antimycotics must be applied two to three times a day for around three to four weeks. During this time, the skin can completely renew itself. In the process, it gradually sheds the skin cells affected by the athlete's foot.
Fungicidal antimycotics contain active ingredients such as terbinafine, which kill the athlete's foot pathogens directly. Fungicidal antimycotics must be used for a much shorter period of time than fungistatic antimycotics. Under certain circumstances, for example in the case of a very mild athlete's foot infection, a single treatment with a fungicidal antifungal agent such as Terbinafine is sufficient.
The mode of action of the antifungal agents also determines how long they need to be used:
Topical vs. systemic treatment of athlete's foot
When treating athlete's foot, a distinction can be made between topical (external) and systemic (internal) therapy, depending on the type of application.
Which of these treatment options is used depends on the extent of the athlete's foot infection. In the case of mild athlete's foot in the early stages, it is usually sufficient to treat the affected areas of skin externally.
Advanced athlete's foot or athlete's foot that does not disappear despite topical therapy, on the other hand, must be treated systemically with tablets.
In topical therapy, the antifungal agents are applied externally in the form of well-tolerated
- creams,
- ointments,
- sprays,
- gels,
- powders or
- pastes
applied to the areas of skin affected by athlete's foot.
Topical antifungals are often available over the counter in pharmacies. They can easily be used for self-medication to treat athlete's foot.
As a rule, they must be applied to the affected skin of the foot two to three times a day for three to four weeks. They penetrate deep into the skin layers in order to reach the deep-seated athlete's foot spores.
In systemic therapy, the antifungal agents are administered orally in the form of tablets. The active ingredient is then distributed throughout the body via the bloodstream.
These internally applied antifungal agents are generally only used in severe, advanced cases of athlete's foot.
Systemic therapy is also necessary if topical therapy has not had the desired effect.
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How long should athlete's foot treatment be carried out?
Consistent use or intake of antifungal medication is necessary to treat athlete's foot effectively.
In particular, the prescribed duration of use should be adhered to. Under no circumstances should the antimycotics be discontinued prematurely as soon as the typical athlete's foot symptoms have disappeared.
Even if symptoms no longer occur, the pathogens responsible for athlete's foot have not necessarily disappeared completely. Remaining germs may have survived in the individual skin layers. If the antimycotics are discontinued prematurely, they can multiply and lead to a renewed flare-up of the athlete's foot infection.
Consistent treatment is therefore very important.
Supportive measures in the treatment of athlete's foot
For successful athlete's foot treatment, sufferers should keep the toes and spaces between the toes clean and dry. Make sure you always dry your feet thoroughly after washing them and do not wear shoes that are too tight. It can also be helpful to place strips of cloth between the toes.
Socks and stockings should be changed daily and washed at a temperature of at least 95 degrees to eliminate athlete's foot pathogens. Bath mats and towels should also be machine-washed as hot as possible.
Worn shoes should be disinfected with a fungicidal agent to prevent re-infection with athlete's foot.
Antifungals against athlete's foot are available with many different active ingredients. A distinction is made between narrow-spectrum and broad-spectrum antifungals depending on the spectrum of action of the antifungals.
Narrow spectrum or broad spectrum?
Narrow-spectrum antifungals are only effective against a small number of athlete's foot pathogens. The exact type of fungus must therefore be known before they are used. The available narrow-spectrum antifungals include, among others
- the antifungal agent nystatin, which is effective against yeast fungi, and
- the antimycotic tolnafate, which is effective against dermatophytes.
Both nystatin and tolnafate are used externally.
Broad-spectrum antifungals, on the other hand, combat several types of fungi at the same time. Common broad-spectrum antifungals are the so-called azoles in particular. These include, for example, the active ingredients
- Bifonazole,
- clotrimazole,
- miconazole,
- itraconazole and
- fluconazole.
Azoles inhibit the biosynthesis of ergosterol, which is an important building block of the cell membrane of fungi. As a result of the intervention, the pathogen stops growing and eventually dies. These are therefore fungistatic antimycotics.
They are usually used externally, but sometimes also internally.
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Terbinafine is another frequently used broad-spectrum antifungal agent. It is suitable for both external and internal use. Unlike azoles, terbinafine has a fungicidal effect, i.e. it kills the foot fungus pathogens.
Over-the-counter creams for self-medication
Over-the-counter medication for topical use against athlete's foot is available in pharmacies.
The choice of the appropriate dosage form for successful topical treatment depends on the condition of the skin. Patients who suffer from heavy foot perspiration are more likely to use powder or gel. For dry skin, treating athlete's foot with a cream has a nourishing effect and provides additional relief.
In around a third of cases, a mixed infection is responsible for the course of mycosis pedis. This means that different fungal pathogens have caused the athlete's foot. Examples:
- Fungi from the dermatophyte family occur together with yeast and/or molds.
- As the disease progresses, bacteria cause a superinfection that leads to inflammatory reactions and bad odor.
The joint activity of all pathogens manifests itself with well-known symptoms. A cream with a broad-spectrum effect is the easiest way to treat the complex symptoms.
Antifungal and antibacterial properties ensure that all relevant groups of pathogens are successfully combated together.
The active ingredient bifonazole belongs to the azole group. Like all azoles, the active ingredient primarily has a fungistatic effect, but it can also develop a fungicidal effect. Creams with the active ingredient bifonazole therefore also have a reliable broad-spectrum effect.
An exact determination of the causative pathogen of an individual fungal infection is not possible in everyday pharmacy practice. This makes it all the more important to choose a drug whose versatile properties can be used successfully against all relevant symptom-causing agents. The drug bifonazole
- simultaneously uses two points of attack in the metabolism of the fungus to inhibit cell wall formation
- has an antifungal effect against all relevant fungal families involved in the disease process
- combats the bacterial infection that spreads as the disease progresses
- alleviates inflammatory skin reactions that occur as a result of the defense against invading pathogens
- is considered to be reliably effective against the infection in both athlete's foot and nail fungus.
Topical treatment of athlete's foot with a cream containing bifonazole lasts about three weeks. Treatment must not be discontinued early, as otherwise it will not be fully effective.
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As with almost all diseases, home remedies are also recommended for athlete's foot. Tips and recipes on how to get rid of the skin parasites are circulating on the Internet in particular.
However, caution is advised. None of the home remedies have been proven to be effective.
It can even be assumed that some of these alleged athlete's foot home remedies have the opposite effect. For example, warm, moist herbal compresses can cause the fungal germs to multiply faster than without them.
If the infected skin is already inflamed, pungent remedies such as raw garlic, vinegar or tea tree oil also cause pain.
But even if the application of a home remedy does not cause immediate harm, it delays the really sensible medical therapy.
It is therefore generally not advisable to use alleged athlete's foot home remedies.
A athlete's foot infection does not heal on its own. In fact, without treatment, athlete's foot usually spreads further and becomes chronic. Consistent and adequate treatment of athlete's foot is therefore essential.
As a rule, however, athlete's foot can be treated very well and easily eliminated within a few weeks.
A visit to the doctor is normally only advisable if
- the athlete's foot appears for the first time or
- appears again and again despite consistent treatment.
After the disease has healed, a new athlete's foot infection can be prevented with targeted measures.
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A number of rules of conduct and preventive measures reduce the risk of athlete's foot infection.
In general
- a healthy lifestyle,
- a balanced and varied diet and
- regular exercise
is important to strengthen the body's own immune system.
You should also take care to
- avoid the usual sources of foot fungus,
- pay attention to proper foot hygiene and
- wear good shoes.
Avoid the usual transmission routes of athlete's foot
A very important measure is to never walk barefoot in public showers, baths, saunas, changing rooms, etc. Wearing bathing shoes or slippers effectively prevents contact with athlete's foot pathogens.
Other possible sources of infection are the wooden surfaces and seats in the sauna and shared towels. You should therefore always use your own towel in the sauna to avoid direct contact with potentially infected surfaces.
Never share towels, shoes or socks with others and wash them regularly at a temperature of over 60 degrees. After washing, the athlete's foot pathogens have usually disappeared from the textiles.
Proper foot hygiene and foot care
Athlete's foot pathogens can penetrate softened skin particularly well and multiply more quickly in a moist environment. You should therefore keep your feet as dry as possible.
Always dry your feet and the spaces between your toes carefully after bathing or washing.
If you have very tight toes or tend to sweaty feet, you can also place strips of fabric between your toes to keep the spaces between your toes dry.
In addition, the feet should be
- with warm water and a mild soap or moisturizing
- moisturizing washing lotions
should be washed daily. Special moisturizing creams prevent dry foot skin and the formation of small cracks.
Good circulation also protects against fungal infections. For this we recommend
- Alternating baths,
- alternating showers and
- thigh casts,
which stimulate blood circulation in the feet.
Long foot baths, on the other hand, tend to be harmful as they cause the skin of the feet to swell excessively, making it more susceptible.
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The right socks and shoes
Shoes and socks made of air-impermeable materials cause the feet to sweat excessively. Damp feet are a risk for athlete's foot infection.
For this reason, it is important to always wear shoes and socks that allow the feet to breathe and ensure good ventilation of the feet. Sneakers should only be worn during sports.
Wearing shoes made of plastic and socks made of synthetic materials are therefore rather harmful. More suitable, on the other hand, are
- Shoes made of air-permeable materials such as leather or modern microfibers,
- open shoes such as sandals and
- socks and stockings made from natural, breathable materials such as wool or cotton.
As feet sweat less in well-fitting, comfortable shoes, it is also important that the shoes fit correctly.
Another important part of preventing athlete's foot is changing socks and shoes regularly. Change your socks daily and wash them at 60 degrees. Ideally, wear a different pair of shoes every day. This will allow the shoes, which absorb moisture during wear, to dry for at least 24 hours before being worn again.
Treat your shoes with a special disinfectant spray or antifungal agent during or after a foot fungus infection. This will kill any athlete's foot pathogens that may be present.
The socks can be washed with a special detergent.
