Athlete's Foot: Information and Doctors Who Treat Athlete's Foot

When the skin on the feet is infected with disease-causing fungal pathogens, this is referred to as athlete’s foot.

Athlete’s foot is a type of dermatomycosis (literally: fungal skin infection). 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

• in the spaces between the toes and/or on the toes,
• the soles of the feet,
• along the edges of the feet, and
• on the top of the foot

. In about 80 percent of cases, the spaces between the toes are affected. The toes themselves, as well as the soles and sides of the feet, are affected less frequently, accounting for about 28 percent of cases. Athlete’s foot is least commonly found on the top of the foot (about 6 percent).

Typically, a fungal infection of the feet is accompanied by a number of easily recognizable symptoms. These include, among other things, moisture, flaking, itching, and an unpleasant odor.

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Athlete’s foot is one of the most common fungal skin infections in Western industrialized countries. It is also one of the most common infectious diseases overall.

An estimated one-third of the population in this country suffers from a fungal infection of the feet. Up to 70 percent of all Germans are affected by athlete’s foot at least once in their lives.

The condition is slightly more common in men than in women. The number of fungal infections affecting the feet increases with age. Children are rarely affected.

Typical symptoms of an athlete’s foot infection include

• whitish, swollen, or weeping skin on the feet,
• redness and flaking of the infected skin areas,
• the formation of blisters or pustules as well as small cracks in the skin,
• itching and burning,
• pain, and
• an unpleasant odor.

These symptoms of athlete’s foot do not always occur simultaneously and vary in severity.

Based on the location and type of symptoms, three forms of athlete’s foot are distinguished:

1. the interdigital form (Tinea pedis interdigitalis),
2. the squamous-hyperkeratotic form (Tinea pedis plantaris), and
3. the vesicular-dyshidrotic form (Tinea pedis interdigitalis).

Athlete's foot spreads further if left untreated © chaipanya | AdobeStock

Interdigital Athlete’s Foot

The interdigital form is the most common type of athlete’s foot. It occurs between the toes.

The first symptoms of this form of athlete’s foot usually appear between the fourth and fifth toes. In the early stages, the infection typically manifests as moist and softened skin (maceration). This is accompanied by an unpleasant itching sensation between the toes.

As the condition progresses, the affected skin areas may become scaly and peel, among other changes. 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 facilitate the entry of other pathogens, such as bacteria. Furthermore, athlete’s foot is often accompanied by an unpleasant odor.

Interdigital athlete’s foot can sometimes go undiagnosed for years. If left untreated, the infection can spread from the spaces between the toes to the rest of the foot.

For this reason, you should not ignore even mild symptoms in the early stages; instead, 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 there, it slowly spreads to the sides and top of the foot as the condition progresses.

Typical symptoms of this form of athlete’s foot in the early stages include increased dryness and flaking of the skin.

As the condition progresses, excessive thickening (hyperkeratosis) of the scaly (squamous) skin occurs. This leads to the formation of thick layers of calluses and painful skin cracks. These skin cracks, also known as rhagades, develop primarily on the heels, which bear the most weight.

Those affected often mistake the squamous-hyperkeratotic form of athlete’s foot for dry skin and therefore do not see a doctor. Here, too, the rule applies: It’s better to see a doctor sooner rather than later, before the athlete’s foot can spread!

Vesicular-dyshidrotic athlete’s foot

The vesicular-dyshidrotic form of athlete’s foot usually originates in the area of the arch and the sides of the foot.

The main symptom here is the formation of small, fluid-filled blisters. Because of the thick stratum corneum on the soles of the feet, they do not burst spontaneously but dry out instead.

As a result, those affected often experience a feeling of tightness and itching in the skin of their feet.

Athlete’s foot must always be treated, as it does not heal on its own.

If treatment is delayed or inconsistent, there is a risk of the infection spreading further or even leading to serious complications.

For example, athlete’s foot between the toes can spread to the entire foot or to the toenails. This can also lead to toenail fungus.

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Other areas of the skin and body are also generally at risk. The underarms and groin provide a warm, moist environment, allowing the fungal infection to spread there.

Infection of other body regions can occur, for example,

• by scratching itchy feet with bare hands, or
• using a single towel to dry your feet and other parts of your body

.

Another possible complication is the development of a secondary bacterial infection, such as erysipelas. Fungal colonization damages the skin’s natural defenses, making 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 infect the skin and its appendages (the nails and hair). They cause only superficial fungal infections.

In rare cases, however, athlete’s foot can also be caused by yeasts and molds.

Infection with these pathogens usually occurs through either direct or indirect contact transmission.

Which pathogens are responsible for athlete’s foot?

Fungal infections caused by dermatophytes are also called dermatophytoses or tinea. In medicine, the term tinea pedis is therefore usually used for athlete’s foot. Among the most important members of the dermatophyte group are the genera

• Trichophyton, particularly Trichophyton rubrum and Trichophyton interdigitale,
• Microsporum, and
• Epidermophyton.

Yeasts reproduce by budding or fission and are therefore also referred to as budding fungi. Important members of the yeast group include the genera

• Candida,
• Cryptococcus, and
• Pityrosporum.

Athlete’s foot caused by yeast fungi is usually due to Candida species, particularly the pathogen Candida albicans. Athlete’s foot caused by Candida typically affects the spaces between the toes and is therefore also known as interdigital candidiasis.

Molds usually cause systemic fungal infections inside the body. However, they can also be responsible for superficial fungal infections such as athlete’s foot.

One type of mold that can cause an athlete’s foot infection is, for example, Scopulariopsis brevicaulis.

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How are the pathogens that cause athlete’s foot transmitted?

Transmission usually occurs from person to person through what is known as a smear or contact infection. There are essentially two different routes of transmission: direct and indirect smear infection.

In direct smear infection, the pathogens are transmitted through direct skin contact with another person’s infected foot. This can happen, for example, in contact sports such as judo.

In indirect smear infection, however, transmission occurs indirectly through skin contact with contaminated surfaces. The disease can be transmitted, for example, by touching used shoes or socks, or even floors or carpets. This form of infection is by far the more common route of transmission.

In most cases, transmission occurs through skin flakes shed by infected people that healthy people come into contact with. Infected individuals shed these skin flakes, particularly when walking barefoot, and then spread them invisibly across the floor. From there, they transfer to the skin of other people’s feet when they walk barefoot and can cause athlete’s foot.

In English, athlete’s foot is also known as “athlete’s foot.” This name stems from the fact that athletes, in particular, frequently suffer from athlete’s foot. Athletes use

• shared showers,
• locker rooms,
• public swimming pools, and
• saunas, and
• often wear shoes that trap sweat.

The fungal pathogens that cause this condition thrive particularly well in warm, humid environments. That’s why athletes are at a higher risk of contracting athlete’s foot. Of course, this risk also applies to other people who enjoy visiting such facilities.

Hotel rooms, vacation resorts, and campgrounds also pose a higher risk, since many people walk barefoot there as well.

Whether a person becomes infected upon contact with athlete’s foot pathogens, however, depends on so-called predisposing factors.

Weakened Immune System

Normally, the body’s immune system can easily fight off athlete’s foot pathogens.

The group of people who are particularly susceptible to athlete’s foot includes, among others

• older adults,
• people with diabetes,
• people living with HIV, and
• smokers.

In addition, people who

• have undergone surgery, a transplant, or chemotherapy,
• are overweight,
• suffer from circulatory problems in their feet and legs, or
• take medications that suppress the immune system,

are particularly susceptible to athlete’s foot.

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Warm, humid environments

In addition to communal showers, locker rooms, and swimming pools, the risk factor of a “warm, humid climate” also affects other areas of life. People are at higher risk of infection with athlete’s foot pathogens if they

• who wear shoes or socks that are too tight or not breathable enough, which hinder blood circulation and ventilation of the feet,
• who tend to sweat excessively—commonly known as having “sweaty feet”—and
• have poor foot hygiene or, for example, do not dry their feet properly after showering.

Entry Points in the Skin

In order to cause an athlete’s foot infection, the pathogen must first penetrate the skin’s natural protective barrier. Small skin cracks and injuries on the feet serve as entry points for the athlete’s foot pathogens.

These skin injuries can be caused, among other things, by shoes that are too tight. Foot deformities such as

• hammertoes,
• flat feet,
• spread feet, and
• flat feet,

which can lead to pressure points and sores on the feet, also increase the risk.

In addition, the skin on the feet can also be damaged by excessive washing with harsh soaps, shower gels, or sprays.

A fungal foot infection is diagnosed through

• a medical history interview,
• a clinical examination of the affected areas of the foot, and
• a microscopic examination of a tissue sample in the laboratory.

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Clinical Examination and Medical History

A suspected diagnosis of athlete’s foot can usually be made through a clinical examination of the feet and a medical history interview. 

To do this, the treating physician—usually a dermatologist—examines the affected areas of skin on the feet. Based on the characteristic symptoms, the physician can usually determine right away whether it is athlete’s foot.

The doctor obtains further clues as to whether the skin changes are caused by athlete’s foot during the medical history interview. For example, the doctor asks the patient whether they are experiencing other symptoms such as itching, burning, or pain in the feet.

In addition, the doctor will try to identify possible risk factors and causes of the athlete’s foot infection. To do this, they may ask, for example, whether the patient

• tends to sweat on their feet,
• frequently uses public showers and swimming pools, or
• often wears shoes that are not breathable 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 direct smear

For a definitive diagnosis of athlete’s foot, microscopic detection of the pathogen in a so-called direct smear is necessary. In this context, a direct smear refers to a skin or scale sample from the infected skin of the foot. The doctor can easily scrape it off with a spatula.

This sample is examined under a microscope at a magnification of 25x to 400x. If athlete’s foot pathogens are found, a diagnosis of athlete’s foot is made.

However, it is usually not possible to determine the exact type of athlete’s foot pathogen under the microscope. To accurately identify the pathogen, a fungal culture is often performed as the next step.

Identifying the Athlete’s Foot Pathogen Using a Fungal Culture

For targeted treatment, the doctor must identify which pathogen is responsible. This is done using a fungal culture.

Using the tissue sample that was taken, the fungus is cultured on a suitable growth medium in the laboratory. The specific type of fungus can then be determined based on the resulting fungal colonies.

It can take up to three or four weeks to receive the results.

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Differential Diagnosis for Athlete’s Foot

Other conditions can also present with symptoms similar to athlete’s foot. As part of the diagnostic process, the doctor must rule out other conditions. Conditions with symptoms similar to those of athlete’s foot include

• psoriasis,
• eczema, or
• bacterial infections of the skin on the feet.

Athlete’s foot should always be treated medically, even if it is only mild and causes minimal discomfort. If left untreated, athlete’s foot can spread, and those affected can also infect others.

So-called antifungals are generally used to treat athlete’s foot. These are antifungal medications that are applied topically to the skin or taken orally in the form of tablets.

Depending on how they work, antifungal medications can generally be divided into two different types.

Fungistatic antifungals contain active ingredients such as clotrimazole, which primarily inhibit the growth of the athlete’s foot-causing pathogens. They prevent the athlete’s foot infection from spreading further.

Fungistatic antifungals must be applied two to three times a day for about three to four weeks. During this time, the skin can completely regenerate, gradually shedding the skin cells affected by athlete’s foot.

Fungicidal antifungals contain active ingredients such as terbinafine, which directly kill the pathogens that cause athlete’s foot. Fungicidal antifungals must be used for a much shorter period than fungistatic antifungals. In some cases—such as with a very mild athlete’s foot infection—even a single treatment with a fungicidal antifungal like terbinafine may be sufficient.

The duration of treatment also depends on how the antifungal medications work:

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 method of application.

Which of these treatment options is used depends on the severity of the athlete’s foot infection. For example, in the case of mild athlete’s foot in the early stages, it is usually sufficient to treat the affected skin areas topically.

In contrast, an advanced case of athlete’s foot—or one that does not clear up despite topical treatment—must be treated systemically with tablets.

In topical therapy, antifungal agents are applied externally in the form of well-tolerated

• creams,
• ointments,
• sprays,
• gels,
• powders, or
• pastes

are applied to the areas of skin affected by athlete's foot.

Topical antifungals are often available over the counter at pharmacies. They can easily be used on your own—that is, through self-medication—to treat athlete’s foot.

They usually need to be applied to the affected skin on the feet two to three times a day for three to four weeks. In doing so, they penetrate deep into the skin layers to reach even the deeper-seated athlete’s foot spores.

In systemic therapy, antifungal medications are administered orally in the form of tablets. The active ingredient is then distributed throughout the entire body via the bloodstream.

These oral antifungal medications are generally used only in severe, advanced cases of athlete’s foot.

Systemic therapy is also necessary if topical therapy has not produced the desired results.

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How long does athlete’s foot treatment need to be continued?

Consistent use of antifungal medications is necessary to effectively treat athlete’s foot.

In particular, the prescribed duration of treatment should be followed. Under no circumstances should antifungal medications be discontinued prematurely once the typical symptoms of athlete’s foot have disappeared.

Even if symptoms no longer occur, the pathogens responsible for athlete’s foot have not necessarily been completely eliminated. Remaining pathogens may have survived in the various layers of the skin. If antifungal medication is stopped prematurely, these pathogens can multiply and lead to a recurrence of the athlete’s foot infection.

It is therefore very important to complete the full course of treatment.

Supportive Measures for Treating Athlete’s Foot

For successful treatment of athlete’s foot, those affected should keep their toes and the spaces between them clean and dry. Be sure to always dry your feet thoroughly after washing and avoid wearing shoes that are too tight. It can also be helpful to place strips of cloth between your toes.

You should change your socks and stockings daily and wash them at a temperature of at least 95 degrees to eliminate the athlete’s foot pathogens. Bath mats and towels should also be machine-washed at the highest possible temperature.

You should disinfect worn shoes with an antifungal agent to prevent a recurrence of athlete’s foot.

Antifungal medications for athlete’s foot are available with many different active ingredients. Depending on the spectrum of activity of the antifungal medication, a distinction is made between narrow-spectrum and broad-spectrum antifungals.

Narrow-spectrum or broad-spectrum?

Narrow-spectrum antifungals are effective against only a small number of athlete’s foot pathogens. Therefore, the exact type of fungus must be identified before use. Available narrow-spectrum antifungals include, among others,

• nystatin, an antifungal agent effective against yeasts, and
• tolnafat, an antifungal that targets dermatophytes.

Both nystatin and tolnafat are applied topically.

Broad-spectrum antifungals, on the other hand, combat several types of fungi at the same time. Common broad-spectrum antifungals include, in particular, the so-called azoles. These include, for example, the active ingredients

• bifonazole,
• clotrimazole,
• miconazole,
• itraconazole, and
• fluconazole.

Azoles inhibit the biosynthesis of ergosterol, which is an important component of the fungal cell membrane. As a result of this inhibition, the pathogen ceases to grow and eventually dies. These are therefore fungistatic antifungals.

They are usually applied topically, but are sometimes taken orally as well.

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Another commonly used broad-spectrum antifungal is terbinafine. It is suitable for both topical and oral use. Unlike azoles, terbinafine has a fungicidal effect, meaning it kills the pathogens that cause athlete’s foot.

Over-the-counter creams for self-treatment

Over-the-counter medications for topical use against athlete’s foot are available at pharmacies.

Choosing the right formulation for successful topical treatment depends on skin type. Patients who suffer from excessive foot sweating tend to prefer powders or gels. For dry skin, treating athlete’s foot with a cream has a moisturizing effect and thus provides additional relief.

In about one-third of cases, a mixed infection is responsible for the progression of a foot fungal infection. This means that different fungal pathogens have caused the athlete’s foot. Examples:

• Fungi from the dermatophyte family occur alongside yeast and/or molds.
• As the condition progresses, bacteria cause a superinfection, leading to inflammatory reactions and an unpleasant odor.

The combined activity of all these pathogens manifests itself through familiar symptoms. A broad-spectrum cream is the simplest way to treat this complex set of symptoms.

Antifungal and antibacterial properties ensure that all relevant groups of pathogens are successfully combated together.

The active ingredient bifonazole belongs to the azole class. Although, like all azoles, it primarily acts as a fungistatic agent, it can also develop a fungicidal effect. Creams containing bifonazole therefore also provide reliable broad-spectrum coverage.

In everyday pharmacy practice, it is not possible to precisely identify the specific pathogens causing an individual fungal infection. This makes it all the more important to choose a medication whose versatile properties are effective against all relevant causes of symptoms. The active ingredient bifonazole

• simultaneously targets two points in the fungus’s metabolism to inhibit cell wall formation
• exerts 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 arise as a result of the body’s defense against invading pathogens
• is considered reliably effective against both athlete’s foot and nail fungus.

Topical treatment of athlete’s foot with a cream containing bifonazole lasts about three weeks. The treatment must not be discontinued prematurely, as it will otherwise not be fully effective.

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As with almost all illnesses, home remedies are also recommended for athlete’s foot. Tips and recipes for getting rid of the skin fungus are circulating widely, especially online.

However, caution is advised. The effectiveness of none of these home remedies has been proven.

In fact, it’s even possible that some of these so-called home remedies for athlete’s foot may actually have the opposite effect. For example, warm, moist herbal compresses can cause the fungal spores to multiply more quickly than they would otherwise.

If the affected skin is already inflamed, harsh remedies such as raw garlic, vinegar, or tea tree oil can also cause pain.

But even if using a home remedy does not cause immediate harm, it delays truly effective medical treatment.

For this reason, the use of so-called home remedies for athlete’s foot is generally not recommended.

An athlete’s foot infection generally does not heal on its own. Rather, without treatment, athlete’s foot usually spreads further and becomes chronic. Consistent and appropriate treatment of athlete’s foot is therefore essential.

As a rule, however, athlete’s foot can be treated very effectively and eliminated without difficulty within a few weeks.

A visit to the doctor is usually only recommended if

• the athlete’s foot occurs for the first time or
• it keeps coming back despite consistent treatment.

Once the infection has cleared up, targeted measures can help prevent a recurrence of athlete’s foot.

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A number of guidelines and preventive measures can reduce the risk of a foot fungus infection.

In general,

• a healthy lifestyle,
• a balanced and varied diet, and
• regular exercise

are important for strengthening the body’s immune system.

Also be sure to

• avoid the usual sources of athlete’s foot infection,
• to practice proper foot hygiene, and
• to wear good shoes.

Avoid the common routes of transmission for athlete’s foot

A very important precaution is to never walk barefoot in public showers, bathrooms, saunas, locker rooms, etc. Wearing bathing shoes or slippers effectively prevents contact with the pathogens that cause athlete’s foot.

Other potential sources of infection include the wooden benches and seating areas in the sauna, as well as shared towels. In the sauna, you should therefore always place your own towel underneath you to avoid direct contact with potentially infected surfaces.

Never share towels, shoes, or socks with others, and wash them regularly at a temperature ofover 60 degrees. After washing, the athlete’s foot pathogens are usually eliminated from the fabrics.

Proper Foot Hygiene and Foot Care

Athlete’s foot pathogens can penetrate softened skin particularly easily and multiply more quickly in a moist environment. That’s why you should keep your feet as dry as possible.

Always dry your feet and the spaces between your toes thoroughly after bathing or washing.

If your toes are very close together or you tend to have sweaty feet, you can also place strips of fabric between your toes to keep the spaces between them dry.

In addition, you should wash your feet daily

• with warm water and a mild soap or
• moisturizing body wash

. Special moisturizing creams help prevent dry skin on the feet and the development of small cracks.

Good blood circulation also helps protect against fungal infections. For this purpose,

• contrast baths,
• contrast showers, and
• thigh baths,

which stimulate blood flow to the feet.

Long foot baths, on the other hand, are actually harmful, as they cause the skin on the feet to swell excessively, making it more susceptible to infection.

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The Right Socks and Shoes

Shoes and socks made of non-breathable materials cause the feet to sweat excessively. Damp feet increase the risk of a fungal infection.

For this reason, it’s important to always wear shoes and socks that allow your feet to breathe and ensure good ventilation. Sneakers should only be worn during physical activity.

Wearing plastic shoes and synthetic socks is therefore more harmful. Better options, on the other hand, are

• shoes made of breathable materials such as leather or modern microfibers,
• open-toed shoes such as sandals, and
• stockings and socks made of natural, breathable materials such as wool or cotton.

Since feet sweat less in well-fitting, comfortable shoes, the proper fit of the shoes is also important.

Another important part of preventing athlete’s foot is changing your socks and shoes regularly. Change your socks daily and wash them at 60 degrees. Ideally, wear a different pair of shoes every day. This allows the shoes, which absorb moisture while being worn, to dry for at least 24 hours before being worn again.

During or after a foot fungus infection, treat your shoes with a special disinfectant spray or antifungal medication. This will kill any foot fungus pathogens that may be present.

Socks can be washed with a special detergent.