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Athlete’s Foot

What is Athlete’s Foot?
Athlete’s foot is the name given to a common fungal infection that occurs on the feet virtually always starting between the toes then spreading over the feet. The infection is one of the group called tinea by physicians, and the full name tinea pedis, refers to a fungal infection and its location (pedis means “foot”). Other locations for tinea infection include the scalp (tinea capitis, or ringworm), the genitals (tinea cruris), the nails (tinea unguium), and the entire body (tinea corporis).

The various fungi responsible for athlete’s foot thrive in warm, moist, enclosed places, such as that found inside poorly ventilated shoes and sweaty socks. The infection in the feet causes the skin between the toes to become itchy and sore, to crack and sometimes peel away. Most commonly, the space between the fourth and fifth toe is affected.

Athlete’s foot plagues more men than women, and rarely occurs in children under age 12. It is most common during the hot, humid months. Sometimes, the infection can clear up spontaneously, simply by improving foot hygiene and wearing better-ventilated shoes. Though harmless, the condition needs to be treated so it doesn’t spread further. Left untreated, the infection can spread over the entire foot and into the nails, or a secondary bacterial infection may develop as well.

Key Symptoms
•    Scaling, peeling, intense itching, or in severe cases, cracked skin between the toes. Almost always, the space between the fourth and fifth toes is initially infected.
•    Redness, itching, scaling, and tiny blisters along the sides and soles of the feet
•    Infected toenails that become thickened, discolored, and crumbly
•    Unpleasant foot odor

What Causes Athlete’s Foot?
Although the various kinds of fungi that cause this condition can be spread by direct contact–such as walking barefoot through showers, locker rooms, and around pools where others have left the infection behind–the term “athlete’s foot” is probably a misnomer. To thrive, the fungus requires an enclosed, warm, and moist environment. And there is a greater chance of developing the condition simply by placing sweaty feet into unclean gym socks or unventilated gym shoes than by direct or indirect contact with an infected floor. In addition, many inexpensive athletic shoes are made of vinyl, which does not breathe. It should be no surprise that athlete’s foot is virtually unknown in societies where people go barefoot or wear sandals.

The tinea fungus thrives on keratin, a protein found in skin, hair, and nails, and does especially well where there’s little air. Other tinea infections caused by various fungi include the scalp (tinea capitis, or ringworm), the genitals (tinea cruris, or “jock itch”), the nails (tinea unguium), and the entire body (tinea corporis). These are usually caused by different types of tinea, rather than a spreading of one tinea fungus into different locations. The exception is that some patients with jock itch are also found to have some athlete’s foot, and vice versa. Both are treated simultaneously and with the same medicine.

People have different susceptibilities to developing athlete’s foot and various fungal infections. In addition, the recent use of antibiotics, which kill off the beneficial bacteria that keep any fungus in check, can contribute to a flare-up. Fungal (yeast) infections in general also thrive on sugar, and some people with recurrent infections improve dramatically when they decrease the amount of sweets, simple sugars, and sweet fruit juices in their diet.

Conventional Treatments
Conventional treatment is extremely effective in treating athlete’s foot. Having tried both therapies over the years, my personal preference is conventional (after all, I am an internist). Lotrimin is an anti fungal available without a prescription. If the infection is accompanied by a lot of inflammation, Lotrisone is a combination of Lotrimin plus a mild cortisone cream, but this requires a prescription. You might say, “Can I combine the Lotrimin with an over-the-counter cortisone cream?” The answer is “Yes,” mixing them about 50:50. If Lotrimin isn’t working, the next step up is Oxistat, safe, effective, but does require a prescription.

For widespread infection (tinea on the feet and in the genital/rectal area), I prescribe Diflucan tablets (fluconazole) 100 mg a day for 3-4 weeks, a system-wide anti-fungal.

Treatment and Prevention
Athlete’s foot occasionally begins to clear up on its own with some simple self-care techniques (see below). Doctors routinely recommend a variety of antifungal creams, either sold over-the-counter or by prescription. The latter are a bit stronger and usually reserved for more stubborn infections.

And you can easily prevent getting athlete’s foot by drying thoroughly after a shower or bath, and paying special attention to the spaces between your toes. Blowing your feet dry with a hairdryer set on low or applying a foot powder can keep the skin especially dry. And, as mom used to say, change your socks. Most people get athlete’s foot in a public area, like a swimming pool or gym. Remember to wear flip-flops (your own flip-flops, dingbat)

A number of supplements and natural remedies can be very effective in treating athlete’s foot. Most cases begin to clear up in a few days.

Supplement Recommendations
Vitamin C helps the body fight fungal infections by boosting the immune system.

Tea tree oil, which has natural antifungal properties, is highly effective as a topical treatment. Look for creams or lotions that list tea tree oil as one of the top ingredients. You can make your own by mixing two parts tea tree oil to three parts almond oil (or another neutral oil).

For an antifungal foot bath, add 20 drops of tea tree oil to a small tub of warm water. Soak your feet for 15 minutes two or three times a day. Dry them well, then dab a few drops of undiluted tea tree oil on the affected skin.

Another option is to rub garlic oil onto the affected area, sprinkle garlic powder between your toes, or put some chopped fresh garlic into your socks. You needn’t go to a health food store for most of this, just check your kitchen.

If pure tea tree oil or garlic irritates your skin, try one of the following topical treatments: Apply goldenseal powder or ointment, or soak your infected area in a footbath containing 8 tsp. of goldenseal tincture with a pint of water.

Self-Care Remedies
Keep your feet clean and dry. A hairdryer set on low will help.

Launder towels you dry your feet with after each use.

After drying, apply antifungal lotion or powder. Avoid over-the-counter foot products that contain cornstarch, which may encourage fungal growth.

Wear clean, dry socks.

Choose well-ventilated shoes, and don’t wear the same pair every day.

Avoid shoes made with vinyl uppers.

Whenever possible, wear sandals or go barefoot.

Cut your toenails straight across to help prevent fungal infections.

Decrease the amount of simple sugars, sweets, and sweet fruit juices in your diet.

Be extra careful about these precautions when you’re  taking antibiotics for a protracted period of time.

When to Call a Doctor
If there’s no improvement in a week to 10 days after starting natural therapies
•    If self-care doesn’t clear up the condition completely within one month
•    If the affected area becomes red and swollen, develops blisters, or starts oozing pus. These are signs of a possible bacterial infection and will probably require antibiotics.
•    If your toenails become brittle, deformed, or discolored. This form of infection, called tinea unguium, is often very difficult to clear up and may require taking an oral antifungal medication for several months.

Products

Tea tree Oil (Eclectic)

Garlic Oil (Eclectic)

Goldenseal Ointment (if available)