Tinea Pedis (Athlete’s Foot)

Tinea pedis, commonly known as athlete’s foot, is a fungal infection of the feet, predominantly affecting the interdigital spaces, soles, and sometimes the toenails.

• It is usually caused by dermatophytes, mainly Trichophyton rubrum, T. interdigitale, or Epidermophyton floccosum.

• The infection is contagious and can spread to other body sites (e.g., hands, groin) via autoinoculation.

• Predisposing factors include:

  • Excessive sweating (hyperhidrosis)

  • Poor foot hygiene

  • Use of occlusive footwear

  • Communal bathing areas (locker rooms, swimming pools)

  • Immunosuppression

Signs & Symptoms

Acute Form

• Erythema of interdigital spaces

• Maceration (softening and whitening of the skin) between toes

• Painful vesicles or bullae may form

• Pruritus and burning sensation

Chronic Form

• Scaling and peeling of the skin, particularly the soles

• Persistent erythema

• May spread to other areas of the foot

• Often less inflammatory than the acute form

Other Features

• Fissures between toes can serve as portals for secondary bacterial infection

• Malodor may be present due to fungal and bacterial colonization

Diagnostic Criteria

• Clinical examination reveals scaling, erythema, and maceration between toes

• Presence of vesicles or bullae in acute infections

• Chronic infection characterized by dry, peeling, or thickened skin on soles

• Typical site: interdigital spaces, lateral borders, and plantar surfaces

• Laboratory confirmation (if needed):

  • KOH preparation to detect fungal hyphae

  • Fungal culture for species identification

Investigation

• KOH microscopy: confirms presence of hyphae

• Fungal culture: identifies causative organism

• Skin biopsy: rarely required, mainly for atypical or resistant cases

• Secondary bacterial infection: may require bacterial swab and sensitivity testing

Treatment

Non-Pharmacological Treatment

• Keep feet dry, particularly between toes

• Frequent change of socks and footwear

• Use cotton socks to reduce moisture

• Separate opposing skin surfaces (e.g., with gauze) to prevent maceration

• Avoid walking barefoot in communal areas to prevent reinfection

Pharmacological Treatment

Topical Antifungals

• Clotrimazole 1% cream: apply 12 hourly for 2 weeks

• Miconazole 2% cream: apply 12 hourly for 2 weeks

• Terbinafine cream: apply once daily for 7 days

For Secondary Bacterial Infection

• Gentian violet: apply once daily for 5 days

Systemic Therapy (for severe or refractory cases)

• Terbinafine (PO) 250 mg daily for 2 weeks

• Itraconazole (PO) 400 mg daily for 1–2 weeks

Notes:

• Systemic therapy is generally reserved for widespread, resistant, or recurrent infections

• Topical therapy remains first-line for localized or mild cases

Prevention

• Maintain foot hygiene: wash and thoroughly dry feet daily

• Frequent change of socks and shoes

• Use breathable footwear and cotton socks

• Avoid sharing towels, socks, or shoes

• Use protective footwear in communal areas (showers, pools)

• Control excessive sweating with powders or antiperspirants if necessary