Background and History
You don't have to be an athlete to have athlete's foot. But, it is spread in
warm moist places like locker rooms. Athlete's foot is also known as tinea
pedis. Tinea is from a latin word that means maggot or grub and pedis refers
to the foot. Although tinea pedis was not described in the literature until
the 19th century, the ancients thought that similar problems were created
by worms which resulted in the older term "ring worm" for tinea
corporis, a fungal infection of the body or tinea capitis, a fungal infection
of the scalp.
Athlete's foot is caused by a fungous or a type of mold and
less often by a yeast. Fungous flourishes in dark, warm, moist
environments. Shoes, being an occlusive covering of the foot,
and dark, warm and moist can be like a fungal heaven.
being dark, warm and moist can be like a fungal heaven.”
Athlete's foot can appear as cracked and peeling skin between the toes or on
the bottom of the foot. It is often itchy but not always. Sometimes one only
sees flaking, scaling, dry skin that most people think is just a bit of excessive
dryness but in reality is evidence of athlete's foot. Small blisters may
occur in conjunction with some fungal infections.
Between the toes the skin can become macerated or excessively
soft and mushy. The fungous can go deeper into the skin and through
cracks or breaks in the skin bacteria can enter and cause a more
troubling secondary bacterial infrection.
Many authorities classify dermatophytic (skin) fungal infections
of the foot as follows:
- Between the toes, with scaling, fissuring or softened,
- Organisms: T. rubrum. Occasionally T. mentagrophytes
var interdigitale, and E. floccosum. Sometimes Candida
albicans can grow concommitantly or there may be a secondary
- Photographic Image
- Mocassin Type or Hyperkeratotic
- Bottom of the foot. May itch or be asymptomatic.
- Organisms: T. rubrum. Sometimes T. mentagrophytes var
interdigitale, E. floccosum, Scytalidium hyalinum and
- Photographic Image 2
- Small blisters. Clear or opaque fluid. May lead to
secondary bacterial infection.
- Organisms: Usually T. mentagrophytes var mentagrophytes.
- Rapidly spreading, with blisters (vesiculopustular
lesions) and a secondary bacterial infection
- Organisms: Usually T. mentagrophytes var mentagrophytes.
As with many things, the best cure is prevention, so we will start with an
approach to limiting your risks of contracting athlete's foot. Since moisture
is a risk factor, keeping your feet dry is important. Make sure you dry your
feet carefully after showers. In the locker room, you might consider wearing
shower sandals to limit exposure to any areas contaminated with fungous.
Be careful to dry between your toes and make sure your feet are dry before
putting on your socks. You may
socks hold moisture against the foot and does not allow
the moisture to readily evaporate.”
sprinkle an anti-fungal foot powder in your
shoes or on your feet.
Another important thing to remember is that cotton socks hold moisture against
the foot and does not allow the moisture to readily evaporate. Athletes performing
endurance sports should make sure that they wear socks that are made of non-cotton
material that wicks the moisture away from the foot.
Taking a quick look at why the feet end up so moist we find lots and lots of sweat glands between the toes and on the soles of the feet. The highest concentration of sweat glands are in the palms of our hands and the soles of our feet. There are between 2 and 4 million sweat glands over our entire body. Each sweat gland is small and weighs little, but all together they weigh as much as one kidney, about 100 grams. An individual can perspire up to several liters per hour and up to 10 liters per day.
The sole actually has the most sweat glands with 620/cm2. The back has the least with64/cm2. The soles of the feet alone have between 250,000 to 300,000 sweat glands in total.
|“...the soles of the feet alone have between 250,000 to 300,000 sweat glands in total..”
- Keep Your Feet Dry
- Change your socks often
- Don't wear cotton socks for sports
- Use Synthetic Fiber Socks That Wick Off Perspiration
- Use Anti-fungal powder if needed
- Change Socks During The Day
Mild fungal infections may be treated with over the counter
medicine that is readily found in your pharmacy. You may ask
the pharmacist for his advice. More difficult to eliminate fungal
infections will require prescription strength medicine.Make certain
that you follow the directions for prevention to avoid a recurrence
and to speed up elimination of the fungal infection. Keeping
your feet dry is one of the keys to eliminating and preventing
Details for physicians and students:
Many problems related to moisture and warmth many be thought
to be tinea pedis but are distinct clinical entities unto themselves.
Some of the other clinical entities to consider include:
also known as: pompholyx, vesicular
palmoplantar eczema. Original thoughts were that this was a
disorder of sweat glands. Current theory is that it may be
related to atopy, but uncertainty about the origin of
A chronic dermatitis caused by the bacteria
Corynebacterium minutissimum, a normal component of the skin
Mellitus, Hyperhidrosis (excessive perspiration),
Weak Cutaneous Barrier, Obesity, and immunocompromised
based therapy of erythrasma.
- Right Axilla (image)
Treatment: Erythromycin, Lotrimin, others see evidence based
- Contact Dermatitis
Antifungal Medications for tinea pedis:
Based Therapy From Medline see for authoritative and complete
listing of medical therapy of fungal infections.
Terbinafine (Lamisil) is an allylamine antifungal. Selectively
inhibits an early step in fungal cell membrane sterol synthesis.
This interferes with the synthesis of the cell membrane and causes
an accumulation of squalene which is toxic to the cell. It is
a fungicidal agent
Econazole nitrate (Spectazole Cream) imidazole antifungal.
Interferes with RNA and protein synthesis and metabolism. Disrupts
fungal cell wall membrane permeability. Fungicidal.
Clotrimazole (Mycelex, Lotrimin) Imidazole broad-spectrum
antifungal agent. Imidazole antifungal.Inhibits growth of yeast
by altering cell membrane permeability, causing death of fungal
Ketoconazole (Nizoral) cream - Imidazole broad-spectrum
antifungal agent. Affects cell wall growth. Inhibits synthesis
of ergosterol, affecting membrane permeability. Fungicidal.
Oxiconazole (Oxistat) cream - Imidazole broad-spectrum
antifungal agent. Cell wall synthesis inhibited by inhibition
of biosynthesis of ergosterol. Membrane permeability impacted.
Naftifine (Naftin) cream and gel - allylamine derivative;
Broad-spectrum. Decreases the synthesis of ergosterol.
Brief overview of mycology for physicians and students:
Mycology is the study of fungal organisms. The term mykos is
a greek word which means mushrooms. There are over 100,000 species
of fungal organisms of which only around 300 have been identified
as causing human or animal disease with about a 10 - 12 of them
causing 90% of human fungal
Fungal organisms are eudaryotes and contain at least one nucleus,
nuclear membrance, endoplasmic reticulum, ribosomes and mitochondrium.
Fungous cells are not able to perform photosynthesis. Fungal
organisms are naturally found in water, soil, and decaying organic
Yeasts and molds
There are two forms of fungal orgamisms: yeasts and molds. Yeasts
are a unicellular growth form. The shape is sperical or ellipsoidal
while their size is from 3 to 15 micrometer in diameter. Most
of these yeasts reproduce by budding, although binary fission
is sometimes observed.
Molds grow as a multicellular and filamentous colony. Growth
occurs by apical elongation or extension from the tip of the
hyphae. Molds grow on surfaces with some hyphae penetrating deeper
which are called vegetative or substrate hyphae.
Some species of fungi can grow in both the yeast and mold form
dependent upon environmental conditions. Cryptococcus is an example
of a yeast like form. Histoplasma is a dimorphic form which makes
hyphae at environmental temperatures and yeast cells at body
temperature. Candida is a dimorphic species that does the reverse
with filamentous form at body temperature and yeast cells in
Two disease types are noted: superficial mycoses occurring in
the skin, hair and nails, and deep mycoses affecting the deeper
structures and internal organs. Fungi are usually free living
organisms that may be acquired as infecting organisms through
cuts or by inhaling. Candida is a part of the normal skin flora
and is more apt to cause infection in immune compromised individuals.
Mycetoma is considered to be caused by a subcutaneous fungous
and not a deep infecting organism.
Fungal cell walls function as antigens. Individuals differ in
their production of antibodies to fungal organisms and this is
one of the origins of differring susceptability to dermatophytic
infections. The cell wall makes up about 90% of the dry weight
of the fungal cell. Over 80% of the cell wall is carbohydrate.
A small amount of polysaccharides are also found in fugnal cell
Skin Disorders Of The Foot, The
Physician And Sportsmedicine, Vol 27, No. 2 February 1999
Skin Care for Active People Michael L. Ramsey, MD The
Physician And Sportsmedicine - Vol 25 - No. 3 - March 97
EMedicine Online Text: Tinea