Beat the Itch: Everything You Need to Know About Athlete’s Foot

Itching, burning, and flaking of the skin on the bottom of the feet are some of the uncomfortable symptoms associated with tinea pedis. Tinea pedis is a fungal infection that affects the outermost (superficial) layers of the skin on the feet. It is often referred to as “athlete’s foot” or “ringworm of the foot” (1). Over the course of a lifetime, approximately 70% of individuals will develop tinea pedis (2). It is most common among individuals aged 16 to 45, with men being affected three times more often than women (2). Tinea pedis is contagious and can spread through direct contact with infected individuals or contaminated surfaces (2). Despite its high prevalence and contagious nature, the infection is typically mild, with well-established causes, identifiable risk factors, and a range of effective diagnostic and treatment options.

Tinea pedis is most commonly caused by a group of fungi called dermatophytes. The most common species causing this disease are Trichophyton rubrum and Trichophytum interdigitale, although various others species are also known to cause this infection (2). A person may contract tinea pedis by coming into close contact with an infected individual or animal, or with contaminated objects or soil (2). The fungus infects surfaces containing keratin and produces enzymes that can penetrate the outermost layers of the skin (3). Additionally, it produces other substances that help it evade the host’s immune system, allowing the fungus to survive (2). The fungus thrives in warm and humid environments, making the feet an ideal area to invade (1).

There are three main forms of tinea pedis: interdigital tinea pedis, hyperkeratotic (moccasin-type) tinea pedis, and vesiculobullous (inflammatory) tinea pedis (2). Less common types include occult tinea pedis, ulcerative tinea pedis, and tinea incognito (2). Interdigital tinea pedis often presents with the skin between the toes appearing “wet” or macerated and is commonly itchy (2). Hyperkeratotic tinea pedis presents with thick, scaling plaques mostly on the bottom and sides of the foot. This type is sometimes itchy but often presents without symptoms (2). Vesiculobullous tinea pedis usually presents with very itchy and sometimes painful blisters on the bottom of the foot. Understanding the different types of tinea pedis is essential for recognizing symptoms and seeking appropriate treatment.

Beyond recognizing the different forms of tinea pedis, understanding who is most at risk and the factors that contribute to infection is key to prevention and early treatment. Sweating and warmth facilitate fungal growth, making this infection particularly common among individuals in physically demanding professions, such as athletes and laborers, as well as those residing in institutional settings or experiencing homelessness (2). People with diabetes are 2.5 to 2.8 times more likely to contract tinea pedis than the general population (4). Other risk factors include a previous history of tinea pedis, living in hot and humid environments, excessive sweating, prolonged exposure to water, shared public facilities like locker rooms and swimming pools, skin abrasions, peripheral vascular disease, skin conditions such as atopic dermatitis and psoriasis, obesity, compromised immune systems, mental health disorders such as depression and schizophrenia, and genetic susceptibility (2,5). Knowing the risk factors can help those predisposed recognize early signs of the disease.

Recognizing the symptoms of tinea pedis is crucial for early diagnosis and treatment. The most common symptom is itching (2), but affected individuals may also experience burning or stinging sensations. Other signs include scaling, peeling, and cracking of the skin between the toes, as well as dry, scaly skin on the soles of the feet. Redness from inflammation, blisters, and thickening of the skin on the sides and bottoms of the feet may also occur (5). While recognizing these symptoms is important, a proper diagnosis is necessary to determine the most effective course of treatment.

The diagnosis of tinea pedis is often made based on a physical examination alone. However, the accuracy of a clinical diagnosis can be low. If confirmation is needed, physicians may use microscopy and culture techniques (5). A potassium hydroxide (KOH) exam involves examining a skin scraping under a microscope (1). While the gold standard for diagnosis is a fungal culture, it is rarely performed. A culture may be considered if there is uncertainty after KOH wet mount or if the infection is severe, widespread, or resistant to antifungal treatment. Other diagnostic tests, such as skin biopsy or DNA-chip assays, are available but are seldom used (2). Once a diagnosis is confirmed, appropriate treatment options can be explored to effectively manage and resolve the infection.

There are several treatment options available for tinea pedis. First-line treatments typically involve topical antifungals, which are over-the-counter creams applied directly to the skin (6). These treatments are usually applied one to two times daily for a period of one to six weeks (2). According to the Mayo Clinic, if the infection does not improve within two weeks of self-treatment with a topical antifungal, it is important to consult a doctor (7). A physician may then prescribe oral antifungals, which are generally reserved for infections that do not respond to topical treatments, for immunocompromised patients, or when a fungal nail infection (onychomycosis) is present (6). In addition to topical and oral antifungal agents, individuals should avoid wearing non-breathable footwear and maintain good foot hygiene by thoroughly washing and drying the feet after bathing. Using drying powders and disinfecting footwear with UVC sanitizing devices or ozone gas, as well as washing socks in hot water, can also help prevent recurrence (2). While treatment is essential for managing tinea pedis, prevention strategies play a crucial role in reducing the risk of infection and recurrence.

There are several ways to prevent tinea pedis. In addition to choosing the right treatment, ensuring proper adherence to the prescribed regimen is crucial for preventing recurrence. Stopping treatment prematurely can lead to the return on the infection (2). It is important to continue medication for the full prescribed duration, even if symptoms improve. Prevention also focuses on maintaining proper foot hygiene and taking precautions to avoid exposure to fungi. Individuals can prevent infection or recurrence of infection by wearing moisture-wicking socks, applying antifungal powder to shoes, and using drying powders after bathing (5). According to the American Academy of Dermatology, to minimize the risk of infection (or reinfection), individuals should keep the feet clean and dry, alternate shoes daily, wear shoes in communal areas, and avoid sharing towels, bedding, or shoes with someone who is infected (8). Despite these preventative measures, complications may still arise if the infection is not properly treated or becomes resistant to antifungal treatments.

While tinea pedis is a relatively benign disease, complications can occur if it is not properly treated. The infection can spread through direct contact, often affecting the toenails and resulting in a condition called onychomycosis. In some cases, secondary bacterial infections such as cellulitis, pyoderma, or lymphangitis may develop (2). The fungus can also lead to a condition known as Majocchi granuloma which causes inflammation around the hair follicles. In more severe instances, the infection may extend into deeper layers of tissue, resulting in subcutaneous dermatophytosis (2).  

In conclusion, tinea pedis is a widespread but manageable fungal infection that affects a significant portion of the population. Timely recognition, accurate diagnosis, and consistent treatment are essential to prevent progression and complications. Understanding the different forms of the disease, who is most at risk, and how to avoid infection plays a vital role in reducing both personal discomfort and transmission to others. With proper hygiene, adherence to treatment, and preventative strategies, tinea pedis can often be effectively managed and resolved.

References:

1.     Athlete's foot. Penn Medicine. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/athletes-foot. Accessed May 4, 2025.

2.     Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Tinea pedis: an updated review. Drugs Context. 2023;12:2023-5-1. doi:10.7573/dic.2023-5-1

3.     Achterman R, White T. Dermatophytes. Curr Biol. 2013;23(10):PR551-R552. https://www.cell.com/current-biology/fulltext/S0960-9822(13)00292-3. Accessed May 4, 2025.

4.     Gupta AK, Shemer A, Economopoulos V, Talukder M. Diabetic foot and fungal infections: etiology and management from a dermatologic perspective. J Fungi (Basel). 2024;10(8):577. doi:10.3390/jof10080577

5.     Nigam PK, Syed HA, Saleh D. Tinea pedis. In: StatPearls. Treasure Island, FL: StatPearls Publishing; October 29, 2023.

6.     Thomas B, Falk J, Allan GM. Topical management of tinea pedis. Can Fam Physician. 2021;67(1):30. doi:10.46747/cfp.670130

7.     Athlete’s foot (tinea pedis). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/athletes-foot/symptoms-causes/syc-20353841. Accessed May 4, 2025.

8.     American Academy of Dermatology. Athlete's foot: prevention. American Academy of Dermatology website. Accessed May 4, 2025. https://www.aad.org/public/diseases/a-z/athletes-foot-prevent

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