Athlete's foot is the
common term applied to a number of different fungal infections of the foot.
The medical term for this condition is tinea pedis; tinea referring to the
causative organism and pedis referring
to the location of the infection.
The two fungal organisms we see most often are tinea rubrum and tinea
mentagrophytes. Tinea rubrum is often mistaken for dry skin and is the most
common fungal organism found in low-grade chronic fungal infections. Acute
athlete’s foot, on the other hand, is characterized by bubbles, blisters and
itching. T. mentagrophytes is the organism most often seen in acute
infections. Both organisms cause inflammation in the skin that leads to
itching.
Fungus,
or the plural, fungi, are non-flowering plants that lack chlorophyll.
As plants, fungi are
very sensitive to their environment. Fungus thrives in a warm, damp and
dark environment. Lacking chlorophyll, fungi can't synthesize their own food and therefore
have to live off other organic material. In the case of athlete's foot, the tinea organism is actually living off of the dead skin cells of our foot.
Treatment of athlete's
foot infections
When working with
patients, the first thing I always stress is the difference between fungal
infections and bacterial infections. Bacterial infections are a finite
problem, meaning to say that you can cure most bacterial infections with an
antibiotic in a brief period of time. A good example would be the treatment
of
strep throat with penicillin. A 10 day course of penicillin and the
strep infection is cured. Fungal infections of the foot cannot be cured and subsequently needs to be treated a bit
differently. To help explain fungal infections to my patients, I often draw
on the analogy between the treatment of fungal foot infections and
crabgrass. Both are nuisance plants. Both will reoccur
without ongoing treatment. My point is that you wouldn’t expect crabgrass
to disappear with a 10 day course of treatment. Nor can you expect a
fungal infection to clear with a short course of oral medicine. You need an
ongoing plan if you intend to control athlete’s foot.
Oral medications used
to treat fungal infections of the skin and nail have become popular over the
past several years. Medications such as Lamasil and Sporanox can be used
successfully to treat an acute fungal infection, but these medications will
not provide long term coverage. Their cost and profile of side effects are
significant. Oral medications simply can’t be looked upon as a cure
for athlete’s foot infections. Therefore, if you choose to use an oral
medication, remember that you will need to continue using a topical
medication once the oral medicine is discontinued.
Some of the
traditional methods used to treat fungal infections are really quite simple
and effective. We spoke of dark, warm and damp-well change that. Create
and environment in the shoe that is cool, dry and accessible to UV light.
Following these simple
suggestions can dramatically change the course of a fungal infection:
1. Rotate your shoes
every other day to allow them to dry thoroughly.
2. Avoid synthetic materials like rubber or vinyl, wear leather or cloth
that can absorb moisture.
3. Frequent changes of socks to wick away moisture.
4. Use talc or baby powder daily to wick away moisture.
One thing to remember
is that for many patients, 'curing' a fungal infection of the foot may never
happen. Those patients who are susceptible to re-infection will, in all
likelihood, be managing this condition for life. One of the best tools we
can offer is an education in how to decrease the tendency to re-infect.
We've already discussed the steps we can use to change the environment in
the shoe. I can't stress how important these steps are in decreasing
re-infection and managing recurrence. Also, the daily use of a
mild
antifungal cream and antifungal soap is essential.
To prevent re-infection, an in-shoe
disinfecting agent is helpful. Control of perspiration is also
important and can be accomplished with daily application of a
drying solution.
When managing an acute
case of athlete's foot, we need to fall back on a prescription strength
topical creams or ointments. There are a number of different prescription
strength creams and lotions available from your doctor. There are also many
other effective topical medications that are OTC and can help manage the
acute phase of these infections. In limited cases where a fungal infection
is quite severe, we may even use an oral antifungal but these cases are few
and far between.
So how is athlete’s
foot best managed? There’s no single best method. Change the environment
in the shoe to be cool, dry and open to the light. And remember the
crabgrass analogy. If you’re sincere about a having a healthy lawn, you’ll
have an ongoing treatment plan. So when treating athlete’s foot, you’ll
need an ongoing plan and a commitment to treat your feet on a regular basis.
