Dr. Tariq Jagnarine
Family Medicine, Endocrinology / Diabetes

An athlete’s foot is a fungal infection that affects the top layer of the skin of the foot, especially when it is warm, moist and inflamed. It is also known as tinea pedis and footworms. Trichophyton is the name of the fungus that causes an athlete’s foot, and is commonly found on floors and in clothing. An athlete’s foot fungus infects the skin only if the conditions are right. It requires a warm and humid environment, like the inside of a shoe. Because of this, only about 0.75 percent of people who walk around barefoot regularly are affected. However, up to 70 percent of people will, at some point in time, develop an athlete’s foot.
An athlete’s foot most commonly develops between the toes. It usually causes burning, stinging, redness and itching; and it can also cause the skin to flare up in some people. It is one of the most common types of fungal infection, but although infectious, an athlete’s foot can usually be treated with over-the-counter (OTC) medication.

Anyone can get an athlete’s foot, but some behaviors can increase an individual’s risk of developing the disease. Factors that increase the risk of an athlete’s foot include:
* Visit barefoot public conveniences, especially locker rooms, showers and swimming pools.
* Share socks, shoes, or towels with an infected person.
* Wearing tight, closed-toe shoes.
* Keep feet wet for long periods.
* Get sweaty feet.
* Have minor injury to the skin or nails on the feet

The athlete’s foot fungus, Trichophyton, is a dermatophyte – associated with other fungi that cause infections in human skin, hair and nails. These fungi exist harmlessly on human skin. As long as the skin is dry and clean, their reproduction is limited. However, under damp and warm conditions, they multiply rapidly. Thick, tight shoes are more likely to trigger an athlete’s foot, because they squeeze the toes together, creating ideal conditions for the fungus to thrive. If socks are damp and feet warm, there is an increased risk of developing an athlete’s foot.

An athlete’s foot can be spread through direct and indirect contact:
* Direct, skin-to-skin contact, so that it can occur when an infected person touches the infected area of ​​someone with an athlete’s foot
* Indirect contact, where the fungi can infect humans through contaminated surfaces, clothing, socks, shoes, bed sheets and towels.
An athlete’s foot often spreads around swimming pools and communal showers. These places are generally moist and warm.
People with weakened immune systems are more prone to developing an athlete’s foot.

The skin on the foot, especially between the toes, becomes itchy. There is a feeling of picking or burning. The skin can also become:
* dry, flashy, red scaly, and cracking.
* Occasionally the skin may crack, and there may be frost or itching, itchy blisters and swelling. The sole and side of the foot may develop grading patterns.
* Bacterial infections can sometimes occur alongside the condition. When an athlete’s foot is severe and causes open sores in the skin, it makes them more susceptible to bacteria. If left untreated, there is a risk that the infection would spread from foot to foot.
In rare cases, an athlete’s foot can spread to the hands, this is known as mana tinea. The symptoms are very similar to those experienced in the feet. People who do not wash their hands immediately after touching the affected area on their foot are at greater risk. Tinea manuum is a rare complication of an athlete’s foot. If the patient scrapes the affected area and touches other parts of the body, the infection can spread.

It is important to treat an athlete’s foot immediately. After touching the affected area, it is important to wash hands thoroughly with soap and warm water.

An athlete’s foot can usually be diagnosed by observing the hallmark signs and symptoms. However, other conditions, such as dermatitis, psoriasis, or low-grade skin infection, should be ruled out.
The most common test is called skin ulcer potassium hydroxide. In this test, a sample of infected tissue is scraped and placed in potassium hydroxide (KOH). The KOH solution destroys human cells, leaving only the fungal cells. These can be easily seen using a microscope.

In most cases, the symptoms of an athlete’s foot are mild, and the patient does not need to see a doctor.
Antifungal medicines (creams) that are effective in clearing the infection can be bought in pharmacies. In severe cases, more powerful antifungal tablets and creams may need to be prescribed.
If the skin is very sore and swollen, hydrocortisone may be used initially for short periods.

Although athlete’s foot symptoms are generally mild, and complications are rare, early treatment significantly reduces the risk of complications. However, serious cases can lead to:

* Fungal nail infection: An untreated athlete’s foot can spread to toenails in a condition known as onychomycosis. The nail becomes thick, opaque, white and crumbly. This can be painful, and inflammation can build up in the skin under the nail. Untreated foot nail infections can eventually lead to increased pain and problems wearing shoes, or even walking.

* Secondary bacterial infection: If this develops, the foot may become sore, hot and swollen.

* Infected lymph system: Sometimes the infection can spread to the lymph system. Lymphangitis is an infection in the lymph vessels, and lymphadenitis is an infection in the lymph nodes.

* Cellulitis: This is a bacterial infection deep in the skin. Skin, fat and soft tissue may be affected. Untreated cellulitis can lead to serious complications, such as septicemia (blood poisoning) or bone infection.
Although it is a very rare complication of an athlete’s foot, cellulitis should be treated immediately with antibiotics.

* Allergy: Some people have an allergy to the fungus that causes an athlete’s foot. This can cause blisters of the hands or feet.

The secret to reducing the risk of developing an athlete’s foot is to always have clean, dry feet, shoes and socks.

* Wash feet twice daily with water and soap. Always clean between toes.

* Keep feet dry. Applying antifungal talcum powder to the feet can help.

* Wear shoes as soon as exercise or sports activity is over.

* Wear loose, well ventilated shoes, especially during the warmer months. The best materials for shoes are leather or canvas.

* Make sure feet are dry before wearing socks, stockings or tights. Wear socks made of materials that remove moisture from the feet, such as cotton, silk or wool.

* When walking around public swimming pools, communal changing rooms or shower areas, wear pool slippers.

* Change shoes regularly, so that shoes are relatively dry. Shoes need time to dry.

* Do not share shoes.

* Wash sheets and towels regularly.

* If a pet in the home is losing hair, this could be an athlete’s foot – take it to the vet. Humans can hold an athlete’s foot away from their pets.

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