Athlete's Foot (Tinea Pedis)

Who's At Risk?

Athlete’s foot may occur in people of any age, race / ethnicity, or sex. However, athlete’s foot is more common in males than in females and it is most common in teens and adults.

Some conditions make athlete’s foot more likely to occur:

• Living in warm, humid climates
• Using public or community pools or showers
• Wearing tight, nonventilated footwear
• Sweating profusely
• Having diabetes or a weak immune system

Signs & Symptoms

The most common locations for athlete’s foot include the:

• Spaces (webs) between the toes.
• Soles of the feet.
• Tops of the feet.

Athlete’s foot may affect one or both feet. It can look different depending on which part of the foot (or feet) is involved and which fungus has caused the infection:

• Between the toes (the interdigital spaces), athlete’s foot may appear as inflamed, scaly, or soggy tissue. Splitting of the skin (fissures) may be present between or under the toes. This form of athlete’s foot tends to be quite itchy.
• On the sole of the foot (the plantar surface), athlete’s foot may appear as skin color changes with scales ranging from mild to widespread.
• Another type of tinea pedis infection, called bullous tinea pedis, has painful, itchy blisters on the arch and/or the ball of the foot.
• The most severe form of tinea pedis infection, called ulcerative tinea pedis, appears as painful blisters, pus-filled bumps (pustules), and shallow open sores (ulcers). These lesions are especially common between the toes but may involve the entire sole. Because of the numerous breaks in the skin, lesions commonly become infected with bacteria. Ulcerative tinea pedis occurs most frequently in people with diabetes and others with weak immune systems.
• On the top of the foot, athlete’s foot appears as a patch or patches ranging in size from 1 to 5 cm. There is sometimes a white, powdery scale. The border of the affected skin may be raised, with bumps, blisters, or scabs. Often, the center of the lesion has normal-appearing skin with a ring-shaped edge, leading to the descriptive but inaccurate name ringworm. (It is inaccurate because there is no worm involved.)
• In lighter skin colors, the border of the affected area is often pink or red. In darker skin colors, it may be dark red, purple, grayish, or dark brown.

Self-Care Guidelines

If you suspect you have athlete’s foot, you might try one of the following over-the-counter antifungal creams:

• Terbinafine (eg, Lamisil)
• Clotrimazole (eg, Lotrimin AF)
• Miconazole (eg, Desenex, Micatin)

Apply the antifungal cream between the toes and to the soles of both feet for at least 2 weeks after the areas are completely clear of lesions.

In addition, try to keep your feet dry, creating a condition where the fungus cannot live and grow:

• Wash your feet daily and dry them well.
• Use a different towel for your feet than the rest of your body, and do not share this towel with anyone else.
• Wear cotton socks and change them once or twice a day, or even more often if they become damp.
• Avoid shoes made of synthetic materials such as rubber or vinyl, and consider throwing out old footwear or treating shoes with antifungal powder.
• Wear sandals when possible.
• Wear protective footwear in locker rooms and public or community pools and showers.

Treatments

To confirm the diagnosis of athlete’s foot, your medical professional may scrape some surface skin material (scales) onto a glass slide and examine them under a microscope. This procedure, called a potassium hydroxide (KOH) preparation, allows them to look for signs of fungal infection.

Once the diagnosis of athlete’s foot has been confirmed, your medical professional will likely recommend treatment with an antifungal medication such as:

• Econazole (Spectazole).
• Oxiconazole (Oxistat).
• Ciclopirox (eg, Loprox).
• Ketoconazole (eg, Nizoral).
• Naftifine (Naftin).
• Butenafine (Lotrimin, Mentax).
• Luliconazole (Luzu).
• Sertaconazole (Ertaczo).
• Sulconazole (Exelderm).

Other topical medications the medical professional may consider:

• Compounds containing salicylic acid or urea to help dissolve the scale and allow the antifungal cream to penetrate better into the skin.
• Solutions containing aluminum chloride, which reduces sweating of the foot.
• Antibiotic creams to prevent or treat bacterial infections, if present.

Rarely, more extensive infections or those not improving with topical antifungal medications may require 3-4 weeks of treatment with oral antifungal pills, including:

• Terbinafine (Lamisil).
• Itraconazole (Sporanox).
• Fluconazole (Diflucan).

The infection should go away within 4-6 weeks of using effective treatment.

Visit Urgency

If the lesions do not improve after 2 weeks of applying over-the-counter antifungal creams or if they are exceptionally itchy or painful, see your medical professional for an evaluation. If you have blisters, pustules, and/or ulcers on your feet, see a medical professional as soon as possible.

Trusted Links

• MedlinePlus: Athlete's Foot
• Clinical Information and Differential Diagnosis of Tinea Pedis (Athlete's Foot, Ringworm of Foot or Feet)

References

Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.

James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.

Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019.