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Posts for category: Routine Foot Care

April 26, 2015
Category: Routine Foot Care

     The term "Athlete's foot" is given to any type of fungal infection of the skin of the foot.  Tinea Pedis is actually the best term for this, and is the proper medical term for this condition.  It has also been called skin fungus and ringworm.   The term ringworm is a really bad term, because it implies there is a worm causing the condition.  Nothing could be more inaccurate.  Tinea or athlete's foot is an infection of the skin of the foot with a fungus or yeast, which is actually a plant.  This is much more similar to mold than it is to any type of animal.  It was called ringworm, because on flat surfaces - often not the foot, but the front of the leg, the abdominal area, or arms - it appears as a red ring with a clear area inside of it.  Someone thought it looks like a worm curled up in a ring, and hence the term ringworm was born!

    Tinea Pedis or Athlete's foot appears most often between the toes or on the bottom of the foot.  It can take more than one form, sometimes appearing as blsters - or vesicles - and other times as red, dry, and scaly skin. There is usually itching, sometimes very significant and persistent itching.  In a diabetic, however, or someone who may have neuropathy or impaired sensation, there may be NO itching.  In those cases, patients or other providers may simply pass this off as "dry skin."   Being able to tell the difference between fungus infections of the skin and dry skin is not always easy.  Similarly, many cases of Tinea are misidagnosed as eczema or other dermatitis conditions and vice versa.  It is not unusual for a patient to come into the office saying they have been on "every possible type of fungus medicine and none of them help!"  In a case like this, there are two possible reasons they may have not gotten better.  First, they may not have a fungus infection.  Contact dermatitis, many types of eczema, and psoriasis can often look just like athlete's foot,  In that case, there is NO antifungal medicine that will help!  Secondly, the patient may have used a very weak form of the antifungal or not used it often enough or long enough.  Even if it is a fungal infection, the condition will not improve if the medication is used for just a few days or only when the patient remembers to apply it.  Some people with fungal infections also become resistant to some of the over the counter antifungals, and these creams and ointments may no longer work.  In these cases, a SKIN BIOPSY is very important.  I talked about skin biopsy before, but briefly, for a skin condition such as Tinea or any dermatitis, a VERY small biopsy punch is needed.  Often less than one cc of local anesthesia, a 2mm biopsy punch, and a small dressing for a day with a bandaid for one or two more days is all that is needed.  The procedure can take five minutes or less, usually less than a minute once the spot is numb.  The information provided from that biopsy may be all that is needed to make the right choice on medication.  This can prevent time and money  being wasted on medications that will not work.  

    There are many topical medications, and there are a few oral medications that can be used successfully for fungal skin infections or Athlete's foot.   Clotrimazole and  Tolnaftate are two of the most common topical medications used.   Fluconazole and Terbenafine are oral medications that are often used for resistamt cases.   Soaks such as epsom salt can also help to dry and heal the blisters that occur, so that skin creams or ointments can be used to kill the fungal organisms.  If we are truly dealing with a fungus or yeast infection of the skin, it must be remembered that the condition will not improve until the fungus organisms die!  Unlike other skin conditions, where some improvement may occur in a day or two, several days may be needed to see any improvement and it may take weeks to get rid of the problem.  My personal feeling is that you never really "cure" the condition.  People who get these fungal infections have a predisposition to them.  In many cases, their feet may sweat excessively, or they take part in sports that increase their likelihood of coming into contact with the organisms in the locker room, showers, or poolside, and it is a matter of time before the problem comes back.  Shoe sprays, such as Clarus antifungal shoe spray and a very state of the art device called a "Steri-shoe" which uses Ultraviolet light to kill greater than 99% of fungal organisms AND bacteria in the shoes are very helpful in keeping this under control.  

   If you have any questions concerning this topic, please feel free to call our office or refer to our website.  


Dr. Richard S. Eby