Athlete's foot

What is athlete's foot, and how common is it?

Athlete's foot is a fungal infection of the skin of the foot. Doctors call it tinea pedis. It's common in people of all ages¹, and often shows up between the toes or on the sides of the foot².

The fungus makes the skin itchy, flaky and red. It can occasionally cause blisters, and white cracks may appear, especially between the toes and on the side of the foot³. It can also spread to the toenails⁴.

What causes athlete's foot, and who gets it?

It's caused by fungi, most often one called Trichophyton rubrum⁵. These fungi grow well in warm, dark, moist places like feet⁶.

You can catch it from skin flakes shed by other people¹, by walking barefoot on damp floors such as communal changing rooms³, or by touching infected skin or contaminated surfaces or objects⁶. Spread within a household is the most common route, and children often catch it this way⁷. Shoes and socks that make your feet hot and sweaty help the fungus thrive, especially in summer⁸.

Older age, being male, obesity and sweaty footwear are linked with getting it⁹, though that doesn't mean they cause it.

What does athlete's foot look like, and how is it diagnosed?

The main signs are itchy white patches between your toes and sore, flaky patches on the feet¹⁰. It usually shows up in one of three ways: between the toes, most often between the fourth and fifth toes⁷; as dry, scaly skin over the soles, heels and sides of the foot; or as blisters⁹. Redness can be harder to see on brown or black skin, so look for scaling, cracking and itch too¹¹.

A GP or podiatrist will look at the skin, but how it looks doesn't show which fungus is involved¹². If the diagnosis is uncertain or the rash isn't responding, a skin sample can be sent to a lab to confirm it.

If a rash hasn't improved after a week of antifungal cream, another condition such as plantar psoriasis may be the cause¹³. Antifungal cream on a rash that isn't fungal is unlikely to help and may make it worse¹⁴.

What can I do first?

Start with a pharmacist. Creams, sprays or powders from a pharmacy can usually treat athlete's foot¹⁰. It isn't clear yet which product works best, so ask what suits you, especially if you're pregnant or breastfeeding, treating a child, older, or taking other medicines.

Try to avoid creams that combine an antifungal with a steroid unless a clinician has advised one, because the steroid part can thin the skin and cause other side effects¹⁴.

What helps if pharmacy treatment isn't enough?

See your GP if you've tried a few pharmacy treatments and they haven't worked, or if you're in a lot of discomfort¹⁵. Tell them what you've used, for how long, and whether any steroid cream was among it. They may reconsider the diagnosis, because a rash that doesn't respond may not be fungal¹³.

A doctor may also consider antifungal tablets. These can cause side effects, most often stomach upset¹, and some need regular blood tests, including liver checks⁵. They're prescription medicines that need a doctor's advice and monitoring.

Will athlete's foot come back, and how can I stop it?

Athlete's foot can usually be treated with pharmacy products, but it can keep coming back¹⁰, and it may become long-lasting or recurring². Reinfection can come from contaminated surfaces, people you live with and warm, moist shoes, so these habits make sense:

• Keep your feet as cool and dry as you can, and take care with footwear that makes them hot and sweaty⁶.
• If someone at home has it, remember it spreads by touching infected skin and contaminated surfaces or objects⁶.

It isn't clear yet how much each habit lowers the chance of it returning. Taking antifungal tablets routinely to prevent it isn't justified, because of side effects, interactions and cost¹.