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There are three conditions that are necessary for us to acquire an athlete's foot infection. First, fungus will only grow in an environment that will support it. Think of how we contribute to the growth of athlete's foot with our lifestyles. We jump out of the shower, put on our socks and shoes and go for the next 18 hours. In a sense, we can contribute a lot to the success of a fungal infection by creating an environment in our shoes that is dark, warm and damp.

Secondly, many people are more susceptible to athlete's foot infections because they lack the immune response necessary to fight it off. This lack of immunity is common in the elderly or in immune compromised conditions such as Aids. It seems that most athlete's foot infections are acquired by individuals that lack that one brick in the wall of their immunity system. Be it genetic or otherwise, some patients seem to be predisposed to athlete's foot infections.

And lastly, patients need to come in contact with the fungal organism. What strikes me about most cases of athlete's foot is that patients seem to focus on this issue and rack their minds about whether they acquired their infection at a hotel, the gym, their sister-in-law's house and so on. In virtually all case they end up chasing their tails to get an answer. I believe the more important issue is what we discussed earlier in that we create an environment conducive to the growth of fungus.

Treatment of athlete's foot infections and tinea pedis

Some of the methods used to treat his infection are really quite simple. 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. One must consider the fact that fungal infections of the hand are somewhat infrequent. But the foot? Now there's a different story. It's all environment. Try these four simple tricks;

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.

But when the acute case of athlete's foot hits us, we need to fall back on a prescription strength topical cream or ointment. There are a number of differnt presciption 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.

Nomenclature:

Tinea - from Latin meaning worm or moth. Hence the name ring worm.

Symptoms:

Acute fungal infections of the foot are usually caused by t. (tinea) mentagrophytes and show characteristic signs of what I think most of us would consider a case of athlete's foot. Small water filled blisters, with a red base, are the first sign of t. mentagrophytes. These blisters itch and begin to peel after several days.

A second and more chronic type of infection is caused by t. rubrum. The classic description of this infection show a moccasin distribution, meaning to say that it effects the areas on the sides and the bottom of the foot. Many patients battle this condition for years with moisturizers and skin creams mistakenly thinking that they have dry skin. the appearance of dry skin is actually exfoliation, or peeling of the once infected, but now dead skin cells. The itch associated with this infection is less intense. Another typical sign of t. rubrum is a patient who is always using one foot to scratch the other.

Differential Diagnosis:

Callus

Cellulitis or other soft tissue bacterial infection

Contact dermatitis

Dyshydrosis

Hyperhydrosis

Ichthyosis

Idiopathic keratosis

Psoriasis

Pustular psoriasis

Yeast infections

 Dr. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.