Medically reviewed by Dr. A.M. van Coevorden, dermatologist
Athlete's footflaking, itch and cracks between the toes
Athlete's foot, also called tinea pedis, is a skin infection caused by fungi that affect the top layer of the skin. It causes flaking and cracks between the toes, itchy blisters on the soles, or red, flaking patches along the edges of the feet. At least one in ten people are affected, mostly adults.
What is athlete's foot?
Athlete's foot (tinea pedis) is a skin infection caused by fungi (dermatophytes) that affect the horny layer of the epidermis. This causes flaking and cracks between the toes, itchy blisters on the soles, or red and flaking patches visible mainly along the edges of the feet. The toenails can also be affected. It is common, affecting at least 10% of the population, mostly adults. Fungi can also infect the skin elsewhere, often causing ringworm: an expanding red and flaking patch that heals in the centre, creating the ring shape. Ringworm is much less common than athlete's foot.
How do you get athlete's foot?
The fungi grow in the outer layer of the epidermis. They thrive in a moist, warm environment, which is why foot infections are common. Sweaty feet and poorly ventilated shoes and socks encourage growth. Swimming and showering also make the skin moist and more susceptible. In busy showers, changing rooms and swimming pools, fungi are usually plentiful, because there are always people with athlete's foot around. Contact with fungi cannot be fully avoided, and it is usually unclear where the infection was picked up.
What symptoms does athlete's foot cause?
Note that redness, flaking and blisters on the feet can also be caused by other skin conditions, without a fungal infection. Four types of skin change can result from a fungal foot infection: white flaking between the toes, sometimes with painful cracks, especially between the fourth and fifth toe; redness and flaking over large parts of the soles and edges, the so-called moccasin type; itchy blisters, mainly on the soles, which later dry into brown spots or crusts after which the skin flakes; and yellow discolouration and crumbling of the nails (nail fungus). During a severe, acute infection, blisters or flaking can appear on the hands or lower legs as a reaction, called an id reaction. There is no fungus there, and it disappears once the infection is treated.
Is athlete's foot contagious?
Yes. You can get athlete's foot by walking barefoot where others with athlete's foot walk, such as the swimming pool or bathroom.
How is the diagnosis made?
To be sure, flakes of skin or pieces of nail are taken for microscopic examination, which can detect fungi relatively quickly. A second method is culturing skin flakes or nails; the result of such a culture takes about six weeks.
What treatments are there?
Athlete's foot is usually treated with a cream containing an antifungal or growth-inhibiting agent, applied once or twice a day to the affected skin. Importantly, keep applying the cream for two weeks after the skin has cleared, to be sure all fungi are killed. To prevent a new infection, an antifungal powder can be prescribed to dust onto the feet and into the shoes. Put on clean socks every day and do not wear the same shoes every day. For extensive infections and for nail fungus, treatment with tablets or capsules is needed, usually terbinafine or itraconazole. For athlete's foot this lasts about a month, for toenail fungus three to six months; a toenail infection does not always clear. Terbinafine and itraconazole are usually well tolerated. Do tell your doctor if you take other medicines or have liver problems.
Can athlete's foot be cured?
Athlete's foot can be treated well, but the infection can return. How great that risk is differs per person; people with sweaty feet, for example, get it again more easily.
What can you do yourself?
Always dry the feet well, especially between the toes, and dry your feet last so you do not spread the fungus to the rest of the body. Put on clean cotton socks every day. Wear breathable shoes; open shoes are ideal, otherwise leather shoes ventilate best, and do not wear the same shoes every day. Wear flip-flops in public bathing areas. Wash socks at at least 60 degrees to remove the fungus.
Frequently asked questions about athlete's foot
Is athlete's foot contagious?
Yes. You can catch it by walking barefoot where others with athlete's foot walk, such as at the pool or in public showers.
How long should I use the cream?
For two weeks after the skin has cleared. This is important to be sure all the fungi are killed.
When are tablets needed?
For extensive infections and for nail fungus. Usually terbinafine or itraconazole, about a month for the foot and three to six months for the nails.
Does athlete's foot come back?
It can. How great the risk is differs per person; people with sweaty feet get it again more easily.
How do I prevent athlete's foot?
Dry the feet well between the toes, wear clean cotton socks and breathable shoes, alternate your shoes, and wear flip-flops in public bathing areas.