Athlete's foot and fungal nails: persistent but curable

What it is, in plain words

Athlete's foot is a superficial fungal infection of the skin, most often between the fourth and fifth toes where the skin stays damp. The same fungi can invade the nail, where they are far harder to reach because no cream penetrates the nail plate properly.

Signs to look out for

• Itching, burning and cracked, white, soggy skin between the toes
• Dry scaling on the sole and sides of the foot, sometimes described as moccasin pattern
• Small itchy blisters on the arch
• Nails becoming thick, yellow-brown, crumbly and lifting from the bed
• Unpleasant odour, and cracks that can let bacteria in

Why it happens

It spreads on wet floors in changing rooms, pools and showers, and in shoes that do not dry out. Diabetes, poor circulation, immunosuppression and heavy sweating increase risk and complications.

How doctors confirm it

The diagnosis is usually clinical, but nail infection should be confirmed by microscopy and culture or PCR before starting months of tablets, because half of thickened nails are not fungal.

Treatments and solutions

• Topical antifungal cream such as terbinafine for two weeks, or an azole for four weeks, continued for a week after the skin looks normal
• Drying carefully between the toes, changing socks daily, alternating shoes, and using antifungal powder in shoes
• Treating the shoes themselves, since they reinfect the skin
• Oral terbinafine for three months for toenails, or amorolfine lacquer for limited nail involvement, with slow visible improvement as the nail grows out
• Treating athlete's foot at the same time, as it is the usual source of nail infection

Living with it day to day

Do not stop early: the commonest reason for recurrence is stopping when symptoms disappear rather than completing the course. Wear sandals in communal showers.

When to seek medical help

See a doctor for spreading redness, pain and fever, for any foot infection if you have diabetes or poor circulation, or for a nail that is painful or changing shape rapidly.

This article explains general health information in simple language. It does not replace advice from your own doctor.