Athletes Foot
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Athlete's Foot: Patterns, Treatment and Why It Returns
Three patterns, two of which get mistaken for dry skin, and a fungus that rarely stays on the feet — plus the seven days of treatment that decide whether it comes back.
Key fact: Athlete's foot is unlikely to get better on its own. It is also the reservoir that seeds fungal nails, jock itch and ringworm elsewhere on the body — so treating it is not cosmetic, and leaving it rarely stays a foot problem.
What athlete's foot is
Tinea pedis — a fungal infection of the skin of the feet, caused by dermatophytes: the same family of fungi behind ringworm, jock itch and fungal nail infection. It is one of the commonest skin infections there is, and it has nothing to do with being an athlete.
The fungus feeds on keratin in the outer layer of skin and thrives in warm, damp, enclosed conditions — which is precisely what a shoe worn all day provides.
The three patterns
Athlete's foot does not always look the way people expect, and two of its three patterns are routinely mistaken for dry skin or eczema.
| Pattern | What it looks like | Where |
|---|---|---|
| Between the toes — the classic | White, soggy, peeling or cracked skin, often itchy or stinging | Usually the outer two toe webs first, where the toes are most crowded |
| Moccasin | Dry, fine scaling across the sole and up the sides of the foot, often with little itch | Sole and heel — frequently moisturised for years as "dry skin" |
| Blistering | Crops of small fluid-filled blisters, often quite itchy or painful | Instep and arch, sometimes with a sudden flare |
The moccasin pattern is the one that gets missed. Persistent fine scaling of one sole, often with a clear edge along the side of the foot, is fungal far more often than it is dry skin — and dry skin does not usually affect one foot considerably more than the other.
Symptoms
- Itchy white patches between the toes, sometimes stinging or burning
- Sore, flaky patches on the feet; redness, which may be harder to see on darker skin
- Cracked or bleeding skin, particularly in the toe webs
- Fluid-filled blisters in the blistering pattern
- Smell, where the skin is macerated and bacteria have joined in
- Often one foot worse than the other, which is a useful clue
- Frequently no itch at all in the moccasin pattern
How you get it
- Walking barefoot where an infected person has been — changing rooms, communal showers, poolsides, hotel bathrooms, gym floors
- Touching the affected skin of someone who has it
- Sharing towels, socks or shoes
- Your own infected nails, which shed fungus onto the skin indefinitely
- Warm, damp feet — shoes worn all day, synthetic socks, hot weather, heavy sweating
It is not a hygiene failing. Feet that spend ten hours a day in a shoe are doing what fungi need, however often they are washed.
Treatment
| Option | Typical course |
|---|---|
| Terbinafine 1% cream — usual first choice, applied thinly once or twice daily | 1 to 2 weeks |
| Imidazole creams — clotrimazole, miconazole, ketoconazole | Longer — at least 4 weeks, continuing after the skin clears |
| Undecenoate preparations | 4 to 6 weeks, continuing 7 days after healing |
| Antifungal plus a short course of hydrocortisone, where inflammation is marked | The steroid for a maximum of 7 days, on advice, and never on its own |
| Oral terbinafine, where the infection is extensive or will not clear topically | Usually 2 to 4 weeks, prescribed after assessment |
Terbinafine is the shortest course because it kills the fungus rather than simply stopping it multiplying. Athlete's foot treatments compared covers how to apply them so they work, and what to do if they do not.
How long it takes
The last figure is the one that decides whether it comes back. Skin can look completely normal while fungus remains in the outer layer, and stopping the moment it clears is the commonest single cause of recurrence.
Where it spreads to
- The toenails — and once nails are infected they need months of treatment and keep reseeding the skin. See fungal nail infection
- The groin — jock itch is frequently the same infection carried up on underwear
- The body — ringworm, as expanding rings with a scaly edge
- One hand — usually from scratching the feet
- Other people, via floors, towels and shared footwear
Jock itch and ringworm covers the same fungus in its other locations, including the detail that stops it travelling: put socks on before underwear.
Why it keeps coming back
- Treatment stopped too early — the moment it looked better
- Infected toenails left untreated, shedding fungus onto the skin
- Shoes that were never dealt with, particularly trainers worn daily
- Feet that stay damp — the toe webs never fully dried after washing
- Reinfection from communal floors
- Someone else in the household carrying it
Prevention
- Dry between the toes properly — dab rather than rub, and give them time to air
- A separate towel for the feet, and dry the feet last
- Clean cotton socks daily, or materials that move moisture rather than hold it
- Do not wear the same shoes more than 2 to 3 days in a row, so each pair dries out fully
- Flip-flops in communal showers, changing rooms and around pools
- Do not share towels, socks or shoes
- Do not scratch the affected skin, which spreads it to hands and elsewhere
- Treat infected nails, or the skin keeps being reinfected
When to get it looked at
Do not self-treat — get assessed — if: you have diabetes, poor circulation or a weakened immune system; the foot or leg is hot, painful and red, which can indicate cellulitis and needs prompt treatment; the pain is severe; the skin is badly cracked, weeping or infected; pharmacy treatment has not worked; or the infection has spread to the nails or elsewhere on the body.
The cellulitis point is the reason this matters more than it looks. Cracked, fissured skin between the toes is a recognised route for bacteria into the leg, and athlete's foot is a well-recognised precipitant of cellulitis — particularly in people with diabetes, leg swelling or a previous episode.
Unlikely. The NHS is explicit that athlete's foot is unlikely to get better without treatment, and left alone it tends to spread to the toenails, the groin, the body or the other foot, and to other people. It also keeps reinfecting skin once nails are involved. Terbinafine 1% cream is the usual first choice, applied thinly once or twice daily for 1 to 2 weeks, because it kills the fungus rather than just stopping it multiplying. Imidazole creams such as clotrimazole and miconazole also work but need at least 4 weeks. One to two weeks with terbinafine cream, or four weeks or more with clotrimazole or miconazole. Whichever is used, keep treating for about 7 days after the skin looks normal, because fungus remains in the outer layer of skin after the appearance has settled. Yes. It commonly spreads to the toenails, the groin as jock itch, the body as ringworm, and to one hand from scratching. Putting socks on before underwear is a simple way to stop the groin being infected from the feet. Usually treatment stopped as soon as the skin looked better, untreated fungal toenails shedding fungus onto the skin, or shoes that were never dealt with. Feet that stay damp, communal floors and an affected household member are the other common reasons. Usually not, but cracked skin between the toes is a recognised route for bacteria into the leg, and athlete's foot is a known precipitant of cellulitis. Seek prompt advice for a hot, painful, red foot or leg, and do not self-treat if you have diabetes, poor circulation or a weakened immune system.Frequently Asked Questions
Will athlete's foot go away on its own?
What is the best cream for athlete's foot?
How long does athlete's foot take to clear?
Can athlete's foot spread to other parts of the body?
Why does my athlete's foot keep coming back?
Is athlete's foot dangerous?
References
- NHS. Athlete's foot. nhs.uk
- NHS. Ringworm and other fungal infections. nhs.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Fungal skin infection — foot. cks.nice.org.uk
- Nottinghamshire Area Prescribing Committee. Dermatophyte infection of the skin. nottsapc.nhs.uk
- DermNet. Tinea corporis and tinea incognito. dermnetnz.org
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. A steroid cream applied to a fungal rash makes it spread while looking better, so a rash that is not clearly diagnosed should be assessed rather than treated with whatever is in the cupboard. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.
