Are you looking after your feet?

Tuesday, 05 October 2010 07:09

Do you ever get itchy sweaty feet? Does your skin get dry and cracked? Do you ever get little red patches around the arch of your foot that itch after a long day in shoes?

“Well, believe it or not, you may be one of the 20% of the population who are regularly effected by athlete’s foot.” (Lorrimer, Et al, 2002).

Do you have a fungal skin and nail infection?

What is athlete's foot?

"Athlete's foot is actually a fungal infection and is one of the most common skin conditions to affect the feet.  The condition generally affects males three times more likely than females." (Lorrimer et al: 2002) Unfortunately the more senior in age we become, the higher the incidence of fungal infection.  Some studies claim around 60% of the senior population has some evidence of fungal infection.  "Athlete's foot is usually caused by anthropophile fungi.  The most common species are microsporum, epidermophyton and trichophyton.  These account for 90% of all fungal skin infections, commonly referred to as ringworm." (Rutherford, 2010; Marcovitch, 2005).

"The medical terms for athlete's foot are tinea pedis or dermatophytosis palmaris; plantaris and interdigitalis - the latter indicates that, in addition to the soles and toes of the feet, the palms of the hands can also become infected" (Rutherford: 2010).

WHAT CONDITIONS DOES THE ORGANISM REQUIRE?

Fungi generally thrive in warm, moist and dark conditions, therefore athlete's foot can be a common and re-occurring problem in people who wear trainers and don't properly dry their feet after bathing.  It can be easily spread by skin to skin contact and from socks, shoes, flooring and towels.

On our skin, we carry one or more of the forms of fungi that can cause athletes foot, but it only becomes a problem when it is given the right conditions to thrive.  The condition is contagious.  Some people however, seem more immune to the condition than others and hence, never catch it.

What are the general symptoms?

In its more acute and minor form, it may present as itching, burning, scaling or blistering of the skin, particularly between the 4^th and 5^th toe spaces.

More severe forms can be extensive on the sole of the foot and can appear with a moccasin type outline creating a border between the sole and the upper portion of the foot. 

Image 1:  Indicates clear demarcation of tinea pedis infection along the plantar arch of the foot.

"A Trichophyton rubrum infection can cause a chronic, dry, scaling inflammation of the foot, eventually extending into the nails and on to the sole and top of the foot which may persist for years if untreated" (Lorrimer, et al: 2002)

Image 2: Tinea (ringworm) plantar foot

Which group of people are most at risk?

Generally, younger people who play sports and wear trainers, or people who wear rubber shoes or boots at work. 

What is the best way to prevent the condition?

We advise good foot hygiene is the best prevention, by washing your feet daily.  Dry between your toes and avoid sharing towels and socks.  When at work it is better to wear natural materials like leather, socks should be cotton or woollen material and may be advisable to change them twice daily.  Below the ankle socks can prove very successful at keeping the feet cool.  Medicated anti-fungal powder is effective at preventing the condition but is not a treatment.

Fungal Nail infections

It is believed that fungal nail infections begin life in the skin as a result of a skin infection first, for example those who suffer with chronic athlete's foot.  Most patients cannot identify a time when the infection began as the condition is usually gradual.

What causes it?

The fungal nail condition is caused almost exclusively by the dermatophyte fungal species.   It generally begins at the outside edges of the nail spreads gradually down progressively down the nail.  Detachment of the nail may start to occur and in some cases may result in a slow shedding of the nail (onycholoyis).  In long term fungal nail infections, the nail may become thickened or weak and crumble away.

Image 3: Deep nail infection (Proximal subunugual Onychomycosis)

Image 4:  Shallow nail infection (Superficial White onychomycosis)

Are there any other forms of fungal nail infection?

"White marks on the surface of the nail can result from 'Superficial White Onychomycosis'.  This is the less common form of fungal nail infection and is usually caused by a different fungal species (T. mentagrophytes).  It is the only type of fungal nail infection that affects the upper surface of the nail and sometimes responds to topical treatment." (Lorrimer et al, 2002). 

Diagnosis:

Medical practitioners will usually diagnose fungal infection of the skin and nail by appearance, however on some occasions as small sample of loose skin or nail may be scrapped away and sent away for further investigation to test for the presence of micro-organisms that may be causing the infection.

TREATMENTS FOR FUNGAL INFECTION OF THE SKIN AND NAIL

Skin Infections:

Athlete's foot is best treated using one of the many topically creams available over the counter in most pharmacies.   The following are known to be effective in treating the skin condition:   Lamisil, Canesten, Daktarin and Mycil.  .

Nail infections:

Loceryl or lamisil laquer are some of the most effective treatments for fungal nail infection.  For deeper or more persistent infection, they are better used in conjunction with stronger medication or tablets that your General Practitioner may prescribe.

Image 4.  Classical appearance of chronic fungal nail with mild thickening at distal end.

As with all medication, It is important to follow the instructions and complete the recommended course for the treatment to be effective and prevent re-infection occurring.

References

Lorrimer, French O'Donnell, Burrow. (2002). Neale's Disorders of the foot, Diagnosis and Management. Churchill Livinstone.

Marcovitch,H. (2005).  Blacks Medical Dictionary 41^st Edition. A & C Black.  London

Websites

Rutherford,D.  (1998-2010) http://www.netdoctor.co.uk/diseases/facts/athletesfoot.htm.  August 2010

Images:

• 1. http://www.dermnet.com/Tinea-Ringworm-Foot-Plantar/picture/11275
• 2. http:://www.dermnet.com/Tinea-Ringworm-Foot-Plantar/picture/11269
• 3. http://www.dermnet.com/Proximal-Subungual-Onychomycosis/picture/22594
• 4. http://www.dermnet.com/Distal-Subungual-Onychomycosis/picture/22027