Athlete's Foot足癣

Most people recognise the itchy, peeling skin between the toes. The version that gets missed looks just like dry skin on the sole, and it is often treated with moisturiser for months before identifying fungal infection.

Athlete's Foot at a Glance

What Is Athlete's Foot?

The fungus that causes athlete's foot lives on the surface of the skin and feeds on keratin, the protein that skin is made of. It thrives in the conditions a shoe creates: warm, dark and damp.

It spreads by contact. Walking barefoot where other people have stepped on is the most common route of transmission, which is why changing rooms, poolsides, gyms and shared bathrooms are hotspots for fungal infection. It also spreads from one part of your own body to another, and from one household member to another through shared towels, mats and floors.

Singapore's climate makes it easier for the fungus to survive. Feet in covered shoes sweat all day, and the humidity means they don't have the chance to fully dry out.

Is It Athlete's Foot, or Just Dry Skin?

This is the question worth getting right, because the two are treated in opposite ways and the wrong treatment worsens the issue.

Athlete's foot does not always look the way people expect. It takes three main forms:

• Between the toes. The familiar one. Itchy, white, soggy or peeling skin, usually worst between the fourth and fifth toes where the gap is tightest.
• On the sole and heel. Dry, fine scaling across the sole, sometimes extending up the sides of the foot in the pattern of a moccasin. It is often not itchy at all. This often gets mistaken for dry skin for months.
• Blistering. Small fluid-filled blisters, usually on the arch or the ball of the foot, which can come on suddenly and be quite sore.

A few things to identify fungal infection from simple dry skin:

• Where it is: Dry skin tends to sit on the heel and the weight-bearing areas. Fungal scaling often reaches up the sides of the foot and involves the spaces between the toes.
• Whether it is symmetrical: Dry skin usually affects both feet fairly equally. Athlete's foot often starts on one foot and stays worse on that side.
• What moisturiser does: Dry skin improves with regular moisturising. Fungal scaling does not, and an occlusive cream applied to damp skin between the toes can make it worse.
• Whether the nails are involved: Thickened, crumbling or discoloured nails alongside scaly skin point strongly to fungus.

If you have been moisturising the same patch for weeks without it settling, that is worth having looked at.

What Causes It, and Why It Keeps Coming Back

The infection itself is straightforward. The recurrence is where most people get stuck, and it usually comes down to one of these:

• Shoes that never dry out. Wearing the same pair every day gives the fungus a reservoir to re-infect from
• Feet that stay damp, from sweating, from not drying between the toes after showering, or from socks that hold moisture
• Walking barefoot in shared wet areas
• Stopping treatment when the itching stops, which is well before the fungus has resolved
• An untreated fungal nail infection, which keeps re-seeding the skin

That last one matters more than most people realise, and it is the most common reason athlete's foot recurs easily.

Athlete's Foot and Fungal Nails Travel Together

Skin and nail fungal infections are frequently the same infection in two places. Fungus on the skin can get under the nail, and an infected nail sheds fungus back onto the skin every day.

Treating one and ignoring the other is why people find themselves clearing the skin, feeling fine for a few weeks, and having to start again. Nail infections are also slower and harder to treat than skin, so they need to be identified early.

If your skin keeps flaring, the nails are worth assessing for fungal nail infection.

How a Podiatrist Helps

Step 1: Confirming fungal diagnosis

• Examination of the skin pattern, the toe spaces and the soles
• A check on all ten nails, since nail involvement changes the plan
• Ruling out the conditions that mimic it, including eczema, psoriasis and simple dry skin
• Where the diagnosis is unclear or treatment has already failed, a skin or nail sample can be sent for testing

Step 2: Clearing the infection

• Removing the thickened, scaling skin so treatment reaches living tissue rather than sitting on dead surface
• Guidance on an appropriate antifungal regime
• Photodynamic antifungal light therapy where nails are involved alongside the skin
• Treating the whole foot rather than only the itchy part, because the fungus is usually wider than the symptoms

Step 3: Prevent recurrence

• Footwear rotation, so no pair is worn two days running
• Decontaminating the shoes you already own, which are otherwise a reservoir
• Appropriate socks material and changing frequency
• Drying technique, particularly between the toes
• Household measures where more than one person is affected

When It Needs More Than Foot Care

Some cases need medical attention rather than treatment at a podiatry clinic. See a doctor if:

• You have diabetes. Any break in the skin of the foot carries a higher risk of infection and ulceration, and athlete's foot creates exactly that. Get it dealt with early rather than waiting to see if it settles
• The skin is red, hot, swollen or spreading, or there is pain out of proportion to what you can see, which can indicate a bacterial infection on top of the fungal one
• There is weeping, pus or a sudden worsening
• You are immunosuppressed, or taking medication that affects your immune system
• It has not improved despite several weeks of appropriate antifungal treatment

When Should You See a Podiatrist?

It is worth booking an appointment if the skin keeps flaring despite treatment, if you are not certain whether it is fungal, if the nails have started to thicken or discolour, or if it has spread to the sole.

You do not need a doctor's referral to see a podiatrist in Singapore.

Frequently Asked Questions on Athlete's Foot