Dear Mirror Doctor, My feet smell after a long day’s work. No matter how much I try I don’t seem to be able to get it treated. I am told it is due to foot rot. How can I prevent it from recurring please?
Worried man.
Dear worried man, Foot rot is a fungal infection. Fungal infections can occur almost anywhere on the body, including the scalp, trunk, extremities (arms and legs), hands, feet, nails, vagina, mouth and groin.
Athlete’s foot or foot rot is a common skin infection of the bottom of the feet caused by fungus called Trichophyton.
It is caused by the tinea group of fungus hence an athlete’s foot is also called tinea pedis. The fungus can be found on many locations, including floors in gyms, locker rooms, swimming pools, nail salons, airport security lines and in socks and clothing.
The fungus can also spread directly from person to person or by contact with these objects. Most people acquire the fungus on the feet from walking barefoot in areas where someone else with an athlete’s foot has walked.
When the feet or other areas of the body stay moist, warm and become irritated, the fungus thrives and infects the upper layers of the skin.
A sizable number of the population may have athlete’s foot at some time during their lives. Some individuals are inherently susceptible to recurrences during their lifetime such as those with chronic conditions such as diabetes, cancer and those with compromised immune systems.
Also office workers who wear shoes all the time are at an increased risk of acquiring the organism.
Most individuals with athlete’s feet have no symptoms at all and do not even know they have an infection. Many may think they simply have dry skin on the soles of their feet.
Common symptoms typically include various degrees of itching and burning.
The skin may frequently peel, and particularly in severe cases, there may be some cracking, pain, and bleeding as well. Foul smell on feet, shoes and socks are also symptoms of the infection. Very rarely, an athlete’s foot can blister, the so-called bullous tinea pedis.
Most cases of an athlete’s foot are barely noticeable with just slightly dry, flaky skin. More extensive athlete’s foot may manifest as red, peeling, dry skin areas on one or both soles of the feet. Sometimes, the dry flakes may spread onto the sides and tops of the feet. Most commonly though, the rash is localised to just the bottoms of the feet especially, the space between the fourth and fifth toes.
Athlete’s foot may also be seen along with ringworm of the groin (especially in men) or hand(s). It is helpful to examine the feet whenever there is a fungal groin rash (jock itch).
It is important to treat all areas of fungal infection at one time to avoid re-infection. Simply treating the soles and ignoring the concurrent fungal infection of toenails may result in recurrences of athlete’s foot. It is important to evaluate and address all potential sources of fungal infection.
Athlete’s foot is not always contagious. There are many households where two people (often husband and wife or siblings) using the same showers and bathroom for years have not transmitted the fungus between them. The exact cause of this predisposition or susceptibility to fungal infections is unknown. Some people just seem more prone to fungal skin infections than others.
Like all the other fungal infections, microscopic examination after treatment with potassium hydroxide confirms the presence of a fungal infection. This test is performed using small flakes of skin.
The treatment of an athlete’s foot can be divided into two parts. The first, and most important part, is to make the infected area less suitable for the fungus to grow, that is, keeping the area clean and dry.
Shoes from leather or another breathable material is very helpful in its prevention. Shoe materials, such as vinyl, that don’t “breathe” cause the feet to remain moist, providing an excellent medium for the fungus to breed. Likewise, absorbent socks such as cotton that wick water away from the feet help.
Medicated powders can help keep the feet dry. Also, the feet can be soaked in a drying solution such as aluminum acetate (Burow’s solution or Domeboro solution) or use a homemade remedy by diluting white vinegar soaks using one part vinegar and roughly four parts water, once or twice a day as 10-minute foot soaks may aid in treatment.
The second part of treatment is the use of antifungal creams and washes.
Many medications are available, including miconazole, (daktarin), clotrimazole, terbinafine (Lamisil) sprays and creams, and ketoconazole shampoo and cream (Nizoral). Like all fungal infections, treatment for athlete’s foot should generally be continued for four weeks or at least one week after all of the skin symptoms have cleared.
More advanced or resistant cases of athlete’s foot may require about a two to three-week course of an oral antifungal such as terbinafine (Lamisil) or fluconazole (Diflucan). It is important to note that topical corticosteroid creams can act as a fertiliser for fungus and may actually worsen fungal skin infections and hence not indicated in its treatment.
If the fungal infection has spread to the toenails, the nails must also be treated to avoid re-infection of the feet.
Often, the nails are initially ignored and the athlete’s foot keeps recurring. It is important to treat all the visible fungus at the same time. Effective nail fungus treatment may be more intensive and require prolonged courses (three to four months) of oral antifungal medications.
An athlete’s foot can potentially spread to other body parts or other people including family members if untreated. Fungus may spread locally to the legs, toenails, hands, fingernails and other areas.
Since some people are simply more prone to fungal infections, they are also prone to repeated infection.
Preventive measures include keeping the feet clean and dry, avoiding prolonged moist environments, using socks in airport security lines, removing shoes and allowing the feet skin to “breathe,” avoid walking on barefoot, especially in public areas such as swimming pools and gyms, avoiding contact with known infected people, and avoid using contaminated tools at nail salons.
Disinfecting old shoes weekly or monthly by sprinkling antifungal foot powder into shoes can also be helpful.
astom2@yahoo.com
A member of Paediatric Society of Ghana.