Fungal infections of both the skin and nails of the feet are caused by microscopic organisms only
in this case, they are fungi, and like their counterparts, bacteria and viruses, are invisible to the naked
eye. They exist everywhere, in the atmosphere and environment, though they do prefer somewhere dark,
moist and warm in order to flourish. They attack human skin and nails, particularly at times of mild
debility or when the skin is damaged and therefore more susceptible to invasion. They are common
conditions affecting 10-15% of the population and are commonest in males.

The most typical fungal infection of the skin is known as “Athletes Foot”, a reference, originally
to the ‘plimsolls’ or ‘pumps’ footwear worn by athletes, which provided the perfect environment for the
growth of the fungi involved.
Infection of the nails is called onychomycosis and is quite often a complication of what was
originally an untreated, or inadequately treated skin infection.

Where Do We Catch Them From?

These fungi are very contagious and the most common sources of infection are communal showers
and bathing facilities in leisure centres and swimming pools, though they can also be contracted by
barefoot activity on dry floors such as those found in gymnasia. Unfortunately the disinfectant baths
frequently found at the entry point to swimming pools are often useless because the fungus lives in tiny
pieces of skin debris which are waterproof.

Signs and Symptoms

The outbreak usually begins between the toes, where the skin becomes sore and inflamed and this
is often accompanied by intense itching. The skin eventually becomes either dry and flaky, or moist and
weeping, depending on which variety of fungus is the cause. Cracks develop which reduce the skin’s
natural defences, and secondary bacterial infections can become superimposed, causing a painful
condition.
In the case of the nails there is often a history of outbreaks of ‘athletes foot’ and quite often it is actually
present at the same time. The nails appear thickened and discoloured and frequently have a crumbly
texture. However, not all nail symptoms like this are due to fungal infection. There are many other
conditions which cause a similar appearance, such as poor circulation to the nail bed, psoriasis of the
nails etc.
Diagnosis is confirmed by a simple laboratory test which can ascertain for certain whether the
problem is a fungal one, or if there is another cause.

Prevention

It is frequently said that prevention is better than cure, and this is very true. Here are some tips
to help you avoid these fungal infections. The first and obvious one is good daily foot hygiene. The feet
should be washed in warm soapy water, then rinsed before drying carefully, paying particular attention
to the skin between and beneath the toes. Dusting afterwards with a medicated talc containing a mild
anti-fungal agent is beneficial and ensures that you do not cause resistance to the stronger agents which
may be needed for an infection at a later date.
If your toes are very tight together, this reduces the natural air-flow between them and makes the
skin more vulnerable. The use of a little surgical spirit between the toes at bedtime, can work wonders.
A cotton bud is a useful applicator. Leave the spirit to vaporise after the application and this will act as
an astringent to the skin and at the same time help to remove any residual moisture from the day’s
activities.
Footwear should be composed of natural materials as far as possible as these allow the feet to “breathe”. Socks of wool or cotton and shoes of real leather are advised for people who are prone to this problem. Whilst it is almost impossible to obtain such things as silk stockings in this day and age, ladies should allow a period of time during regular parts of the day when they can dispense with nylon hosiery and allow air to the feet, for at least half an hour at a time. Never wear anyone else’s footwear.

Why Should We Treat This Problem?

Firstly, none of us take kindly to pain and discomfort. Secondly, the condition does not usually resolve without treatment. Thirdly, once infected we can pass the fungus on to someone else, often within the family. Finally, the results of these infections, particularly the nails, can become disfiguring and if left untreated over a period of time, can cause
permanent destruction of the nail plate.

Treatment

Should you suffer the misfortune of contracting a fungal infection, keep a towel and shower / bath
mat solely for your use. Avoid standing barefoot on the bathroom floor and seek the advice of your
chiropodist regarding the disinfection of shoes, which can remain a source of infection if not dealt with.
Usually, skin infections of this type respond very well to anti-fungal preparations which take the
form of creams, ointments, paints and powders. These are called topical medications, ie they are applied
to the skin and are not taken internally. Your chiropodist will be able to recommend a suitable
preparation for your problem.
In the past, attempts were made to eliminate the fungal infections in nails in this manner, but
because of the difficulties associated with achieving penetration of tissue as hard as nail, success rates
were poor. The good news is that modern pharmacy has developed some tablets that can be taken orally which eliminate the fungus from within the body (systemically). Those most recently developed are very efficient indeed and whilst fairly expensive initially, are cost effective in that they eliminate the need for protracted periods of treatment. Whilst present regulations prevent your chiropodist from prescribing them for you, he or she will be able to refer you to your family doctor who is able to issue a prescription.

Good foot care makes sense, your doctor and chiropodist are there to help you.

© The Institute of Chiropodists and Podiatrists