How your itchy foot could be a sign of a deadly infection affecting one in 10 Americans

Millions of people experience intense itching sensations on their feet and think nothing of it – until it becomes unbearably uncomfortable. 

But fewer people may be familiar with something called tinea pedis, better known as fungal foot infection or ‘athlete’s foot.’

Tinea pedis is a fungal infection that occurs when a person’s feet remain in a dark, warm and moist environment for too long, allowing parasitic fungi called dermatophytes to survive and grow. 

The intense itching sensations in the feet are caused by the dermatophytes breaking down the skin barrier causing an inflammatory immune response.

Approximately 33 million Americans will develop tinea pedis in their lifetime, or about 10 percent of the population. 

It may occur in people who wear socks or shoes for prolonged periods or from scratching other parts of the body that may be affected by the fungi, such as the groin. 

While it may sound relatively benign, it could develop into serious conditions such as foot ulcers in some cases if it goes untreated. And in rare cases, the infection can spread to the bloodstream, resulting in deadly sepsis. 

This makes prompt treatment with antifungal creams or pills essential to keep the infection from spreading and wreaking havoc on the whole body.

More than 10 percent of the population may be living with a foot infection that could cause severe secondary infections and sepsis

Tinea pedis can become an advanced infection when the break in the skin becomes ulcerative, especially in individuals with diabetes. 

The moister the skin, the more likely the skin may break down in areas of pressure such as the heel and toes. 

Forms of tinea pedis, such as Moccasin Tinea, point to potential causes such as poor footwear and unwashed socks, which allow the infection to spread across the entirety of the bottom of the foot.

With tinea pedis, the extreme buildup of scaly plaques on the bottom of the foot reduces the effectiveness of skin softening products called emollients, which may contribute to yet more moisture.

Tinea pedis may be a condition that feels sudden when its symptoms manifest, however, the underlying causes may have been occurring for years.

I remember a particular patient, a man in his 40s, who had worked in construction for over 10 years and worked long shifts, sometimes 14 hours. He reported getting home late most nights with barely enough time to shower, eat and go to bed.

He had developed a fissure in the skin between his first and second toes, which had been compounded by wearing steel toe-capped boots every day and wearing socks across the entire day with few breaks and heavy lifting activities. 

The appearance of wet, flaky and peeling skin between his toes suggested fungal skin infection had become advanced, which raised alarm bells.

The patient didn’t know how serious this was until I pointed out that a wound had developed with secondary bacterial infection requiring antibiotics and weekly visits to the clinic. Once he had realized that this would disrupt his work pattern, it became an incentive for a change of habits.

Within six weeks he had adjusted his work schedule so he could apply an antifungal cream on the bottom of his feet and spray between his toes, washing his feet daily and changing his socks when he got home.

Too often there are cases where symptoms of tinea pedis have been occurring for an extended period and seeking assessment has been delayed, resulting in more serious cases such as ulceration. 

People with a fungal skin infection who do not receive prompt treatment may go on to develop secondary bacterial infections of the skin and fungal nail infections. 

This leads to the typical yellow hue seen on toenails when exposed to dermatophytes overwhelming the site.

And because tinea pedis is caused by a dark, warm and moist environment over a prolonged period, urgent treatment is required to avoid the spread of the condition to other parts of the body.

Antifungal creams, gels and sprays are the main over-the-counter treatments available to individuals with tinea pedis.

Seeking advice from a podiatrist is important even if there is uncertainty over the level of itchiness experienced, particularly at rest. 

Don’t ignore it. The earlier you seek assistance, the more likely the reduced risk of fungal foot infection and spread to others and other parts of the body.

Jonathan Brocklehurst, MSc, MIRL, MRCPod, is a podiatrist and author based in the UK.