What is the treatment for foot rot?

Treatment for Foot Rot

For athlete's foot (tinea pedis), the most effective treatment is topical terbinafine applied twice daily for 1-2 weeks, depending on the location of infection. 1

Types of Foot Rot

Tinea Pedis (Athlete's Foot)

• Presents as a fine scaly or vesiculopustular eruption that is often itchy, commonly affecting the fissures and scaling between toes 1
• Three main clinical forms: interdigital, hyperkeratotic (moccasin-type), and vesiculobullous (inflammatory) 2
• Most commonly caused by Trichophyton rubrum and Trichophyton interdigitale 2
• More prevalent in warm, humid environments and affects men more than women 1
• Risk factors include obesity and diabetes 1

Treatment Options

Topical Antifungal Therapy (First-Line)

• Terbinafine (Allylamine):

  • For infections between the toes: Apply twice daily (morning and night) for 1 week 3
  • For infections on the bottom or sides of the foot: Apply twice daily for 2 weeks 3
  • Has demonstrated superior efficacy with faster clinical resolution compared to other treatments 1, 4

• Ciclopirox olamine cream/gel (0.77%):

  • Apply twice daily for 4 weeks 1
  • Shown to be effective in eradicating T. pedis with approximately 60% cure rate at end of treatment and 85% cure rate two weeks after treatment 1

• Other topical options:

  • Clotrimazole (azole) applied twice daily for 4 weeks 1, 4
  • Butenafine applied twice daily for 2 weeks (adults only) 1

Oral Antifungal Therapy (For Severe or Resistant Cases)

• Terbinafine: 250 mg once daily for 1 week

  • Similar efficacy to 4 weeks of clotrimazole 1% cream but with faster clinical resolution 1, 4
  • More effective than griseofulvin for treating dermatophyte infections 5

• Itraconazole: 100 mg daily for 2 weeks or 200 mg daily for 1 week

  • Effective for treating resistant infections 1
  • More effective than placebo in controlled trials 5

• Fluconazole: Can be used as an alternative when other treatments cannot be tolerated 1

Treatment Algorithm

1. For localized, mild-to-moderate tinea pedis:

   • Begin with topical terbinafine applied twice daily (1 week for interdigital, 2 weeks for plantar) 3
   • Alternative: ciclopirox olamine 0.77% cream/gel twice daily for 4 weeks 1

2. For severe, extensive, or resistant infections:

   • Oral terbinafine 250 mg once daily for 1 week 1, 4
   • Alternative: oral itraconazole 100 mg daily for 2 weeks 1

3. For diabetic foot infections:

   • Assess infection severity and obtain cultures before starting antibiotics 1
   • For mild infections: 1-2 weeks of antibiotic therapy targeting gram-positive cocci 1
   • For moderate-severe infections: 2-4 weeks of broader-spectrum antibiotics 1
   • Surgical consultation for deep abscesses, bone involvement, or extensive necrosis 1

Prevention Measures

• Thorough drying between toes after bathing/showering 1
• Daily changes of socks 1
• Regular cleaning of athletic footwear 1
• Use of foot powder after bathing (has been shown to reduce rates of T. pedis from 8.5% to 2.1%) 1
• Wearing protective footwear in public bathing facilities 1

Special Considerations

• For diabetic patients with foot infections, wound care is crucial in addition to antimicrobial therapy 1
• Proper wound cleansing, debridement of callus and necrotic tissue, and off-loading of pressure are essential components of treatment 1
• In veterinary medicine (sheep), foot rot is treated with foot paring, topical treatments, vaccination, and parenteral antibiotics, with prevention through footbathing and vaccination 6, 7

Common Pitfalls

• Inadequate treatment duration leading to recurrence 2
• Failure to address underlying risk factors (humidity, occlusive footwear) 1
• Misdiagnosis based on clinical appearance alone (laboratory confirmation recommended) 2
• Not treating all affected family members simultaneously, leading to reinfection 1
• Continuing to wear contaminated footwear after treatment 1