Treatment of Athlete's Foot (Tinea Pedis)
For uncomplicated athlete's foot, apply topical terbinafine 1% cream twice daily for 1 week if infection is between the toes, or twice daily for 2 weeks if infection involves the bottom or sides of the foot. 1
First-Line Topical Treatment
- Terbinafine 1% cream is the preferred topical agent, applied twice daily (morning and night) with treatment duration based on location 1
- Before applying medication, wash the affected skin with soap and water and dry completely 1
- For interdigital (between-the-toes) infection: treat for 1 week 1
- For plantar or lateral foot infection: treat for 2 weeks 1
- Terbinafine cures most athlete's foot infections and relieves itching, burning, cracking, and scaling 1
Essential Footwear and Hygiene Measures
- Wear well-fitting, ventilated shoes and change shoes and socks at least once daily 1
- Apply foot powder after bathing, which reduces recurrence from 8.5% to 2.1% 2
- Clean athletic footwear periodically to prevent reinfection 2
- Wear nonocclusive leather shoes or sandals with absorbent cotton socks 3
- Keep feet dry at all times, as moisture encourages fungal growth 3
Treatment for Extensive or Refractory Cases
If topical therapy fails after the recommended treatment duration, switch to oral itraconazole using pulse dosing of 200-400 mg per day for 1 week per month. 2
Before Switching Therapy:
- Obtain fungal cultures to verify treatment failure 2
- Consider discontinuing antifungals for a few days before specimen collection to optimize culture yield 2
Oral Antifungal Options:
- Itraconazole is the recommended oral alternative, with similar mycological efficacy to oral terbinafine 2
- For extensive tinea pedis, use continuous dosing of itraconazole 100 mg daily for 2 weeks 2
- Take itraconazole with food and in acidic pH for optimal absorption 2
- Fluconazole 150 mg once weekly is less effective than terbinafine or itraconazole but can serve as an alternative 2
- Monitor liver function tests at baseline and during prolonged therapy, especially with itraconazole 2
Critical Steps to Prevent Recurrence
- Examine and treat concomitant onychomycosis (nail fungus), as nail infection serves as a reservoir for reinfection 2
- Check for dermatophyte infection at other body sites, present in 25% of cases 2
- Treat all infected family members simultaneously to prevent reinfection 2
- Apply talcum or antifungal powder at least twice daily as a preventive measure 3
Common Pitfalls to Avoid
- Do not assume treatment failure is due to drug resistance alone—poor compliance, inadequate drug penetration, bacterial superinfection, or reinfection from nails/footwear are more common causes 2
- Do not treat the feet in isolation; failure to address nail involvement or other body sites leads to recurrence 2
- Do not allow feet to remain in moist environments, as this perpetuates fungal growth 3
- Avoid tight, occlusive footwear that traps moisture 3