Treatment of Foot Fungus (Athlete's Foot)
For athlete's foot (tinea pedis), apply topical terbinafine 1% cream twice daily for 1 week for infection between the toes, or twice daily for 2 weeks for infection on the bottom or sides of the foot. 1
First-Line Topical Treatment
Terbinafine 1% cream is the most effective topical agent, achieving 66% effective cure rate with twice-daily application for just 1 week for interdigital disease—superior to longer courses of other antifungals. 2
For interdigital (between-toes) tinea pedis: Apply terbinafine 1% cream twice daily (morning and night) for 1 week. 1
For plantar (bottom or sides of foot) tinea pedis: Apply terbinafine 1% cream twice daily for 2 weeks. 1
Alternative topical option: Ciclopirox olamine 0.77% cream/gel applied twice daily for 4 weeks achieves 60% cure at end of treatment and 85% cure two weeks post-treatment, making it superior to clotrimazole 1%. 2
Clotrimazole 1% cream is less effective than terbinafine but widely available over-the-counter. 3
When to Use Oral Therapy
Reserve oral antifungals for severe disease, failed topical therapy, concomitant toenail fungus (onychomycosis), or immunocompromised patients. 3
Oral Treatment Options:
Terbinafine 250 mg once daily for 1-2 weeks is the most effective oral treatment, providing faster clinical resolution than topical treatments and superior efficacy against dermatophytes. 2, 3
Itraconazole 100 mg daily for 2 weeks has similar mycological efficacy to terbinafine but may have slightly higher relapse rates. 2
Fluconazole is less effective than both terbinafine and itraconazole but may be useful when other agents are contraindicated due to fewer drug interactions. 3
Essential Prevention Measures
Thoroughly dry between toes after showering—moisture promotes fungal growth. 2
Change socks daily and clean athletic footwear periodically. 2
Apply foot powder after bathing, which can reduce tinea pedis rates from 8.5% to 2.1%. 3
Wear well-fitting, ventilated shoes and absorbent cotton socks. 1
Cover active foot lesions with socks before wearing underwear to prevent spread to the groin area. 2
Critical Pitfalls to Avoid
Failing to treat all infected family members simultaneously results in reinfection. 3
Neglecting contaminated footwear as a source of reinfection leads to recurrence—address this by cleaning athletic shoes periodically. 3
Do not share towels, clothing, or personal items, as these fomites transmit infection. 2
If infection has not resolved after 4 weeks of apparently appropriate therapy, re-evaluate and reconsider diagnostic studies or alternative treatments. 4
Special Populations
For diabetic patients, prefer terbinafine over itraconazole due to lower risk of drug interactions and hypoglycemia—up to one-third of diabetics have onychomycosis, which significantly predicts foot ulcer development. 3
In persons with diabetes at risk of foot ulceration, prescribe anti-fungal treatment for fungal infections to help prevent foot ulcers. 4
Athletes require minimum 72 hours of antifungal therapy before return to contact sports, with lesions covered appropriately. 3
For children under 12 years: consult a physician before treatment. 1
Risk Factors
Risk factors include swimming, running, warm humid environments, male gender, obesity, and diabetes. 2, 3