Is a vinegar‑water soak an appropriate treatment for tinea pedis (athlete’s foot)?

Vinegar-Water Soaks Are Not Recommended for Tinea Pedis

Vinegar-water soaks are not an evidence-based treatment for athlete's foot and should not be used as primary therapy. Current clinical guidelines do not support vinegar soaks for tinea pedis, and no high-quality evidence demonstrates their efficacy against dermatophyte infections. 1, 2

Why Vinegar Soaks Are Inadequate

• Established antifungal agents have proven efficacy against the causative organisms T. rubrum and T. mentagrophytes, whereas vinegar lacks documented fungicidal or fungistatic activity against these dermatophytes. 1
• Guidelines from the American Academy of Pediatrics and British Journal of Dermatology recommend topical terbinafine, ciclopirox, or azoles as first-line therapy—none mention vinegar as an acceptable alternative. 1, 2
• Delaying appropriate antifungal treatment allows the infection to persist, spread to other body sites (groin, hands, nails), and potentially infect household members. 1

Evidence-Based First-Line Treatment

Topical terbinafine 1% cream applied twice daily for 1 week is the gold-standard first-line therapy for interdigital tinea pedis, offering superior efficacy and shorter treatment duration than other topical agents. 1, 2

Alternative Topical Options

• Ciclopirox olamine 0.77% cream/gel applied twice daily for 4 weeks achieves approximately 60% cure at end of treatment and 85% cure two weeks later, significantly outperforming clotrimazole (85% vs 16%). 2
• Clotrimazole 1% cream applied twice daily for 4 weeks is less effective than terbinafine but remains widely available over-the-counter. 1, 2

When to Use Oral Therapy

Oral antifungals should be reserved for severe disease, failed topical therapy, concomitant onychomycosis, or immunocompromised patients. 1

• Oral terbinafine 250 mg once daily for 1-2 weeks provides faster clinical resolution than topical therapy and has similar efficacy to 4 weeks of topical clotrimazole. 1, 2
• Oral itraconazole 100 mg daily for 2 weeks has comparable mycological efficacy to terbinafine but may have slightly higher relapse rates. 1, 2

Critical Prevention Measures to Avoid Recurrence

Failing to address contaminated footwear is a major cause of treatment failure and recurrence. 1

• Decontaminate shoes by placing naphthalene mothballs inside, sealing in a plastic bag for ≥3 days, then airing to eliminate viable fungal spores. 1
• Spray terbinafine solution inside shoes periodically for additional antifungal protection. 1
• Apply antifungal foot powder after bathing daily, which reduces infection rates from approximately 8.5% to 2.1%. 1, 2
• Thoroughly dry between toes after showering and change to cotton, absorbent socks daily to reduce moisture that promotes fungal growth. 1, 2

Common Pitfalls

• Treating only the index patient without examining and treating all infected household members simultaneously leads to reinfection cycles. 1
• Neglecting to examine for concomitant onychomycosis (nail infection)—this requires extended oral terbinafine therapy (12-16 weeks) and acts as a reservoir for reinfection. 1
• Stopping treatment when symptoms improve rather than completing the full course allows residual organisms to cause relapse. 3