What are the treatment options for fungal infections of the feet, specifically onychomycosis (fungal infection of the toenails) or tinea pedis (athlete's foot)?

From the Guidelines

For treating foot fungus, I strongly recommend starting with oral terbinafine tablets (250mg daily for 6-12 weeks) as the first-line treatment, due to its high cure rates and low relapse rates compared to other antifungal agents, as supported by the study 1.

Treatment Overview

When it comes to treating foot fungus, it's essential to consider the severity of the infection and the patient's overall health.

• For mild cases, over-the-counter antifungal medications like clotrimazole (Lotrimin), miconazole (Micatin), or terbinafine (Lamisil) can be effective when applied twice daily for at least two weeks.
• However, for more severe infections, oral terbinafine is the preferred treatment option, with a dosage of 250mg daily for 6-12 weeks, as it has been shown to have higher cure rates and lower relapse rates compared to other antifungal agents, including itraconazole, as demonstrated in the study 1.

Prevention and Self-Care

In addition to medical treatment, it's crucial to practice good foot hygiene and take preventive measures to avoid reinfection.

• Keep your feet clean and dry, washing daily with soap and water, then thoroughly drying, especially between toes.
• Wear breathable footwear and moisture-wicking socks, changing them when damp.
• Avoid walking barefoot in public areas like pools and showers, as these environments can harbor fungal spores.

Considerations and Precautions

When treating foot fungus, it's essential to consider the potential side effects and interactions of antifungal medications.

• Terbinafine, for example, can cause reversible taste disturbance in some patients, and its plasma concentrations can be reduced by rifampicin, as noted in the study 1.
• Itraconazole, on the other hand, can have enhanced toxicity when combined with certain medications, such as anticoagulants, antihistamines, and anxiolytics, as highlighted in the study 1. By prioritizing oral terbinafine as the first-line treatment and practicing good foot hygiene, patients can effectively manage foot fungus and reduce the risk of recurrence, as supported by the study 1.

From the FDA Drug Label

Directions • adults and children 12 years and older o use the tip of the cap to break the seal and open the tube o wash the affected skin with soap and water and dry completely before applying o for athlete's foot wear well-fitting, ventilated shoes. Change shoes and socks at least once daily. ▪ between the toes only: apply twice a day (morning and night) for 1 week or as directed by a doctor. ▪ on the bottom or sides of the foot: apply twice a day (morning and night) for 2 weeks or as directed by a doctor. Uses • cures most athlete's foot (tinea pedis) • cures most jock itch (tinea cruris) and ringworm (tinea corporis) • relieves itching, burning, cracking and scaling which accompany these conditions

The treatment for feet fungal infection, specifically athlete's foot, is to apply terbinafine (TOP) twice a day, morning and night, for:

• 1 week when the infection is between the toes
• 2 weeks when the infection is on the bottom or sides of the foot It is also recommended to wear well-fitting, ventilated shoes and change shoes and socks at least once daily 2. Terbinafine (TOP) is used to cure most athlete's foot and relieve itching, burning, cracking, and scaling that accompany the condition 2.

From the Research

Feet Fungal Treatment Options

• Topical treatments are generally successful for feet fungal infections, unless the infection covers an extensive area or is resistant to initial therapy 3
• Oral therapy is usually used for chronic conditions or when topical treatment has failed 4
• Terbinafine and itraconazole are effective oral treatments for fungal infections of the skin of the foot, with terbinafine being more effective than griseofulvin 4
• Combination of terbinafine and itraconazole may have a higher clinical and mycological cure rate compared to using either drug alone as monotherapy 5

Topical Treatment Efficacy

• Allylamines, azoles, ciclopiroxolamine, tolnaftate, butenafine, and undecanoates are effective topical treatments for skin infections, with allylamines curing slightly more infections than azoles 6
• Topical treatments for nail infections, such as ciclopiroxolamine and butenafine, require daily application for prolonged periods (at least 1 year) and have varying degrees of effectiveness 6
• Amorolfine may be substantially more effective than ciclopiroxolamine for nail infections, but more research is required 6

Treatment Duration and Considerations

• Treatment for tinea pedis (feet fungal infection) typically lasts for four weeks with an azole or one to two weeks with allylamine medication 3
• Treatment should continue for at least one week after clinical clearing of infection 3
• The presence of inflammation may necessitate the use of an agent with inherent anti-inflammatory properties or the use of a combination antifungal/steroid agent, which should be used with caution due to potential complications 3