Fungal infections are among the most common infections seen by a podiatrist. Podiatrists are involved in treating two types of fungal infections:

• Infections of the skin of the feet (tinea pedis) commonly known as athletes foot

Common signs & symptoms may include an itching/burning sensation of the feet, redness, peeling of the skin, malodour and sometimes even blistering.

• Infections of the nail bed and nail plate known as onychomycosis.

The infected nail often becomes thickened, brittle/crumbly, distorted in shape and discoloured. The infected nails generally have an unpleasant appearance. It may lead to malodour of the foot including the socks and shoes.

Risks and predisposing factors for fungal infections include:

Fungal infections love warm, moist and closed environments and there they thrive in such environments.

FOOTWEAR: Wearing occlusive footwear increases the risk of infection because this provides an ideal environment for fungal infections to thrive. It can also be one of the causes of trauma to the nails which can increase susceptibility to the infection. Old footwear may contain high amounts of fungal spores accompanied by malodour, and these shoes lead to reinfection.

WALKING BAREFOOT IN PUBLIC SHOWERS, SWIMMING POOLS AND CHANGING ROOMS: These areas are suitable for the transmission of infection since there may be infected fungal spores on the floors. This is one of the most common ways of transmission of the infection.

SHARING TOWELS, SHOES, SOCKS, NAIL CLIPPERS AND FOOT FILES: These items may contain fungal spores in them, therefore by sharing these items it increases the likelihood of transmitting the infection to other people or even contracting the infection.

INADEQUATE DISINFECTION: All items that may potentially be shared or in current use that makes contact with an infected area, need to be adequately disinfected and washed with a good antimicrobial soap/alcohol based solution or antifungal spray and left to air out in the sun preferably after each use. It is also advisable to wash the items at high temperatures to kill the fungal spores. If these precautions are not followed, chances are high that the items may be inadequately disinfected and this may result in reinfection or recurrence of infections.

FOOT AND HAND HYGIENE: It is vital that personal foot and hand hygiene is off the highest standard. This should be done daily with a good antimicrobial agent and dried properly thereafter. Hands need to be washed each time after foot-care to prevent transmission of the infection to the hands. Socks and shoes need to be changed daily coupled with washing and disinfection after each use which is a vital aspect of foot hygiene.

UNDERLYING MEDICAL CONDITIONS AND CURRENT MEDICATION: Certain pre-existing medical conditions and pharmacological drugs may predispose a patient to fungal infections by compromising circulation or even suppressing the immune system.

INCOMPLETE COURSE OF MEDICATION AFTER CLINICAL SIGNS AND SYMPTOMS RECEDE: It is essential to complete the course of the antifungal medication at the correct dosage, directions of use and for the stipulated time the podiatrist has advised, otherwise infections may recur. This must be coupled with the advice given on the daily measures to be done during the course of treatment, to ensure successful treatment. Antifungal therapy and prophylactic measures should be continued for several months after the signs and symptoms are no longer evident to prevent recurrence.

So how can a Podiatrist help?

It is important to see a Podiatrist to adequately treat the infection and at the same time break the cycle of recurrence and reinfection.

General Podiatric Care

During the course of treatment of nail infections, general podiatric care will be beneficial to the patient. Infected nails generally become thickened, discoloured and brittle/crumbly with an unpleasant appearance.  As a result of the clinical presentation, it makes it very difficult for a patient to cut and file their own nails due to the thickening. When the nails become thickened the amount of fungal spores present is increased and this leads to malodour of the feet together with the socks and shoes. Sometimes the fungal spores may infect the skin of the foot. Podiatrists can help by cutting the patients nails, filing it down with a nail drill and providing foot care advice. This can lead to overall improvement of the appearance of the nail, reduction in malodour of the feet, and reduce any pain associated with shoe pressure against the thickened nail. Literature suggests that infected nails need to be thinned down as far as possible prior to the application of a topical antifungal in order to penetrate the nail bed and facilitate its full potential.

Skin infections has a shorter course of treatment than nail infections, and usually responds well to topical treatment. Common symptoms include intense itching of the feet, malodour, inflammation or blisters in some cases, fissuring, maceration and peeling of the skin. Skin infections can also occur in association with hard skin build up and treatment will then involve debridement of the hard skin with a scalpel or the use of a keratolytic agent. During the duration of treatment a podiatrist can give foot care and footwear advice as this can contribute to a reduction in malodour and reinfection during the course of treatment. Regular screenings can be done to note any secondary bacterial infections or portals of entry that can lead to infection and this can then be managed accordingly. Conservative management of any associated inflammation, blisters, maceration and fissures can be carried out. Necessary offloading can be done for severe fissures or blisters. Prescriptions for any necessary socks and footwear, antifungals, astringents and other devices can also be given in attempt to benefit the patient.

Treatment

The goal of treatment is to get rid of the infection, prevent reinfection during the course of treatment including preventing the spreading of infection to other areas on oneself and to other people. Thereafter success of treatment, the goal remains to prevent recurrence of the infection.

• Your Podiatrist will recommend an anti-fungal medication best suited for you.
• Provision of general podiatric care during the course of treatment.
• Laser therapy for fungal infections
• Advice on alternative therapies for the treatment of fungal infections.
• Recommendation of best foot care products to be used in the course of treatment.
• Recommendation of appropriate socks and footwear
• Advice on precautions to take during the course of treatment and after successful treatment.
• Advice on adequate and easy disinfecting methods to be carried out during treatment.

Complementing advice with pharmacological management for the infection, will provide a holistic approach to treatment and increase the success rates in the curing of fungal infections.