Condition

Athlete's Foot

Athlete's foot is a fungal infection of the skin on the feet. It causes itching, peeling and cracking, most often between the toes. You do not have to be an athlete to get it.
At a Glance

Athlete's foot is a fungal infection of the skin on the feet, and it shows up in three quite different patterns: soggy, cracked, itchy skin between the toes; dry silvery scale across the whole sole that looks exactly like ordinary dry skin; and a sudden crop of itchy blisters on the arch. Most cases clear with an antifungal cream from the pharmacy used twice a day for two to four weeks, and you have to keep going for a week or two after it looks better. The honest catch is that it comes back easily, because the fungus lives in your shoes and on the floors you walk on. The dry, scaly kind in particular is often moisturised for years before anyone realises it is fungus.

Key Facts

How CommonVery common. Somewhere around 15 to 25 percent of people have it at any given time, and most people get it at some point.
Who Gets ItAnyone. More common in men, in adults, in athletes, and in anyone who wears closed shoes all day or uses communal showers.
Chronic or CurableCurable, but it comes back easily. Plenty of people manage it on and off for years.
Rx RequiredNo. Over-the-counter antifungal cream clears most cases. Pills are used for the thick, scaly moccasin type and when the toenails are infected too.
ContagiousYes, but not strongly. It spreads through damp shared floors, shared towels and shared shoes rather than casual contact.
CostLow. A tube of terbinafine or clotrimazole cream is a few dollars, and that clears most cases.

Symptoms

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What athlete's foot looks like depends entirely on which pattern you have. Between the toes it is soggy and cracked. On the sole it is dry and scaly. On the arch it can be blisters.

What it looks and feels like

White, soggy, peeling skin between the toes — usually between the fourth and fifth toes first. The skin looks waterlogged and rubs away.
Cracks and splits — in the web spaces, which sting and can bleed.
Fine dry scale across the sole — silvery, powdery, often looking like nothing more than very dry skin, and often barely itchy.
Small itchy blisters — a sudden crop on the arch or instep, sometimes larger and sore.
Itch — usually worst just after taking shoes and socks off.
Smell — more with the between-the-toes type, and usually because bacteria have moved into the damaged skin alongside the fungus.
Thickened, crumbly or discoloured toenails — very often present at the same time, and usually the reason the skin keeps getting reinfected.

Where it shows up

  • Between the toes, particularly the outer two.
  • The sole, heel and sides of the foot — the moccasin pattern, in the shape a moccasin would cover.
  • The arch and instep — the blistering pattern.
  • One foot more than the other — common, and a useful clue that it is not simply dry skin, which is normally even on both feet.
  • The groin and the hands — the same fungus moved by hands or by pulling underwear on over infected feet. "One hand, two feet" is a classic pattern.

How it looks on different skin tones

On light skin, the affected skin usually looks pink or red under the scale. On brown and Black skin, it is more often brown, grey, purple or simply darker, and the scale can be the only obvious change. The white, waterlogged look between the toes is the same on every skin tone. After it clears, darker or lighter patches can stay for weeks to months — that is pigment change, not scarring.

Light
Medium
Brown
Deep

Several things cause scaly, itchy or blistering feet. If yours does not fit the description above, see Lookalikes near the bottom of this page.

Types

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Athlete's foot is not one rash. It shows up in three patterns that look nothing like each other, and two of them are regularly mistaken for something else entirely. Which one you have changes what to put on it and how long it takes.

Interdigital athlete's foot
Soggy, cracked, itchy skin between the toes
The most common pattern by far. The skin between the toes — usually the two smallest ones — turns white, soggy and soft, then peels and cracks. It itches and often smells. Bacteria frequently move into the cracks alongside the fungus, which is why it can get sore and start to smell strongly. This is also the pattern that most often spreads to the groin and to the nails.
Moccasin athlete's foot
Dry, scaly skin across the whole sole
Fine, dry, silvery scale spread across the sole, the heel and up the sides of the foot, in the shape a moccasin would cover. It often barely itches. This is the pattern people moisturise for years thinking it is dry skin, and the clue that it is not is that one foot is usually worse than the other, and the nails are often thickened too. It is the hardest type to clear with cream alone and the one most likely to need pills.
Vesicular (blister) athlete's foot
A sudden crop of itchy blisters on the arch
A sudden outbreak of small fluid-filled blisters, usually on the arch or the instep, sometimes larger and painful. It often flares in hot weather. It looks alarming and is easily mistaken for dyshidrotic eczema or a reaction to something. Soaks and a short course of drying treatment settle the blisters, and antifungal cream then clears the fungus underneath.

Causes & Risk Factors

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Athlete's foot is caused by dermatophytes — fungi that feed on keratin, the protein in the outer dead layer of skin and in nails. Trichophyton rubrum is the usual one. It is not a sign of poor hygiene. These fungi are common in the environment, and feet give them exactly what they want.

Shoes are the main reason feet are so vulnerable. A closed shoe worn all day is warm, dark and damp, and skin softened by sweat is far easier for fungus to get into. On top of that, you pick the fungus up from surfaces — communal showers, changing room floors, pool decks, gym mats, hotel bathrooms, and shared towels, socks and shoes. The fungus survives on those floors and in the lining of shoes for a long time, which is why treating your skin without dealing with your shoes so often ends in it coming back. Some people simply get it more than others: heavy sweating, wearing the same shoes every day, diabetes, poor circulation and a weakened immune system all make it more likely and slower to clear. Infected toenails are the biggest hidden factor of all, because they act as a reservoir that reinfects the skin as fast as you clear it.

What Hurts and What Helps

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What Makes It Worse

  • Wearing the same closed shoes every day. They never fully dry out, and the fungus lives in the lining.
  • Damp socks, and leaving feet wet between the toes after a shower. The web spaces are the last place to dry and the first place to get infected.
  • Sweaty feet, and shoes made of plastic or other materials that do not breathe.
  • Walking barefoot in communal showers, changing rooms and around pools.
  • Moisturising the sole and ignoring the fungus. This is the usual story with the dry, scaly moccasin type — years of foot cream on something that needed an antifungal.
  • Stopping the cream as soon as the itch goes. The fungus is still there for a week or two afterwards.
  • Untreated toenail fungus. If the nails are infected and nothing is done about them, the skin keeps getting reinfected no matter how carefully you treat it.
+1 more
  • Steroid creams. As with ringworm, a steroid calms the itch briefly and then lets the fungus spread.

Daily Habits That Help

  • An antifungal cream from the pharmacy, applied to the whole foot rather than just the obvious patch. Terbinafine, clotrimazole, miconazole and butenafine all work.
  • Drying carefully between every toe after a shower, including with a corner of the towel or a few seconds of a hairdryer on cool.
  • Wearing a different pair of shoes each day so each pair gets a full day to dry out.
  • Changing socks whenever they are damp, and choosing wool or a wicking synthetic over cotton, which holds moisture against the skin.
  • An antifungal powder or spray inside the shoes while you are treating the skin, so you are not walking back into the fungus every morning.
  • Sandals or flip-flops in communal showers and changing rooms.
  • Putting socks on before underwear, which stops fungus travelling from the feet to the groin.
  • Carrying on for a week or two after the skin looks normal, and getting the toenails checked if they are thick or discoloured.

Try at Home

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Most athlete's foot clears with a cream you can buy without a prescription. What you do with your shoes and socks matters as much as which tube you pick.

Drying carefully between every toe
Always
The web spaces are the last part of the foot to dry and the first place fungus takes hold. Use a corner of the towel between each toe, or a few seconds of a hairdryer on cool. It sounds trivial and it is one of the highest-value things you can do.
Rotating shoes and changing damp socks
Always
A shoe worn every day never dries out, and the fungus lives in the lining. Alternate two pairs so each gets a full day to dry, and choose wool or a wicking synthetic over cotton, which holds moisture against the skin.
Sandals in shared showers and changing rooms
Always
Wet communal floors are where most people pick it up in the first place, and where they pick it up again after treating it. Flip-flops in the gym shower, at the pool and in hotel bathrooms.
Strong evidence
The most effective cream you can buy without a prescription, and the shortest course — usually once or twice a day for one to two weeks between the toes. Put it on the whole foot, not just the obvious patch.
Clotrimazole 1% cream
Strong evidence
Cheap, everywhere, and effective. It needs a longer course than terbinafine — twice a day for four weeks — and people often stop too early because the itch settles in the first week.
Strong evidence
Works about as well as clotrimazole, over a similar four-week course. Also useful between the toes because it has some activity against the bacteria that often grow there alongside the fungus.
Strong evidence
Works the same way as terbinafine and just as well, usually once a day for two to four weeks. A good alternative if terbinafine is not on the shelf.
Moderate evidence
Weak at clearing an active infection but genuinely useful for keeping it away. Use it in your shoes and socks while you treat the skin with a cream, so you are not walking back into the fungus every morning.
Moderate evidence
For the dry, scaly moccasin type only. It thins the thick scale on the sole so the antifungal cream can actually reach the fungus underneath. On its own it does nothing to the fungus — use it alongside an antifungal, not instead of one.
Moderate evidence
For the blistering type and for very soggy skin between the toes. A 15-minute soak once or twice a day dries the blisters and the wet skin so cream can be applied to something other than a soaking surface. It does not kill fungus, so an antifungal is still needed.
Limited evidence
It does have antifungal activity, and studies at higher strengths show modest improvement. But it clears athlete's foot far less reliably than a standard cream that costs about the same, and it causes allergic rashes in a fair number of people. Worth knowing about, not worth choosing first.

When to See a Dermatologist

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Most athlete's foot clears with a cream from the pharmacy. Book a visit if:

  • Four weeks of proper antifungal cream have not cleared it.
  • The dry, scaly type covers the whole sole. This one often needs pills, and cream alone rarely finishes it.
  • The toenails are thick, crumbly or discoloured. Skin treatment will keep failing while infected nails are still there.
  • The foot is red or darkened, hot, swollen or increasingly painful, or there are red streaks spreading up the leg. That is cellulitis and it needs treating quickly.
  • You have diabetes, poor circulation, or a weakened immune system. A cracked foot is a serious infection risk in those situations, and this is worth getting seen rather than self-treating.
  • The blistering type keeps coming back.
  • You are not sure it is fungus at all, particularly if a steroid cream has already been on it.

What the visit gets you: a scraping that confirms whether it is actually fungus, which matters because eczema and psoriasis on the feet look very similar and are treated in the opposite direction. If it is fungus, you get the right drug, the right length of course, and a decision about whether the nails need treating too.

What Happens at the Dermatologist?+

Athlete's foot is usually recognised by looking, and a straightforward case between the toes is treated without any test. Testing earns its place when the diagnosis is in doubt, and especially before anyone commits you to a course of pills.

KOH scraping. The scale is scraped off with a blade and looked at under the microscope in the room, with a drop of potassium hydroxide to dissolve the skin cells and leave the fungus visible. It takes a few minutes and does not hurt. This is the test that separates athlete's foot from eczema, psoriasis and plain dry skin on the sole — conditions that look extremely similar and need completely different treatment. If you have been putting antifungal cream on a scaly sole for months with no change, this is the test to ask for.

Fungal culture. The same scrapings are sent to a lab and grown, which takes two to four weeks and names the exact fungus. It does not guide the first prescription. It matters when the KOH is negative but fungus is still suspected, when treatment has failed, or before starting oral antifungal tablets for a stubborn moccasin-type infection — because those tablets need weeks of treatment and it is worth knowing you are treating the right thing.

A bacterial swab. Taken when the skin between the toes is very soggy, sore, smelly or eroded. Bacteria often grow alongside the fungus there, and if they are the bigger problem an antifungal cream alone will not fix it.

Toenails are usually examined at the same visit, because infected nails are the most common reason skin treatment keeps failing. Nail testing is a separate step and is covered on the nail fungus page.

Prescription Treatments

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Used when a cream has been tried properly and has not worked, when the whole sole is involved, or when the toenails are infected too and the skin keeps getting reinfected.

Which pattern looks like your feet?
Showing everything below.
Topical prescriptions
Strong evidence
A prescription-strength azole cream, once a day. Worth asking for when four weeks of an over-the-counter cream has not finished the job.
Topical prescriptions
Strong evidence
Particularly useful for the soggy, smelly kind between the toes, because it treats bacteria as well as fungus — and that mix is usually what is going on there when it is sore and smells.
Topical prescriptions
Strong evidence
A newer prescription cream, once a day for two weeks between the toes — one of the shortest courses available. The main drawback is cost, since it is usually more expensive than the older creams.
Topical prescriptions
Moderate evidence
Works by a different route from the other antifungals, which makes it a good option if the azole creams have irritated your skin. Twice a day for up to four weeks.
Pills and injections
Strong evidence
The usual pill when the dry, scaly type covers the whole sole, or when creams have failed. Two weeks is typical for skin. If the toenails are infected too, the course is much longer and liver blood tests are checked.
Pills and injections
Strong evidence
An alternative pill when terbinafine is not suitable, usually a one to two week course for skin. It interacts with a long list of other medicines, so take your full medication list to the appointment.
Pills and injections
Moderate evidence
Taken once a week for four to six weeks. It is a third choice for athlete's foot — it works, but less reliably than terbinafine or itraconazole against these fungi.

What to Expect

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Step 1
The first week

The itch and the soreness settle. The skin still looks peeling and scaly.

Step 2
Weeks two to four

The skin between the toes closes up and the scale drops away. Most between-the-toes infections are clear by now.

Step 3
The dry, scaly type takes longer

Moccasin athlete's foot often needs four to six weeks of cream and frequently does not clear at all without tablets. If the whole sole is involved, expect a longer road and a conversation about pills.

Step 4
A week or two after it looks normal

Keep applying. This is the step that decides whether it comes back next month.

Step 5
The nails are a separate job

If the toenails are thick or discoloured, they will not improve with the skin, and they will keep reinfecting it. Nails take twelve to eighteen months to grow out even when treatment works.

Step 6
The long view

Athlete's foot comes back for a lot of people, and that is not a treatment failure. Drying between the toes, rotating shoes and using a powder in the shoes are what keep it away, and they are worth doing permanently.

Complications

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Athlete's foot is a nuisance rather than a danger for most people. A few things can follow if it is left.

Bacterial infection and cellulitis
Cracks between the toes are a common way in for bacteria. The foot or lower leg becomes red or darkened, hot, swollen and painful, sometimes with fever. This is the reason athlete's foot matters more in people with diabetes or poor circulation, and it needs antibiotics quickly.
Toenail fungus
The infection moves into the nails, where it is much harder to treat and takes a year or more to grow out.
It spreads elsewhere
To the groin (jock itch), to the hands, and to other people through shared floors and towels.
An id reaction
An itchy blistering rash on the hands or elsewhere that appears in response to the fungal infection on the feet, without any fungus being present in the rash itself. It clears once the feet are treated, but it causes a lot of confusion in the meantime.
Diabetic foot complications
In someone with diabetes and reduced sensation, a small crack that would be trivial otherwise can become a serious wound. This is the one situation where athlete's foot is worth treating promptly rather than casually.
Marks left behind
Darker or lighter patches after it clears, most noticeable on brown and Black skin. They fade.

Lookalikes

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Scaly, itchy or blistering feet are not always fungal, and this is one of the places where the wrong guess costs the most time. A scraping settles it in minutes.

  • Plain dry skin — the biggest confusion with the moccasin type. Dry skin is usually even on both feet, has no fine silvery scale up the sides, improves within days of moisturising, and does not come with thickened nails. Fungal scale is often worse on one foot, creeps up the side, and does not respond to cream.
  • Eczema on the feet — itchy, red or darkened, sometimes weeping, and it usually spares the spaces between the toes, which is where athlete's foot likes to start. It gets better with steroid cream, which would make fungus worse.
  • Dyshidrotic eczema — deep, intensely itchy small blisters on the arch, soles and sides of the fingers. Nearly identical to blistering athlete's foot. The difference is that dyshidrotic eczema is usually on the hands too, and a scraping shows no fungus.
  • Psoriasis of the soles — thick, well-defined, silvery plaques, often symmetrical on both feet, and usually with patches on the elbows, knees or scalp and with nail pitting.
  • Contact dermatitis — a rash in the shape of the shoe or the strap, from a dye, rubber or glue in the footwear. It stops at the edges of what touched the skin.
  • Pitted keratolysis — small shallow pits across the sole with a strong smell, caused by bacteria rather than fungus, in people with sweaty feet. Treated with antibacterial rather than antifungal treatment.
  • Erythrasma — a bacterial infection between the toes that looks very like the fungal kind but is browner and less soggy. It responds to different treatment.
  • Juvenile plantar dermatosis — shiny, cracked, glazed-looking skin on the front of the sole in children, from damp shoes and socks. It is not an infection.
FAQ+
Can I get athlete's foot if I don't play sports?Yes. The name is misleading. It comes from closed shoes, damp feet and shared floors, not from exercise.
How long does athlete's foot take to clear?Two to four weeks with cream for the between-the-toes type. The dry, scaly moccasin type often takes four to six weeks and sometimes needs pills. Keep applying for a week or two after it looks normal.
Is it contagious to my family?Mildly. It spreads through shared showers, bath mats, towels and shoes rather than casual contact. Separate towels and no shared footwear is enough.
Why does it keep coming back?Usually one of three things: the fungus is still living in your shoes, your toenails are infected and reinfecting the skin, or treatment was stopped as soon as the itch went.
Why is only one foot affected?That is common with fungal infection and is actually a helpful clue. Dry skin and eczema are usually even on both feet.
Can I use hydrocortisone for the itch?No. It will help for a day or two and then let the fungus spread. If the itch is bad, an antifungal cream will settle it within a few days.
Do I need to throw out my shoes?Not usually. An antifungal powder or spray in them, and letting each pair dry fully for a day between wears, is normally enough. Old shoes you wore daily through a long infection are worth replacing.
Does a vinegar or Epsom salt soak work?Soaks can dry out soggy skin between the toes and make it feel better, which is genuinely useful for the blistering type. They do not kill the fungus, so a cream is still needed.
Does tea tree oil work?It has some antifungal activity, and studies at higher concentrations show modest results, but it clears athlete's foot far less reliably than a standard antifungal cream that costs about the same. It also causes allergic reactions in some people.
Why do my toenails look bad too?Because the same fungus has moved into them. Nails need much longer treatment, usually tablets, and they take twelve to eighteen months to grow out even when the fungus is dead.
Why did I get jock itch at the same time?Because you moved the fungus from your feet to your groin, usually by pulling underwear on over your feet. Putting socks on first prevents it.
Is it dangerous?For most people, no. For someone with diabetes, poor circulation or a weakened immune system it is worth treating promptly, because cracks in the skin are a route in for bacteria.