History

The infection started in the First World War, wherein ringworm

of the groin was found amongst the troops in France. Damp and
crowded conditions increased the susceptibility and were ideal for
contagion and that a new fungus had been discovered from the
people of the war. Tinea Pedis was a disease of hygiene. In the
military, the highest rates of infection were found amongst the
officers who bath often and had been vulnerable to infection by
contact and softening of their skins—with their tight laced ankle
boots in a hot and damp environment, an ideal condition for
Tinea Pedis have flourished.
The first use of the term “athlete’s foot” was discovered in
December 1928, Dr. Charles Pabst claimed that the condition has estimated ten million sufferers, three
quarter are unaware of the infection. Further research of the medical condition, Tinea pedis was endemic
amongst students, specifically the people who are athletic.
“Athlete’s Foot, A Disease of Fitness and Hygiene.” (Homei A., Worboys M., 2013) Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK16 9220/

Etiologic Agent
Fungal infections are often common in our general population. With the prolonged period of treatment
and increase of infections, foot mycoses are considered as a major public health problem affecting one’s
life since theses fungal infections affect our lifestyle, environment and climatic conditions. The twentieth
century had a global increase in Tinea Pedis, due to this phenomenon it is likely due to the increase of
urbanization and the use of sports and fitness facilities. The increase prevalence of obesity and the
growing population.
Tinea Pedis is a superficial fungal infection of the epidermis cause by Trichophyton Mentagrophytes,
Trichophyton rubrum or Epidermophyton floccosum. The study from human volunteer suggested that the
fungi do not normally invade the skin, but a moist environment and maceration of the skin is an important
predisposing factor. There are three clinical forms of Tinea Pedis and the most common form is caused by
a variety of dermatophytes manifested as maceration, peeling and fissuring of the areas of the toes. The
second form—Trichophyton mentagrophytes manifests as vesicle and occasionally erosion on the instep
of the plantar surface of the foot and as the lesions heal, the plaques and scales form. The least common
form is chronic, diffuse scaling and hyperkeratosis of the plantar surface of the feet and heels. From time
to time, it is associated with a strong foul odor that manifests small crateriform depression of the sole and
heel.
“Prevalence, Etiology and Risk Factors of Tinea Pedis.” (Canadian Journal of Infectious Diseases and
Medical Microbiology., 2017) https://www.hindawi.com/journals/cjidmm/2017/6835725/

Pathophysiology
There are three major varieties of fungal infections of the foot, the interdigital infections involve
an ecological interplay between dermatophytes and bacteria. It is the most characteristic type of Tinea
Pedis with erythema, maceration, fissuring and scaling, most often seen between the fourth and fifth toes.
With maceration, erosive infections are cause by selection and overgrowth of bacteria that leads to
inhibition and accounts for the lower recovery of dermatophytes. Plantar surface infections consist of
widespread infection and localized scaling infections with series of intense inflammation. Inflammatory
or vesicular Pedis can be associated with an eruption called dermatophytid reaction that develops in the
palmar surface and sides of the fingers that involves papules, vesicles, bullae or pustules in symmetrical
fashion and this is an allergy or hypersensitivity response to the infection on the foot containing no fungal
elements.

Signs and symptoms

Patients with Tinea Pedis commonly have painful fissures, pruritic, and scaly sores between their
toes and sometimes have vesicular or ulcerative lesions. Since athlete’s foot is known as a skin infection,
the symptom of it is a reddened, cracked and a peeling skin with itching, stinging and burning sensation
with a strong odor.
Tinea Pedis Clinical Presentation” (Robbins C. 2018 Feb.) Retrieved from
https://emedicine.medscape.com/article/1091684-clinical#b2

Treatment
Treating have been recommended to alleviate symptoms, to reduce and limit the risks for
bacterial infections. There are two therapeutic treatment, first is a Topical antifungal therapy for most
patients and the second is the systemic antifungal agent, primarily for patients who fail with the
medication of topical therapy. Before treating the infected area, the skin should be cleaned and dried.
Treatment is initially aimed at removing the scaling tissue by the application of surgical spirit. After
clearing the scales, an antifungal dusting powder is applied. Improving hygiene is a must, socks and
footwear needs to be changed and preferably disinfected. One example of an antifungal medication is the
Melaleuca alternifolia essential oil, it reduces the symptom of the infection and have been shown to
produce a faster response to cure. A patient with chronic hyperkeratotic should be instructed to apply
medication to the bottoms and sides of his or her feet.
Dermatophyte Tinea Infections. (Goldenstein A., 2018) Retrieved from
https://www.uptodate.com/contents/dermatophyte-tinea-infections

Clinical Management
With nonpharmacologic measures, people who have been infected are encouraged to wear loose garments
made of cotton materials to lessen moisture away. Infected areas should be dried completely before
covering it with clothes like socks and patients should avoid walking bare feet as well as sharing
garments. Varieties of traditional agents without prescribed, specific antimicrobial function are still in use
like Whitfield’s ointment. Lesions that cover a substantial surface area tend fail to clear the treatment
using different topical agents should be considered for systemic therapy. According to the article topical
medications have better pharmacokinetics rather than the systemic counterparts. Combinations are from
different groups for wide coverage and also prevents emergence of resistance. The provided drugs for a
shorter duration with a higher dose has a less chance of development of resistance compared to lower
doses in a longer period. Furthermore, a drug with keratophilic and lipophilic property that is given with
higher dose tend to have reservoir effect and can lead to a better mycological clearance.
Clinical management involves the use of tropical antifungals in limited disease, and oral therapy
that is usually reserved for extensive care. Over the past few years, notable rise of incidence of chronic
dermatophyte infections of skin that have proven to be difficult to treat. Nevertheless, the updated
national, international guidelines lack on the management of these treatment with systemic antifungals are
verified.
“Management of Tinea Corpus, Tinea Cruris and Tinea Pedis.” (Sahoo A., Majahan R. 2016) Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804599/

Epidemiology (General)
Sources of this infection is our environment and our physical hygiene. The cases for fungal
infections were observed most in the spring and summer. During the increase of the season to frequency,
wearing of shoes causes heat and sweat to the feet which develops maceration. According to a study, the
prevalence of tine Pedis have sought
to people who are in regular
activities, full-time work, nail
traumas, reduced nail growth and
inadequate foot care. Physical
activities is also a risk factor for the
growth of infection. According to
another study, swimmers and
marathon runners have high rate of
clinical and subclinical infection. In
frequency, Tinea Pedis is the
world’s most common
dermatophytosis and 70% of the
population can be infected. Most
likely, males are affected compared
to females. The prevalence increases
with age and mostly occurs after puberty. The cases of tinea pedis were observed more in male.
The incidence of tinea pedis was drastically increased after 20 years old in tinea pedis survey. Therefore,
it is inevitable that tinea pedis cases increase by aging. The incidence of tinea ungium is increased in
proportion to aging and that was supported by this epidemiological study.

Epidemiology (Janssen Pharmaceutical, 2016) Retrieved from

http://mzch.c4m.jp/column/result/e_03.html
Epidemiology of Tinea Pedis. (Auger P., Marguis G., Attye A.) Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/8316260

Epidemiology (Philippines)
Within this study, it conducted at least 284 uniformed Philippine National Police personnel at
Camp Catitipan, Davao City Philippines. The study aimed to determine, identify and evaluate the
different factors that can lead to the development of the disease. Among the subjects, 31 percent came
from the combatant group while 69 percent were non-combatant. Males outnumbered females. The
overall prevalence of tinea pedis is 27 percent, almost three times higher than that expected from the
general population. For the combatant group, it was twice a higher positivity than the non-combatant
group. Occlusive footwear especially the leather combat shoes and the type of socks being used led to an
increased rate of infection. Other factors as poor drying habits of the feet and bathing barefoot added to a
higher risk of infection.

Prevalence of Tinea Pedis

Female
31%

Male
69%

Male Female

“The Prevalence of Tinea Pedis” (Lagda L., Visitacion L., N.D) Retrieved from
http://www.herdin.ph/index.php/component/herdin/?view=research&cid=36111