InStep Foot Clinic

The Specialists in
Podiatric Medicine

Opening Hours

Monday: 8.00am - 5.00pm
Tuesday: 9.00am - 4.00pm
Wednesday: 8.00am - 8.30pm
Thursday: 8.00am - 6.00pm
Friday: 8.00am - 2.00pm

Telephone:

01780 783982

Fungal Foot Infections



Introduction
Fungal foot infection (FFI) is the most common infection on the foot. It is rarely life threatening but it does affect one’s quality of life especially when it affects the toenails.

Approximately 34% of the European population has FFI either as tinea pedis between the toes as Athlete’s Foot, onychomycosis of the nails or both. FFI is more common in nails and the incidence increases with age. Fungal elements are acquired from the ground, where they lie dormant for long periods. Fungal infection resides on the plantar surface before spreading in between toes and eventually into the nails. If the conditions are optimal they start to germinate within 24 hours. Fungal Nail Infection rates increase with age and are seen most in the over 50s. Nails that have been damaged are particularly susceptible to fungal invasion.

Diagnosis of Fungal Foot Infections

Not every nail that looks as if it is affected with fungus has a fungal infection. Trauma, caused by a one-off accident or everyday impact from footwear can damage nails to give the appearance of a FFI. Most diagnoses are made following a visual inspection of your feet. Sometimes we take samples to culture here at InStep Foot Clinic. We also take samples as requested by your GP before the prescription of oral drugs such as Terbinafine (Lamisil ® AT).

Treatment of Fungal Foot Infections

The current best practice for the treatment of FFIs is to make the foot as inhospitable as possible for the fungus to survive and thrive. We do this as follows:

For Athlete’s Foot (tinea pedis) feet should be washed and dried very thoroughly every day. Please pay particular attention to drying between your toes. Socks, preferably cotton, should be changed daily. Use the antifungal preparation as prescribed by your Podiatrist. The condition should clear up after several days. If it does not, please make an appointment to see our Podiatrist.

For Fungal Nail Infections (onychomycosis) your Podiatrist will remove as much of the infected nail tissue as possible. This is not usually uncomfortable. Your nails will look much better after this treatment which will make you feel more confident about your feet immediately. We will then apply an anti-fungal preparation and ask you to continue its daily use for 6-8 weeks; after which we will review your progress. After 3 months you should start to see an improvement in the condition of your nails. The whole treatment may take up to one year.

After Treatment For Fungal Foot Infections

There is a slight chance that the appearance of your nails will not return to ‘normal’ following the treatment regime even though the active fungus has been destroyed. The reason for this is that the nails have also suffered some trauma; and, it is this which is responsible for their appearance. Also, please be aware that FFI’s are very likely to recur in the future unless you continue to limit the chance of re-exposure. Fastidious foot hygiene and a prophylactic antifungal spray will help.
Generic Name
Proprietary Name
Remarks

Imidazole

Miconazole
Clotrimazole
Econazole
Ketoconazole

 

Daktarin
Canesten
Pevaryl
Nizoral, Daktarin Gold

Much more effective than the placebo.Slightly lower cure rate than allylamines. Cheaper than allylamines. Oral form, Nizoral has been suspended by the European Medicines Agency due to high risk of liver toxicity.

Allylamines

Terbinafine
Triethanolamine

Lamisil ®AT
Mykored

Much more effective than the placebo. Higher cure rate than Azoles. More expensive than Azoles. Equally effective in all its formulations. Can have rapid antifungal effects within 48 hours and a single application can last up to 3-6 weeks. Lamisil Once is equally effective to traditional application cream. Twice as effective as Griseofulvin.

Others

Griseofulvin

 

Grisol AF

Older oral antifungal drug effective in dermatophyte infections. 50% less effective than terbinafine. Useful for patients unable to take terbinafine. Not to be used to treat non-dermatophyte moulds due to limited spectrum of activity
Undecenoates
Mycota
Less effective than azoles & terbinafine
Tolnaftate
Mycil
Less effective than azoles & terbinafine
Melaleuca
Tea Tree Oil
Use not recommended by NICE. Propensity to cause irritancy & allergy remain an issue. 3.8% of subjects developed dermatitis.