Athlete's foot - when is it time to see a doctor?
September 19, 2016 5:50 AM   Subscribe

I've had athlete's foot for 5-6 months now, but I didn't recognize and start treating it until more recently. I've tried multiple treatments for the last several weeks, and while some symptoms have improved, the infection seems like it's still spreading. How long can athlete's foot take to heal when a treatment is actually working? When should I conclude that my OTC treatments are not working and it's time to see a doctor?

I've read previous AskMe threads on athlete's foot, but am wondering more specifically about when it's really necessary to see a doctor for this (assuming I want to kill this once and for all asap).

Some background on my specific case: Once I realized I had what appears to be athlete's foot, I tried Lamisil Once (terbinafine) first, which kept it mostly in check for a couple of weeks, but it came back with a vengeance after a few days of wearing my old hiking boots. Then I tried clotrimazole twice a day between my toes for 1-2 weeks, to absolutely no avail. At this point, there was extensive peeling and redness between most of my toes and moderate itching. I switched to Lamisil DermGel (terbinafine again), applying once a day between the toes and over the entire sole/heel/sides of my feet after washing my feet with soap and water, soaking in vinegar (1:2 or 1:3 dilution) for 30 minutes, and fan drying my feet. I also put Daktarin (miconazole nitrate) powder on my feet before putting my socks on each morning, and I switched from wool to moisture-wicking athletic socks. In the first few days of this new treatment, I noticed new peeling on the balls of my feet (previously only had peeling between my toes). However, the between-the-toes situation seemed to improve very marginally so I continued with the Lamisil. Eventually I stopped the vinegar treatment as it seemed to make my feet itchier. In week two of Lamisil treatment, mild new peeling appeared between two pairs of toes that previously looked okay. After two weeks of Lamisil treatment, the peeling and redness between my other toes had reduced but not disappeared, and the peeling on the bottom of my feet pretty much cleared up, but now spots were appearing on my heels that looked like precursors to peeling. In week three of Lamisil, I increased the foot washing and Lamisil application to twice daily (upon realizing that the exact same product gives different instructions in the US than in NZ, where I am currently). I also started swabbing my feet with Listerine before application of the medication. As of now (start of week four on Lamisil), my heels are definitely peeling, I think I see spots on the balls of my feet again, and although no more new peeling/redness has appeared between my toes, I can still see the ring of extra skin around the edges of the previous peeling.

Sorry for the novel on my feet, but if you've had athlete's foot before and successfully treated it, does this sound anything like your experience? Does it sound like my treatments aren't actually working, or are they probably working but just very very slowly? If it sounds like they're not working, are there other OTC meds that have worked for people for whom terbinafine and clotrimazole failed, or should I just go straight to a doctor for a prescription of some sort? (Some people on previous Asks mentioned tolnaftate, but I don't think I've seen that here in NZ....) All things being equal I'd prefer to avoid shelling out big bucks for a doctor and prescription here if I can (insurance won't reimburse until much later), but I'm willing to pay if it's likely that the infection would go away completely much faster. Weeks of OTC Lamisil isn't turning out to be particularly cheap anyway :/
posted by st elmo's fire to Health & Fitness (18 answers total) 2 users marked this as a favorite
I'm in the UK and don't know how the different treatments compare, but I spent weeks trying to treat my not massively serious case with OTC stuff to no avail whatsover. Finally went to the doc who gave me something on prescription that started working within days and wished I'd saved myself lots of money by doing that in the first place (tho this was on the fabulous Scottish NHS so not even any prescription charges).
posted by penguin pie at 6:14 AM on September 19, 2016

Not to be alarmist, but there are drug resistant fungal strains. You have tried a bunch of stuff that's not working. It's probably time for a doctor.

A doctor can prescribe you a systemic anti-fungal, if needed. Doctors can also check for concurrent infections and do blood work to check for underlying issues.

If I'd try anything first (only out of desperation), it's a couple days of using the OTC med treatment without the extra washes (vinegar, listerine, etc) that may be irritating your skin. And I'd wear nothing but flip flops to keep the area dry.
posted by zennie at 6:29 AM on September 19, 2016 [2 favorites]

I've had good luck with Tinactin (Tolnoftate). It clears up my mild athlete's foot or jock itch within days. Your condition sounds like it may be time for a doctor visit. Have you tried going barefoot or wearing sandals? Shoes provide a wonderful environment for fungi.

Here's another remedy I noticed recently. I don't know if it works.
posted by H21 at 6:35 AM on September 19, 2016 [1 favorite]

Anecdata: I had a fungal rash on my chest that turned out to be similar to AF for ~6 months, which I tried unsuccessfully to treat with OTC meds. I ended up going to my doctor, who prescribed a moderately priced, generic anti-fungal/steroid combination cream that knocked it out seemingly for good in less than two weeks.

TLDR - fungal infections can be tenacious, the big guns are low risk and not very expensive, and if you have insurance you should go for it.
posted by ryanshepard at 6:46 AM on September 19, 2016

This sounds way beyond my experiences with athlete's foot. I would see a doctor.
posted by needs more cowbell at 6:48 AM on September 19, 2016

Yes, go see your doctor. It might be a resistant strain of fungus, it might be something that isn't actually athlete's foot...a doctor, specifically a dermatologist, can really help you here.

Also, you mentioned that you reinfected yourself after wearing your old hiking boots - you might want to invest in an ultraviolet shoe sterilizer, or a spray-on sterilizer like for bowling shoes. It's not enough to clear the fungus from your skin; you need to be sure shoes, socks, towels, shower floors, etc. are fungus-free as well.
posted by Rosie M. Banks at 6:48 AM on September 19, 2016 [3 favorites]

Exactly as Rosie M. Banks said: you may be reinfecting yourself over and over because you can't sterilize the boots properly. Time for the doctor, and sadly, maybe time for another pair of boots.
posted by fiercecupcake at 6:51 AM on September 19, 2016 [6 favorites]

Yes, see a doctor. But also, here is my standard advice for this situation.
posted by seasparrow at 7:09 AM on September 19, 2016

For me, when treatment is working you basically get NO new outbreaks and things heal up within a week or two. On my feet peeling is sort of the last stage and can last longer but if it's not accompanied by itching/redness/swelling I presume it's part of the healing stage and not the infection stage.

The big thing, as people have said, is avoiding reinfection. I changed socks a few times a day whenever my feet would get sweaty and I tossed out old shoes that I didn't seem to be able to get "clean
" You can also try a shoe spray of the sort they have in bowling alleys (sort of spray anti0fungal) but you really do need to not only get shoes properly dried out but maybe swap shoes around so that they have time to dry between wearings.
posted by jessamyn at 7:44 AM on September 19, 2016 [1 favorite]

Is it possible you are allergic to your socks, are they manmade (now, I mean) ? I ask because my father had for several years a persistent rash on his feet that resisted any and all attempts to kill it off using antifungal / antibacterial agents.

He then switched to all-cotton socks, and his rash disappeared almost instantly. Obviously, YMMV.
posted by northtwilight at 8:36 AM on September 19, 2016

I tried OTC stuff for several months, but they didn't work for me. What did work was assiduously cleaning my shower floor with powdered Ajax and bleach after every shower, thoroughly drying my feet after every shower with a hair dryer or a fresh, sterilized (bleached) towel, throwing away my favorite pair of shoes (I rarely rotated from that pair and suspect I was just reinfecting myself), soaking my feet for 10 minutes in a bucket of full strength vinegar in the morning and a 1:1 solution of bleach and water before bed, rotating between shoes, and going barefoot at home whenever possible. I also drastically cut down the amount of refined carbs and sugars I was consuming. My case sounded about as bad as yours and it cleared up in less than two weeks. If it hadn't, I was planning on going to the doctor.
posted by LuckySeven~ at 9:05 AM on September 19, 2016 [2 favorites]

The pills are so good these days and they don't have the liver damage side effects they used to. Prescriptions in NZ are so reasonable, the pills start working in days, and once it's gone it's gone. The fungus will eventually start damaging your nail beds so why wait?
posted by shelleycat at 9:22 AM on September 19, 2016 [1 favorite]

Try De-colorized Iodine (Walgreens has it).
posted by 445supermag at 12:30 PM on September 19, 2016

Thanks all, sounds like the general consensus is that seeing a doctor would probably be worth it at this point. Follow up question on the shoes/socks issue since that's been pointed out several times: at what point in the treatment/recovery does it make sense to get new shoes and socks to prevent re-infection? I did stop wearing my hiking boots after they seemed to cause this outbreak, but I've still had to wear my old mesh sneakers every day since then. Unfortunately I do have to wear closed-toe shoes several hours a day as I work in a laboratory. I didn't get new shoes yet because I figured as long as I had signs of active infection, I'd just be inoculating the new shoes with fungus too. Am I right that it makes sense to wait until near the end of the treatment when the infection seems to be completely gone (or at least until I'm more sure the treatment is actually working)?
posted by st elmo's fire at 1:34 PM on September 19, 2016

Can you wear crocs? They're pretty disinfectable and I'd consider them lab-safe, though your lab manager may disagree. At the least, get some more cotton socks and change them out mid-day. Bleach them at wash time.
posted by zennie at 3:20 PM on September 19, 2016

It would also be good to know that you're not allergic to the active ingredient in the topical anti-fungals (I am).
posted by heatherlogan at 3:56 PM on September 19, 2016

Start wearing new shoes and socks on the first day you begin treatment. Buy some cheap slip on shoes like Van's or Slides and rotate them daily or more often if necessary (over here in the States, stores like Payless Shoes sell inexpensive, knock-off versions). You can even buy cheap inserts for each pair until your treatment is complete if you're worried about contaminating your new shoes. If your feet get sweaty at work, make sure you have spare socks to change into on your breaks. Don't wear shoes at all at home. Your goal is to keep your feet dry as a bone all day long.

My feet hate acrylics or rayon blends (even those that supposedly "wick" moisture away), and wool socks; I also don't do well with Crocs or plastic type shoes. You have to pay attention to your feet and figure out what works best for you. If a particular type of sock or shoes make your feet sweat, avoid! And if you frequent a gym, always always ALWAYS wear flip flops when you're not wearing your workout shoes, even in the shower. I was careless about this and I'm certain that I got infected that way as a result.

After showers, go through your entire routine, including makeup, before handling your feet. Feet last. Always. Use completely separate towels for your feet and make sure your thoroughly wash and dry your hands after touching your feet so you don't inadvertently spread it to other parts of your body. If you're diligent about rotating, sterilizing your shower floor, and keeping your feet dry, you shouldn't suffer a re-infection while under treatment. Good luck.
posted by LuckySeven~ at 4:17 PM on September 19, 2016

My husband didn't bother replacing anything when he finally got the pills. And his years long, well entrenched, quite widespread infection was cured by the medication and never came back. And he wears neoprene orthotic inserts (which are sweaty) and closed shoes most of the time (because of the orthotics), as well as spending a lot of time in various sports shoes/hiking boots/etc. Now that there's no infection and no resulting damage to his skin, his skin barrier and immune system are good enough to keep it out. YMMV of course, but washing all your socks in hot water and proper detergent should be enough. This fungus is already all around you in the environment after all.
posted by shelleycat at 9:33 AM on September 20, 2016

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