Athlete's foot and toenail fungus

Athlete's foot (tinea pedis) is a fungal infection of the skin on the feet. The fungus grows where it is warm and damp: closed shoes all day, sweaty feet, wet socks and small breaks in the skin. In Puerto Rico’s humid heat it is very common.

It spreads on wet floors such as gym showers, pools and locker rooms, and by sharing towels or shoes. Left untreated, the fungus can spread to the toenails.

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Athlete's foot and toenail fungus are handled in a US$79 doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. The lab and the pharmacy charge separately. See all prices.

The most common signs are:

• Cracked, peeling or flaking skin between the toes or on the side of the foot
• Itching or burning on the feet
• Redness
• Blisters
• Yellow, thick or brittle toenails if the fungus has reached the nails

Athlete's foot usually improves with an antifungal cream, powder or spray. Keep using it for 1 to 2 weeks after the skin looks clear so it doesn’t come back. If it isn’t better in 2 to 4 weeks, the doctor decides whether you need a prescription medicine.

In the meantime, dry your feet well, especially between the toes; wear cotton socks and change them when they get wet; alternate shoes so they dry out; and wear sandals in public showers and pools.

When the fungus reaches a nail, the nail thickens, gets white or yellow streaks and breaks easily. It is harder to treat than athlete's foot: the most effective treatment is an antifungal by mouth for about 2 to 3 months for toenails, and even then it clears the fungus in only about half of people. A new, clear nail can take up to a year to grow.

These oral medicines need blood tests to check the liver. If the doctor decides that treatment is appropriate, we give you the lab order and go over the results with you in a follow-up visit. Don’t share nail clippers or manicure and pedicure tools. If what hurts is the edge of the nail digging into the skin, see ingrown toenail.

Diabetes can damage the nerves in the feet, so you may not feel a wound or an infection until it is advanced. Small problems can become serious if they aren’t treated early. Check your feet every day and don’t go barefoot.

If you have diabetes or poor circulation and see a wound, a blister that isn’t healing, redness or swelling on your foot, you need to be seen in person soon. We can advise you by video, but a wound on a diabetic foot needs an in-person exam. See type 2 diabetes.

Scratching and cracks can let bacteria in and cause cellulitis. For your safety, go to the emergency room or call 911 if you notice:

• A swollen, warm, red foot, with red streaks moving up the leg
• Pus or drainage, with fever
• A wound, blister or redness on the foot if you have diabetes, especially if it looks dark or smells bad