Athlete’s foot

“Athlete’s foot” can sound a bit puzzling. It isn’t a commonly used term in Poland, but it’s one our American colleagues use all the time. Athlete’s foot is simply a fungal infection of the feet that has a characteristic appearance. Why does it occur in children with clubfoot, and how can you deal with it? Find out!

Why “athlete’s foot”? It’s a fascinating term—and in fact it doesn’t apply only to athletes, even though that’s where it started. The name comes from the fact that athletes’ feet were prone to chafing and minor skin injuries due to prolonged wearing of damp, sweaty shoes. Using shared locker rooms, swimming pools, and showers also helped spread this dermatological problem.

CAUSES OF INFECTION

Casting and a foot that’s tightly “sealed” inside a cast, followed by Mitchell boots—any prolonged immobilization of the foot—can promote moisture buildup and contact-related fungal overgrowth (it’s rarely a whole-body fungal infection, though it can happen). Why is the risk higher in children with clubfoot?

• prolonged cast wear
• poor-quality materials used during casting (e.g., low-grade synthetic padding)
• inadequate foot hygiene between cast changes
• long hours in the foot abduction brace (often 23 hours/day in the initial phase)
• the boot’s silicone insert (medical-grade silicone), which can trap sweat and heat up
• limited ventilation inside the boot
• socks worn most of the day (especially those with a high proportion of synthetic fibers)
• sweaty feet (hyperhidrosis)
• minor skin injuries (chafing at the heel, on the top of the foot)
• not drying the feet thoroughly after bathing.

Warmth, sweat, and moisture promote the development of infection.

Athlete’s foot can be caused by different types of fungi, including species from the genera Trichophyton, Epidermophyton, and Microsporum, which you can pick up, for example, at a swimming pool. But it’s hard to link a small child wearing an abduction brace with going to the pool. So… take a look at your own feet, Parent. Fungal infections like to spread from person to person through contact with the fungus—so your hands can carry and transfer these organisms, too.

TYPICAL SYMPTOMS

Athlete’s foot is usually fairly easy to recognize. Typical symptoms include:

• redness between the toes, often pink to raspberry-red
• small cracks between the toes and on the sole of the foot
• small fluid-filled blisters, sometimes with bacterial superinfection (rare)
• skin maceration (white, waterlogged skin)
• peeling/flaking of the skin (fine, powdery scale) and dry patches on the soles and between the toes
• itching (children don’t always report it, but rubbing the soles may signal a problem)
• an unpleasant odor (sweetish, foul smell)
• red, diffuse patches on the soles of the feet
• yellowish toenails (yellowing with grayish, greenish, or bluish tones) occurring along with the symptoms above
• nail splitting/peeling (delamination) with similar discoloration as above

In infants and young children, the presentation can be less typical—more often it’s simply persistent redness and scaling, which may be mistaken for mechanical irritation.

In children, athlete’s foot is sometimes mistaken for:

• allergic contact dermatitis (e.g., a reaction to heat inside the boot, the boot material, or the sock fabric)
• dyshidrotic eczema (pompholyx)
• bacterial superinfection (often with honey-colored crusts)

If you’re unsure, a mycological swab/culture can clarify the diagnosis.

TREATMENT

Thorough hygiene and topical treatment usually work very well—but they require consistency. Treatment typically lasts 14 to 28 days (do not stop when symptoms improve!).

• Do not apply creams, ointments, or lotions to your child’s feet—this isn’t necessary and may increase the risk of fungal overgrowth.
• Wash the feet with activated charcoal soap with the shortest possible ingredient list, or with bay leaf soap.
• Dry the feet very thoroughly after bathing (especially between the toes).
• Dry with paper towels rather than a cotton towel.
• Change socks twice a day.
• Wash socks at 60°C.
• Disinfect the inside of Mitchell boots (wipe with gauze moistened with e.g. Octenisept or colloidal silver/nanosilver).
• For young children, you can use lavender essential oil (we recommend doTERRA because of its composition—we’ve tested it); for older children, apply tea tree oil to the affected skin.
• For children who wear regular shoes, you can use an antifungal spray inside the footwear.
• Apply clotrimazole ointment/cream in a very thin layer twice daily for 2–4 weeks.

WHEN TO SEE A DOCTOR URGENTLY

• no improvement after 10–14 days
• swelling, pus, or fever develops
• a walking child complains of pain and refuses to bear weight on the foot
• the changes involve the toenails
• a severe, very itchy rash appears and the child is scratching intensely

The information in this article is for educational purposes only and does not replace an individual medical consultation. If symptoms persist, worsen, or any concerning signs appear, you should consult a doctor—even if the article describes possible ways to address the problem.

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MEDICAL RESEARCH & MEDICAL SOURCES:

1. Likness L.P.: “Common Dermatologic Infections in Athletes and Return-to-Play Guidelines”
2. Moriarty B., Hay R., Morris-Jones R.: “The diagnosis and management of tinea.”
3. Al Hasan M., Fitzgerald S.M. et al.: “Dermatology for the practicing allergist: Tinea pedis and its complications”. Clin Mol Allergy. 2004 Mar 29;2(1):5. doi: 10.1186/1476-7961-2-5. PMID: 15050029; PMCID: PMC419368.
4. Hirschmann J.V. et al.: “Pustular tinea pedis” Journal of the American Academy of Dermatology, Volume 42, Issue 1, 132 – 133
5. Kaushik N., Pujalte G.G.A. et al.: “Superficial Fungal Infections.”
6. Bell-Syer S.E.M, Khan S.M. Torgerson D.J.: “Oral treatments for fungal infections of the skin of the foot (Review).”