Health Matters | News, Sports, Jobs - Marquette Mining Journal
Conway McLean, DPM, Journal columnist
When any popular entertainment centers on some infectious disease, chances are good it's some epidemic (or even pandemic?). As we all know, movies are not reality. When it comes to infections in the real world, some of the most common everyday problems are due to a fungus. Most fungal organisms like a dark, moist environment, like your garden variety mushroom. And the inside of your shoe is a wonderful habitat.
With the increasing temperatures of summer upon us, activity levels are rising as well. Moisture levels naturally rise, creating a wonderful place for fungus. These are opportunistic infections, and are out and about, simply part of our environment. To flourish, they simply need the right opportunity. A closed-toe shoe, a sweaty foot, a shoe material that doesn't breathe, all these are part of the complex equation leading to the development of a fungal infection of the foot.
Naturally, as with all things, genetics is a huge part of this formula. Some people pretty much will never get one of these. The corollary is true as well. Genetics also determines how much your feet perspire, this being a critically important factor. Those with greater production are at a disadvantage when it comes to these frequently-developing skin conditions.
Most of us don't appreciate all that fungal organisms do for us. They are nature's recyclers, returning all things to the earth. Fungi are also necessary for such popular items as beer, wine, cheese, and bread. And they are everywhere. We are not even certain how many varieties of fungi exist, although we know they are ubiquitous in nature, meaning they are everywhere, including inside your shoe.
Fungi behave rather like a plant, moving only slowly, gradually. Some have said bacteria are more like mammals, moving faster with a higher metabolism. The mold that develops on a shower curtain is a type of fungus as is the portabello on your sandwich at a neighborhood bistro.
The medical term for a fungal infection of the skin on the foot is tinea pedis, colloquially referred to as an athlete's foot infection. It is one of the most common skin conditions experienced by humanity (even making the top 10!). When it occurs in the foot, the skin changes develop either between the toes or in the arch and bottom of the foot. Both types are common and often under-reported, unrecognized, and consequently, under-treated.
Infections in these two areas behave and look very differently, with varied consequences possible. When seen between the toes, there tends to be redness, cracks in the skin, and small, fluid-filled blisters. These lesions can be quite uncomfortable, painful even. More importantly, these openings in the skin can let bacteria in, resulting in a secondary bacterial infection. The conclusion: fungal infections can have serious consequences.
A very common reason for a chronic athlete's foot is the presence of onychomychosis, the dreaded infection of toenails from this all-too-common organism (with nail fungal infections having reached epidemic proportions). It rather makes sense, having a reservoir of fungal organisms hanging around at the end of each toe should lead to a skin infection. Although tinea pedis is noticeably easier to treat than the nail infection, many people tend to have recurrent problems with tinea as long as their toenails remain infected.
Because of their impaired immune system, people with diabetes need to take tinea infections seriously since athlete's foot can produce small cracks in the skin, blisters, or various kinds of defects. Bacteria are more likely to gain a foothold when the individual is immuno-compromised as with diabetes. The consequence is that a fungal skin infection can, and has, led to infection and amputation. A dedicated and thorough plan of care for tinea is necessary in the face of diabetes.
Numerous factors are involved in any discussion of treatment, with the largest being one's genetic makeup. Some have a predisposition for fungal infections and theirs is an uphill battle. For others, it's a rare occurrence and easily dispatched. From the material composing your shoe gear to the surfaces you walk on, the age of your tennis shoes to your nutrition, all these and more play a part.
The most obvious treatment, one that is sometimes sufficient, is a topical over-the-counter anti-fungal medicine. Again, for some people, some of the time, this may be enough. If inflammation of the skin has developed and itching or irritation are experienced, the addition of a topical steroid is common. A prescription antifungal medication is sometimes required.
Critical to this discussion is the opportunistic nature of these organisms. Depriving them of the opportunity to replicate can be enough to resolve the condition and is helpful in any treatment plan. An environment less hospitable to fungi means less problems with tinea infections.
Shoes tend to build up microbes over time and since they are impossible to sterilize, old shoes can be a source of reinfection. Certain shoe materials are less conducive to air flow providing a better situation for fungal microbes. Even sock materials are important. Those that wick moisture away from the skin keep the skin drier and less susceptible to tinea.
The type of fungi leading to many skin structure infections are spore formers, in which the microbe goes into a kind of hibernation, forming a dormant spore. Unfortunately, this allows the fungus to withstand difficult conditions. Too often, people go to great measures to resolve a fungal skin infection, only to be reinfected by their shoes. A dedicated product for this purpose or even a shoe sterilizing device is needed by some.
To those who have problems with excess foot perspiration, they must deal with a real impediment to fungus-free feet. Changing socks frequently is a necessity, with the addition of a moisture-absorbent innersole beneficial. Even a foot powder can help to absorb perspiration inside the shoe. And since it takes more than eight hours for a pair of shoes to dry thoroughly, it is recommended you not wear the same pair of shoes two days in a row.
Although tinea pedis has been the subject of innumerable jokes, it can be a serious matter. Besides, who wants to live with a fungus among us? Although some forms of athlete's feet are quite subtle and easy to miss, medically-speaking, living with these organisms is generally not a good idea. Treat your feet well and keep them fungus free; they're your ticket to your next walk!
Editor's note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean's practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L'Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.
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