The medic in austere settings may have to deal with major medical issues; there are minor issues, however, that don’t threaten your patients’ lives, but can seriously affect their quality of life or work efficiency.  In times of trouble, you’ll need your people at 110%, and many issues, such as toothaches or foot infections, can become a nuisance or worse.

One problem that is very common (and will be more so off the grid) is foot and toenail fungus, also called “Athlete’s Foot”.  When your dogs (by that, I mean your feet) are howling because you aren’t able to change socks often, Athlete’s Foot might be the cause.  Expect this to be particularly relevant in scenarios where you’re constantly on the move.

Athlete’s Foot

Athlete’s foot (also known as “tinea pedis”) is an infection of the skin caused by a type of fungus known as Trychophyton. A fungus is a microscopic organism that likes dark and humid conditions.

This condition may be a chronic issue, lasting for years if not treated. Neglect can lead to its spread from between the toes to hands and groin.

It’s important to know that fungal infections are likely to be contagious. They can be passed by sharing shoes or socks and even from wet surfaces such as shower floors.  Those affected by Athlete’s Foot may also find themselves with other fungal conditions like Ringworm or Jock Itch (“Tinea Cruris”).

What Are Risk Factors For Athlete’s Foot?

Any fungal infection is made worse by moist conditions. People who are prone to Athlete’s foot commonly:

• Spend long hours in closed shoes
• Keep their feet wet for prolonged periods
• Have had a tendency to get cuts on feet and hands
• Perspire a lot
• Are male
• Are older or have chronic medical conditions like diabetes

What Does Foot Fungus Look Like?

To make a diagnosis, look for whitish flaky skin between the toes or fingers., which often appear red and raw. The nails may be yellowed, thickened, and “crumbly”.  Toenails may even separate from the underlying nail bed. Itching and burning in the affected areas is common and sometimes becomes severe. If the skin has been traumatized by scratching, you might see some fluid drainage.  Often, the damage caused by scratching is worse than the infection itself, leading to secondary bacterial infections like cellulitis.

Although toenails will appear yellowish in Athlete’s Foot, dark spots (brown, blue, or black) under the nail may be just debris or could be related to other issues. After an injury, a collection of blood under the nail (called a “hematoma”) will be dark and, often, painful. Less often, a tumor such as a cancer called “melanoma”, may first present with a dark or mottled appearance.

Treatment of Foot Fungus

If the condition is mild, keeping your feet clean and dry may be enough to allow slow improvement of the condition. Oftentimes, however, topical antifungal ointments or powders such as miconazole or clotrimazole are required for relief.  In the worst cases, oral prescription antifungals such as fluconazole (Diflucan) or terbinafine (Lamisil) are needed.

Although creams and ointments cover the skin between the toes more thoroughly, don’t use them too often; excessive moisture may delay healing.

In the worse cases, an infected nail may require removal. If so, it may take a year to grow back.

Patience is a virtue when monitoring the healing process, which may take more than a month for a significant case of Athlete’s Foot to resolve. In the meantime, disinfect shoes with antifungal powders on at least a weekly basis.

Home Remedies

A favorite home remedy for Athlete’s Foot involves placing Tea Tree Oil liberally to a foot bath and soaking for 20 minutes or so.  Dry the feet well and then apply a few drops onto the affected area. Repeat this process twice daily. Try to keep the area as dry as possible otherwise. For prevention of future outbreaks of Athlete’s Foot, apply tea tree oil once a week before putting on socks and shoes.

5% Apple cider vinegar foot soaks (2-4 cups) may work as well. The acid will kill the fungus, as well as soften and break down the skin changes it causes. Use a washcloth to gently scrub the infected areas. If you notice irritation from the bath, dilute with water.

Others recommend soaks with other items, such as black tea, cinnamon, betadine, or Epsom salts.

Long-term therapy with Snakeroot extract may help. Apply every third day for the first month, and once a week thereafter for two to three months. Alternatively, dip a cotton ball in the vinegar and hold to affected areas for several minutes.

Vicks Vap-o-Rub, applied with a swab, shows partial improvement in more than half of cases.

One method that doesn’t work is urinating on your feet in the shower. Although there is ammonia in urine that might kill germs, it’s not strong enough to kill the Athlete’s foot fungus.

You might have your own home remedy for foot fungus. If so, feel free to post it in the comments section.

Joe Alton, MD

Find out more about foot fungus and other minor and major medical issues related to survival, check out a copy of our Third Edition (700 pages) of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at amazon.com and here at store.doomandbloom.net.