A tiny itch between the toes may be the start of tinea pedis; this guide explains why some infections resist treatment and how to cut the risk
The first hint of a fungal foot infection is often dismissed: a faint itch, dry skin or a small patch of flaking between the toes. These early signs can be easy to ignore, but clinicians warn that when left unchecked the condition known as athlete’s foot can worsen and spread.
The fungus that causes it is commonly a dermatophyte, and medical writers often use the term tinea pedis to describe the clinical pattern. While many people respond well to high-street treatments, an increasing number of cases are proving stubborn or resistant to standard therapy.
When athlete’s foot takes hold, the affected skin can become sore, red and cracked, sometimes peeling in sheets as the itch intensifies. In advanced cases the infection moves into the nails, producing thickened, discoloured and brittle toenails. Breaks in the skin are not only uncomfortable; they provide an entry point for bacteria, raising the risk of secondary infections such as cellulitis.
Experts stress that early attention, correct medication and changes in habits are vital to prevent complications that can require urgent care.
How the infection behaves and why resistance matters
Dermatophytes prefer warm, moist environments and can colonise the spaces between toes, the soles and sometimes the heels. The species trichophyton is frequently implicated, and clinicians report the emergence of strains less responsive to standard treatment. For many years, a course of the antifungal terbinafine—the active ingredient in common over-the-counter remedies—cleared most cases. Now, however, around one third of patients treated within the NHS may need repeat therapy, and some infections no longer respond to topical creams, prompting the use of oral antifungals and longer treatment plans.
Transmission and typical starting points
Tinea pedis spreads easily by direct skin-to-skin contact and via contaminated surfaces. Spores can survive on wet towels, bathroom floors and inside trainers, silently waiting to infect vulnerable skin. The infection often begins between the fourth and fifth toes or on dry, flaky patches at the heel before extending across the sole. Because the soles of the foot contain about 600 sweat glands per square centimetre, moisture control is central to prevention. Practical measures to limit exposure and keep the skin intact are essential to stop the cycle of reinfection.
Why shoes and socks influence risk
The environment inside footwear can reach temperatures around 35°C, with limited airflow and trapped sweat creating ideal conditions for fungal growth. Research has linked shoe type and material to infection risk: a 2019 study in Japan found that enclosed cloth or leather shoes produced higher humidity and increased tinea pedis rates in wearers. Socks matter too; research from 2000 suggested wool blends reduce prolonged contact between spores and skin compared with many synthetic fibres. Experts recommend breathable shoes, rotating footwear to allow drying, and using socks as a moisture barrier rather than going sockless.
Who is most vulnerable and why
Certain groups are far more likely to develop persistent infection. A study published in the Qatar Medical Journal in 2026 reported that people aged over 70 had a much higher diagnosis rate—about 25 times more likely than those under 30—while obesity raised risk roughly 15-fold. Diabetes increases both the chance of athlete’s foot and the likelihood of complications: impaired circulation and reduced sensation can allow minor breaches in skin to progress to serious bacterial infections. Clinicians frequently caution patients with diabetes to seek assessment early because the consequences can be significant.
Treatment realities and practical advice
Most cases still respond to correct use of topical antifungals, but success depends on consistent application and completing the full course. Many people stop once symptoms ease, which encourages recurrence and persistence. Where creams fail, practitioners may prescribe systemic drugs and suggest lifestyle steps such as drying thoroughly between toes, changing socks after exercise, avoiding shared towels and wearing flip-flops in communal showers. Some specialists are urging wider use of skin-scrape tests so resistant strains can be identified in the laboratory and treated with the most appropriate medication from the outset.
When to consult a healthcare professional
See a GP or podiatrist if an infection does not improve after a few weeks of correct topical treatment, if it spreads beyond the feet, or if you have diabetes or a weakened immune system. Clinicians like Professor Darius Armstrong-James and dermatologists such as Dr Sabika Karim and Dr Sangeeta Punjabi advise that persistent or recurrent infections may need oral medication and habit changes to avoid relapse. Routine skin scrapings are not yet universal in primary care, but targeted testing can reveal resistance patterns and guide effective therapy.
Simple prevention measures
Prevention focuses on keeping feet cool, clean and dry. Change socks regularly, especially after exercise, favour breathable and moisture-wicking materials such as natural wool blends, rotate shoes to allow airing, and avoid walking barefoot in communal wet areas. Use antifungal powders inside footwear when needed and treat any early signs promptly. Remember that a single small crack or blister can become the gateway to wider infection, so early attention combined with sensible foot care goes a long way toward keeping athlete’s foot under control.
