Why your athlete’s foot won’t go away – and how to finally clear it
Still dealing with itchy, scaly feet months (or even years) after National Service? Experts explain why athlete’s foot lingers, how drug-resistant fungi are complicating treatment, and what you can do to finally clear it.
(Photo: iStock/Ake Ngiamsanguan)
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Long after you’ve dropped off your old army uniforms and swapped boots for executive-appropriate dress shoes, you may still be hanging on to one last vestige of National Service (NS) – athlete’s foot. Not that you want to, of course, but the itchy, scaly or cracked skin on your feet, particularly between the toes, is as tenacious as your desire to book out all those months ago.
Despite your best efforts to medicate, air your toes, and avoid going barefoot on suspicious surfaces such as the locker room, the infection is just not going away.
So, why does athlete’s foot persist long after you’ve cleared your ORD (operationally ready date)? For some, it’s even affecting the toenails that thicken and become yellow, brittle, or in extreme cases, crumbly. Have fungi become resistant to medications the way certain bacteria do not succumb to antibiotics?
HOW COMMON IS ATHLETE’S FOOT?
Athlete’s foot, medically known as tinea pedis, is a common concern among military personnel with a global incidence of 17 per cent. And it doesn’t discriminate between uniformed individuals and civilians.
In Singapore, athlete's foot was the most common skin infection, according to a National Skin Centre study that looked at patients between 1999 and 2003.
“Tinea pedis accounted for more than one in four fungal skin infections treated during that period,” said Dr Isabelle Yoong Rui Wen, a family physician and clinical member with SingHealth Polyclinics’ Infection Prevention and Infectious Disease Committee Workgroup. There isn’t more recent local research, she added, to show how common tinea pedis is in Singapore today.
In the clinics, podiatrists such as Nur Ashikin Ismail, who heads SingHealth Polyclinics’ Podiatry Services, see about two or three cases a day on average. “It adds up to roughly 40 to 60 cases each month. I also notice that cases tend to increase during hotter, more humid periods, when people perspire more.”
Over at Tan Tock Seng Hospital, its Podiatry Service receives 20 to 30 cases monthly on average, “with a notable increase during Singapore's wetter monsoon periods”, said podiatrist Eunice Yang. “Tinea pedis is more common in men than women with the peak age of incidence between 16 and 45 years old.”
So yes, it’s not only NS men who are likely to get infected. “Despite the name, the infection is not confined to athletes either, and can affect people of all ages and activity levels,” said Nur Ashikin.
“Certain groups are more prone to developing tinea pedis,” she continued, including diabetics with compromised immune systems, individuals who are required to wear enclosed footwear for prolonged periods in non-air-conditioned or wet work environments, and those with hyperhidrosis, a condition that leads to excessive sweating.
WHY DOES IT TAKE SO LONG TO HEAL?
Tinea pedis is caused by dermatophyte fungi, most commonly, Trichophyton rubrum, Trichophyton interdigitale and Epidermophyton floccosum, said Nur Ashikin.
And these dermatophytes are highly resilient. “Their cell walls contain mannans, which suppress the immune system and slow down the natural skin cell renewal process,” Yang explained. “When skin turnover is reduced, the infected skin takes longer to shed, allowing the infection to persist.” Then, when it spreads and infiltrates the nails, “the nails serve as fungal reservoirs, creating a reinfection cycle”, said Yang.
Many patients also stop their antifungal medication once the symptoms disappear. You should complete the full recommended course and continue for an additional two weeks after symptoms resolve, said Yang. “This premature discontinuation allows small reservoirs of dermatophytes to survive and eventually cause symptom relapse.”
There is another worrying factor. “Some fungi have changed over time and no longer respond to the usual creams and pills that doctors have relied on for decades,” revealed Dr Yoong. “These drug‑resistant fungi behave much like superbugs, making common skin infections harder to treat.”
She highlighted Trichophyton indotineae as one of the most concerning new strains affecting the skin and feet. “It causes a particularly itchy, fast‑spreading form of athlete’s foot, and does not respond well to terbinafine, the standard, first‑line medication commonly prescribed by doctors,” said Dr Yoong.
The culprits, she believed, are over‑the‑counter combination creams that mix antifungal medication with strong steroids.
“While the steroids temporarily reduce redness and itching, they do not kill the fungus,” said Dr Yoong. “Instead, they mask the symptoms, allowing the fungus to survive, spread and gradually become resistant to treatment. Medical journals have confirmed that this resistant strain has already been detected in Singapore, meaning infections that look routine may be harder to clear.”
HOW DO YOU TELL IF YOU HAVE ATHLETE’S FOOT?
The infection does not always look serious at first, said Nur Ashikin. “The early signs can include dry and flaky skin, itching, small blisters, or a stinging sensation where the skin cracks.” One common observation, she said, is that the dryness and scaling take on a “moccasin” pattern affecting the soles and sides of the feet.
“Some people may also notice an unpleasant smell,” Nur Ashikin continued. “In more severe cases, the skin between the toes can become soggy, broken or cracked, which can allow bacteria to enter and cause further infection.”
Another frequent symptom is maceration, which refers to the “whitish, softened skin that develops between the toes, most often between the fourth and fifth toes”, said Nur Ashikin. “This can also occur in the other toe webs, particularly among individuals with bunions, venous insufficiency or lymphoedema, where their toes are pressed closely together and moisture becomes trapped.”
Maceration can have serious consequences as breaks in the skin can allow bacteria to enter the body, increasing the risk of infection. “There have been cases where people with diabetes developed cellulitis originating from such skin breakdown, leading to severe complications including gangrene and, in extreme instances, amputation,” she said.
HOW CLEAN IS YOUR FLOOR?
“The type of floor surface and how well it is cleaned, play important roles in how athlete’s foot spreads,” said Dr Isabelle Yoong Rui Wen, a family physician with SingHealth Polyclinics. Here’s a look:
Hard floors: These include porcelain and vinyl tiles – and yes, they can harbour fungi, with studies showing spores surviving for up to four weeks. Wood and concrete are generally less favourable for fungal survival when kept dry.
Rubber flooring: Commonly found in gyms and locker rooms, rubber can retain heat and moisture, and create conditions that allow fungi to persist.
Carpet: It acts like a sponge that trap skin flakes and fungal spores shed by infected feet. These spores can survive deep within carpet fibres for months or even years. What’s more, walking on carpets can stir up trapped spores, making it easier for them to stick to healthy skin.
Diatomite mats: Unlike textile mats, which trap moisture and skin debris within their fibres, diatomite mats have a hard surface that absorbs water quickly and dries rapidly. This helps prevent moisture from lingering, which is an environment fungi need to survive.
WHEN SHOULD YOU SEE A DOCTOR?
For mild cases of tinea pedis, start with over-the-counter (OTC) treatments such as antifungal powders or creams containing terbinafine or miconazole, advised Yang. If the skin between your toes is infected, opt for a powder as a cream can trap moisture and worsen the infection, she said. When applying an antifungal cream, make sure to cover 2cm to 3cm beyond the margins of the affected areas.
While prescribed antifungal medications may be more potent than OTC ones, they carry a higher risk of side effects, including possible strain on the liver or interactions with other medications, cautioned Dr Yoong. “Due to these risks, they are reserved for stubborn or recurring infections, and must be prescribed and monitored by a doctor to ensure the diagnosis is correct and the body is responding safely.”
Dr Yoong advised consulting a doctor if the redness, itching or scaling does not improve after about 14 days of using OTC medications daily. “This may be a sign that the problem is not a fungal infection at all but another skin condition such as eczema or a bacterial infection.”
You should also see a doctor promptly if the rash spreads to the other parts of your body. Make an appointment, too, if there’s an appearance of painful blisters, skin swelling or oozing, or if you have diabetes or a weakened immune system in the first place, said Dr Yoong.
CAN YOU GET ATHLETE'S FOOT FROM DOING THESE?
Podiatrist Eunice Yang from Tan Tock Seng Hospital gives her take:
Driving barefoot: It is unlikely to cause athlete's foot, unless someone with an active infection previously drove the vehicle barefoot. However, the risk may be higher if the pedals are dirty, or if you have a reduced immunity or compromised skin integrity, such as small cuts, fissures or hyperhidrosis.
Trying on new shoes: Yes, it can. Best to BYO socks or use the disposable ones provided. The previous shopper may have an infection, and direct contact with a shoe’s infected inside can transmit the infection. The socks’ thickness does not matter as much because the sock itself already forms a protective barrier.
Getting a pedicure: Highly possible. Before booking an appointment, clarify whether the staff follows thorough sterilisation protocols using high temperatures and pressures, or if they can provide dedicated-use or single-use instruments to reduce your risk of cross-contamination.
WHAT SHOULD YOU DO IF YOU’RE INFECTED?
Keeping your feet and toes dry, cool and well-ventilated is your best bet, said the experts, which means “yes” to slippers and sandals.
If you must wear socks with your slides (we’re not judging), opt for moisture-wicking, natural fibres such as cotton or bamboo, suggested Yang. Nur Ashikin recommended toe socks as they reduce skin‑to‑skin moisture.
Washing socks in hot water, ideally at 60 degrees Celsius or higher is key to killing the fungus, said Dr Yoong. “Make sure the socks are fully dried before wearing them again. It is also a good habit to change socks at least once a day, or more often if your feet become sweaty.”
For office workers who have to wear closed-toe footwear, such as oxfords or heels to work, choose natural, more breathable leather over synthetic materials, advised Dr Yoong. Get more than a pair of work shoes, so you can rotate them “and let each pair dry out overnight before wearing them again”.
