COMMON SKIN AND NAIL PROBLEMS IN ATHLETES

COMMON SKIN PROBLEMS

Athlete's Foot (Tinea Pedis)
Athlete's foot is a common fungal infection of the skin.  The fungi are found in locker rooms, showers, swimming pool decks and other warm moist surfaces.  In athlete's foot there can be scaling, cracking, and peeling of the skin between the toes or on the bottom of the feet.  It may itch, but is not usually painful.  To prevent athlete's foot, the feet need to be kept as dry as possible.  Foot powder, changing socks when they get moist, drying between the toes, and wearing sandals or going barefoot when not exercising are also helpful.  Once athlete's foot develops it can be treated with anti-fungal cream like Tinactin or Lotrimin twice a day.  If anti-fungal creams do not clear the infection in 3-4 weeks, a physician can prescribe an oral medication that may help. 

Jock Itch (Tinea Cruris)
Jock itch is an infection caused by the same fungus that causes athlete's foot.  It causes a scaly extremely itchy rash over the inner thigh and groin areas.  The fungus likes damp skin and often occurs because the same towel used to dry off the feet after a shower is used to dry the rest of the body.  To prevent jock itch, it is important to keep the thighs and groin area as dry as possible, to treat the athlete's foot, and to use different towels for the body and feet (or at least to dry the feet after the body).  It is also important not to scratch.  Anti-fungal creams, like Lotrimin, to treat jock itch are also available at discount and drug stores.

Friction Blisters
Blisters develop where an area of skin is repeatedly and intensely rubbed.  Since the skin is composed of several layers of cells, constant rubbing can make the layers separate.  Fluid fills the space a blister forms.  To prevent a blister from forming, it is important that shoes fit properly and the shoe does not have rough seams inside to rub against a blister.  Other actions that may be helpful in preventing blisters are keeping feet as dry as possible, changing socks often, wearing two pairs of socks, and wearing sandals when not exercising.  Once a blister has formed, it is best not the take the top of it off because this can not only be painful, but can leave the open area susceptible to infection.  The fluid can be drained from a big blister (more that a half centimeter) without removing the top.  A topical antibiotic ointment and moleskin or gauze can be applied to protect and help heal the blistered area.

Calluses
Calluses are areas of skin that are repeatedly rubbed but generally with less intensity than that which causes blisters.  Calluses tend to occur over bony areas of the feet and hands.  Unlike blisters which can cause much discomfort, calluses are nonpainful places where the skin actually gets hardened.  This hardening may help to protect the areas from repeated rubbing.  The skin can be softened with water and a pumice stone if desired, but this is not generally necessary.

Warts
Warts are skin colored areas with rough surfaces that usually occur in areas where there has been some kind of injury (like a cut or scrape).  These sites of injury let the virus (the human papilloma virus), which causes warts, into the skin where it grows.  Flat type warts are nonpainful and often will go away by themselves in 6 months to 2 years without treatment.  These may be frozen with liquid nitrogen to try and get rid of them sooner.  Plantar type warts (name because they occur on the bottom or "plantar" surface of the foot) can be extremely painful.  These may also be frozen to kill the virus, but generally are better treated by a physician using salicylic acid and possibly by shaving the wart with a scalpel to make it smaller and less painful.  Treatment of warts sometimes takes multiple tries before it is successful.  Warts can also recur, especially if the area is injured again.

COMMON NAIL PROBLEMS

Ingrown Toenails
Click here for information on ingrown toenails.

Subungual Hematoma
A subungual hematoma is a collection of blood (like a bruise) under the nail, as a result of trauma to a fingernail or toenail.  This injury can be the result of jamming the toes into the end of the shoe as in sports where there are quick starts and stops or kicking or running.  If one of these hematomas occurs, it can be quite painful, and the nail itself can be damaged and fall off after awhile (it will eventually grow back).  A pretty simple treatment by a physician done in just a few minutes also relieves the pain.  If more than a quarter of the nail is involved, the physician may want to take an x-ray to make sure the bone underneath is not fractured.

Paronychia
Paronychia is an inflammation of the fingernail or toenail where it is joined to the skin of the finger or toe.  This can be just pain and swelling from and injury, or an infection due to bacteria or fungus can occur.  On the toe, a paronychia can result from an ingrown toenail.  If the paronychia is due to an infection, it is important to see a physician for antibiotics and proper treatment.  These can be hard to treat, especially if there is a fungal infection (onychomycosis).  To prevent paronychia, the nails should be cut straight across and kept short, clean, and dry.

Article written by:           

K. Victoria Butler, MD
ACH Sports Medicine
September 2000

References:

Burkhart, CG. Skin disorders of the foot in active patients. The Physician and Sportsmedicine, 1999:27(2);pp88-101.

Schmidt, BD.  Pediatric Telephone Advice, 2nd Ed.  Lippencott-Raven Publishers, Philadelphia, 1999;pp105-108.

Current Pediatric Diagnosis and Treatment, 14th Ed. Edited by: Hay, WW Jr., et al.
Appleton and Lange, Stamford, CT, 2000; pp350-352.

Tanzi, EL and Scher, RK.  Managing common nail disorders in active patients and athletes. 
The Physician and Sportsmedicine, 1999;27(2);pp35-47.