Team Training: Fungal Foot Infections
Source: Irish Pharmacy News, May 2026, page 79.
A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.
The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Fungal Infections.
Fungal nail and skin infections can present with various symptoms. Athlete’s foot, a common fungal infection that usually develops between the toes, most commonly affects teenagers and young adults. The infection usually clears up within days or weeks with antifungal treatment. Customers can choose between fungicidal products that kill the fungus and fungistatic products, which slow down its growth until it stops. A low-potency steroid cream may be recommended if the skin is very sore.
Athlete’s foot is highly infectious, as the fungi multiply quickly in warm and humid environments, such as swimming pools, showers and changing rooms. Good foot hygiene can help to reduce the spread of an infection and involves drying the feet thoroughly, particularly between the toes, wearing clean cotton socks, rotating footwear and avoiding walking barefoot in changing rooms.
Tines pedis can present with red, sweaty, hot, and itchy feet. It is very common during the warmer months and can be accompanied by small red pustules on certain areas of the foot. It can be seen interdigitally and underneath the arch profile on the plantar aspect of the foot. The risk of leaving tinea pedis untreated is that small tears in the skin epidermis form, resulting in a portal for infection that can escalate to cellulitis. In warm weather, feet tend to sweat more, and such conditions as tinea pedis can be exacerbated.
Symptoms of Athlete’s foot include:
- An itchy, red rash, which often starts in between the 4th and 5th toes, before spreading to the other toes.
- Scaling or cracking of the skin may occur.
- Blisters can occur. If these burst, they can cause pain & swelling.
Unfortunately, fungal toenails are notoriously common, and the patients coming in to see pharmacists are getting younger.
Fungal nail infections can make the nail:
- thicker
- change colour
- brittle
- painful
Fungal nail infections sometimes start at the edges of the nail. The infection often spreads to the middle of the nail. The nail becomes yellow and can lift off. The nail may become brittle and pieces can break off. It sometimes causes pain and swelling around the nail.
Often the infection is just in one nail but several may be affected. It is usually painless. The most common symptoms are:
- Thickened nail.
- Discoloured nail (often a yellowish colour).
Commonly, this is all that occurs and fungal nail infections often cause no other symptoms. The main reason people see their doctor is because the appearance is unsightly.
Sometimes the infection becomes worse and additional symptoms occur. These include:
- The nail becoming soft and crumbling.
- White or yellow patches appearing where the nail has come away from the skin.
- The skin next to the nail becoming inflamed or scaly.
Sometimes the whole nail comes away. If left untreated, the infection may eventually destroy the nail and the nail bed, and may become painful. Walking may become uncomfortable if a toenail is affected.
Between 3 and 8 out of 100 people will develop a fungal nail infection (tinea unguium) at some stage of their lives. Toenails are more commonly affected than fingernails. It is more common in people aged over 60 and in younger people who share communal showers, such as swimmers or athletes.
What causes fungal nail infections?
- Spread from a fungal skin infection. For example, athlete’s foot (tinea pedis) is a fungal skin infection of the toes. This may spread to the toenails if the skin infection is not treated early.
- Fingernail infection may occur after a toenail infection has become established. The fungus may spread to a finger after scratching itchy toes and toenails.
- Fingernail infections are also more likely to occur in someone who washes their hands frequently or has them in water a lot, for example, cooks or cleaners. Constant washing may damage the protective skin at the base of the nail. This may allow fungi to enter.
- A nail that has recently been damaged is also more likely to become infected.
- There is an increased risk of developing a fungal nail infection with various other conditions – for example: o Diabetes. o Psoriasis. o Poor circulation. o A weakened immune system (for example, if you have AIDS or are on chemotherapy). o A general poor state of health such as heavy alcohol consumption.
- Nail infections are more common in people who live in hot or humid climates.
- Smoking also increases the risk of developing a nail infection.
- In some cases there is no apparent reason. Fungal germs are common and an infection can occur ‘out of the blue’.
Fungal nail infection diagnosis
Other nail conditions can sometimes look like a fungal infection (typically “trauma” to the nails from shoes). Therefore, to confirm the diagnosis, a doctor will usually request that a nail clipping is sent to the laboratory for testing.
Consider
- Those most likely to suffer from athlete’s foot and fungal foot infections
- Conditions which may lead to fungal infections
- The signs and symptoms of athlete’s foot and fungal foot infections
- Any follow-up actions that may be required
Key Points
- Check your pharmacy team are aware and understand the following key points:
- Are able to recognise the signs and symptoms of athlete’s foot and fungal nail infections
- Be aware of the OTC treatment options available
- Know when to refer and spot red flags
Actions
- Ensure efficient sign posting to discreet consultation areas within the pharmacy for further help and advice
- Educate staff on being able to identify the presenting features of some common fungal infections of the feet
- Ensure that I know the recommendations for OTC treatments
- Educate the team to advise patients on the use of these treatments
- Ensure pharmacy staff are able to explain management options and possible complications
- Be familiar with when to not treat fungal infections OTC
- Train the team to meet all the above considerations
