Best Treatments for Athlete’s Foot (aka Tinea Pedis) versus Toenail Onychomycosis : Natural Options and Drugs

Even though I am an eye surgeon, a couple of patients each year ask me about their Athlete’s foot/ toe nail fungus as they are really afraid their fungus has spread to their eyes. 

The good news is eyelid/eye fungus is very rare. 

Still, it is good to review all the best options for Athlete’s Foot and Toe Nail Fungus.

Below are some good references.

Key points:

1. If not improving with natural or topical meds, consider a culture as some fungi can occur together & need appropriate oral medication. Also check with MD to be sure no circulation issue or underlying inflammatory condition. 

2. Keep feet clean & air dry; 

3. Wear sandals as much as can. 

4. Natural remedies do work: be sure to focus on diet as well

Above is a patient who came in mostly concerned about her painful toe fungus. The good news is that there is not case report of catching an eye fungus from a toe fungus. But there has been a couple of case reports below (**) of catching a corneal fungus from a toe fungus and another case of getting a retina fungus from a skin fungus.
More below.

Tinea pedis is a common fungal foot infection often associated with high rates of treatment failure and recurrence. Most cases, tinea pedis can be managed with topical antifungal treatment (natural, OTC, or Rx), however, oral antifungal treatment is sometimes required, especially if a patient has severe infections, concomitant onchomycosis (see below), or repeated topicaltreatment failures.

Coexistence of toenail onychomycosis and tinea pedis is more common as one gets older and more prevalent in men. Estimates note 25.7% of elderly individuals have both types of infections.17 Older patients have demonstrated significantly more advanced toenail onychomycosis with a higher number of involved toenails and longer duration of the disease.19However, we noted that only the hyperkeratotic subtype of tinea pedis is significantly more frequent in elderly subjects with toenail onychomycosis.


Here are top natural ways to treat tines pedis:

1. Rubbing alcohol can help kill surface fungus:directly to the affected area or soak your feet in a foot bath of 70 percent rubbing alcohol and 30 percent water for 30 minutes.

2. Hydrogen peroxide effectively kills fungus: Pour hydrogen peroxide directly onto the affected area. It may sting & should bubble, especially if you have open wounds. Do this twice daily until the infection subsides.

3. Tea Tree Oil: you can use 100% directly on skin if no open sores and you have treated a test spot area to be sure you are not allergic. You can also use 5% dilution but publications say it takes about 16wks to improve.  

Tea tree oil has antifungal and antibacterial properties, which is part of the reason it’s commonly used to treat many fungal infections (including both ringworm and candidiasis).

One 2002 study foundTrusted Source that applying tea tree oil daily could treat both the symptoms of athlete’s foot and the fungus that causes it within a few weeks.

You can also use warm coconut oil with tea tree oil for a concentration of 25 to 50 percent tea tree oil. Apply it to the affected area two times a day.

4. Coconut oil alone also has antifungal activity: apply over area liberally; wash off when need to put shoes back in. 

5. Garlic: effective topical treatment for athlete’s foot. Below study (***) found a garlic derivative, alone, resulted in a complete cure in 79 percent of participants after 7 days. Crush & smash 5 cloves: rub into affected area 2x/day for 7-10 days. 

Trusted Sourcjust 7 days.

Talcum powder, corn starch, or baby powder work to treat athlete’s foot by keeping the affected area dry and clean. This makes it difficult for the fungus to thrive and spread by keeping sweat and moisture under control.

To use this treatment, apply talcum powder (or antifungal powder) directly to the dried, affected area every time before putting on socks. Be careful not to inhale talcum powder.

Not only can Vicks VapoRub reduce symptoms from a bad cough, it can help treat athlete’s foot. This may be because of its use of eucalyptus oil and menthol, both of which have antifungal properties

Rub Vicks on the affected area every night, massaging it into the foot. Do this every night for at least a month, or up until a week after the infection has disappeared.

Some researchers have identified olive leaf extract as a potential home remedy for toenail fungus. People have used olive leaf extract for centuries, though not many people in the U.S. use it, today.

According to one review, olive leaf extract is a safe way to help treat toenail fungus.

However, olive leaf extract may cause potential side effects. These include flu-like symptoms, such as:

How to use it

Both neem oil and neem leaf extracts have incredible antifungal capabilitiesTrusted Source that can help fight athlete’s foot. You can apply the neem oil (or extract) directly to the affected area two to three times a day, massaging it into the skin. This can also be helpful for treating infections that develop under the toenails.

Sea salt has strong antibacterial and antifungal propertiesTrusted Source, making it a great natural treatment for athlete’s foot and any complications it could cause. It may actually inhibit the growth and spread of athlete’s foot.

Some treatments involve mixing sea salt with other natural treatments, like vinegar, to make a sort of paste. The most effective way to use this treatment may be to dissolve a cup of sea salt into a warm foot bath. Soak your feet for at least 20 minutes. Dry your feet thoroughly when you’re finished soaking.

Talcum powder, corn starch, or baby powder (though isn’t there a law suit on baby powder?) work to treat athlete’s foot by keeping the affected area dry and clean. This makes it difficult for the fungus to thrive and spread by keeping sweat and moisture under control.

To use this treatment, apply talcum powder (or antifungal powder) directly to the dried, affected area every time before putting on socks. Be careful not to inhale talcum powder.

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Medical management with antifungals

A variety of traditional agents without specific antimicrobial function are still in use, including Whitfield’s ointment and Castellani’s (Carbol fuchsin solution) paint. The efficacy of these preparations has not been well quantified.[Table 1 summarizes the classification of commonly employed antifungals.[,,] Lesions covering a large body surface area fail to clear with repeated treatment using different topical agents should be considered for systemic therapy.[] There is no definite comparative study on combination of systemic and topical versus monotherapy with systemic antifungal treatment. Topical medications have better pharmacokinetics than their systemic counterparts. Hence, combination is expected to have better mycological clearance than systemic and topical alone. Combination should be from different groups for wide coverage and also to prevent emergence of resistance. Drugs given for shorter duration with higher dose there has a less chance of development of resistance compared to lower dose for longer duration. Drug with keratophilic and lipophilic property, when given in higher doses will have reservoir effect and will lead to better mycological clearance.


Best oral drugs for Tinea Pedis:

Terbinafine is the first-line oral treatment for tinea pedis

In adults with tinea pedis, the recommended oral treatment regimen is terbinafine 250 mg, once daily, for two to six weeks.

Good full list is table here:

A person can change their diet to improve their overall health. Though no clinical evidence suggests a dietary change can cure toenail fungus, certain diets may help improve a person’s overall health and well-being.

Diets should include plenty of nutrients. In particular, a person can eat foods rich in vitamins, minerals, and other materials that help aid nail growth and development.

Some foods to include in a nail-healthful diet:

  • any food rich in calcium and vitamin D
  • fatty acids found in oily fish, such as salmon
  • yogurts that contain probiotics
  • food rich in lean protein to help nail growth
  • foods rich in iron to help prevent brittle nails, such as spinach




A person’s foot with a fungal nail infection ten weeks into a course of terbinafine oral medication. Note the band of healthy (pink) nail growth behind the remaining infected nails.


Most treatments are with antifungal medications either topically or by mouth.[2] Avoiding use of antifungal therapy by mouth (e.g. terbinafine) in persons without a confirmed infection is recommended because of the possible side effects of that treatment.[19]

Topical agents include ciclopirox nail paint, amorolfine, and efinaconazole.[22][23][24] Some topical treatments need to be applied daily for prolonged periods (at least 1 year).[23] Topical amorolfine is applied weekly.[25] Topical ciclopirox results in a cure in 6% to 9% of cases; amorolfine might be more effective.[2][23] Ciclopirox when used with terbinafine appears to be better than either agent alone.[2] In trials, about 17% of people were cured using efinaconazole as opposed to 4% of people using placebo.[26] Although eficonazole, P-3051 (ciclopirox 8% hydrolacquer), and tavaborole are effective at treating fungal infection of toenails, complete cure rates are low.[27]

Medications that may be taken by mouth include terbinafine (76% effective), itraconazole (60% effective) and fluconazole (48% effective).[2] They share characteristics that enhance their effectiveness: prompt penetration of the nail and nail bed,[28] and persistence in the nail for months after discontinuation of therapy.[29] Ketoconazole by mouth is not recommended due to side effects.[30] Oral terbinafine is better tolerated than itraconazole.[31] For superficial white onychomycosis, systemic rather than topical antifungal therapy is advised.[32]


Chemical (keratolytic) or surgical debridement of the affected nail appears to improve outcomes.[2]

As of 2014 evidence for laser treatment is unclear as the evidence is of low quality[33] and varies by type of laser.[34]

Tea tree oil is not recommended as a treatment, since it is not effective and can irritate the surrounding skin.[35]


United States[edit]

According to a 2015 study, the cost in the United States of testing with the periodic acid–Schiff stain (PAS) was about $148. Even if the cheaper KOH test is used first and the PAS test is used only if the KOH test is negative, there is a good chance that the PAS will be done (because of either a true or a false negative with the KOH test). But the terbinafine treatment costs only $10 (plus an additional $43 for liver function tests). In conclusion the authors say that terbinafine has a relatively benign adverse effect profile, with liver damage very rare, so it makes more sense cost-wise for the dermatologist to prescribe the treatment without doing the PAS test. (Another option would be to prescribe the treatment only if the potassium hydroxide test is positive, but it gives a false negative in about 20% of cases of fungal infection.) On the other hand, as of 2015 the price of topical (non-oral) treatment with efinaconazole was $2307 per nail, so testing is recommended before prescribing it.[20]

Co-operative inhibitory effects of hydrogen peroxide and iodine against bacterial and yeast species

Clinical Trial


2002 Aug;43(3):175-8.

doi: 10.1046/j.1440-0960.2002.00590.x.

Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: a randomized, placebo-controlled, blinded study



Tea tree oil has been shown to have activity against dermatophytes in vitro. We have conducted a randomized, controlled, double-blinded study to determine the efficacy and safety of 25% and 50% tea tree oil in the treatment of interdigital tinea pedis. One hundred and fifty-eight patients with tinea pedis clinically and microscopy suggestive of a dermatophyte infection were randomized to receive either placebo, 25% or 50% tea tree oil solution. Patients applied the solution twice daily to affected areas for 4 weeks and were reviewed after 2 and 4 weeks of treatment. There was a marked clinical response seen in 68% of the 50% tea tree oil group and 72% of the 25% tea tree oil group, compared to 39% in the placebo group. Mycological cure was assessed by culture of skin scrapings taken at baseline and after 4 weeks of treatment. The mycological cure rate was 64% in the 50% tea tree oil group, compared to 31% in the placebo group. Four (3.8%) patients applying tea tree oil developed moderate to severe dermatitis that improved quickly on stopping the study medication.


Published online 2019 May 27. doi: 10.1186/s12348-019-0173-z

Tinea corporis infection manifestating as retinochoroiditis—an unusual presentation



Diagnosis and Management of Tinea Infections

Am Fam Physician. 2014 Nov 15;90(10):702-711.

  Patient information: A handout on this topic is available at

Author disclosure: No relevant financial affiliations.

Tinea infections are caused by dermatophytes and are classified by the involved site. The most common infections in prepubertal children are tinea corporis and tinea capitis, whereas adolescents and adults are more likely to develop tinea cruris, tinea pedis, and tinea unguium (onychomycosis). The clinical diagnosis can be unreliable because tinea infections have many mimics, which can manifest identical lesions. For example, tinea corporis can be confused with eczema, tinea capitis can be confused with alopecia areata, and onychomycosis can be confused with dystrophic toe-nails from repeated low-level trauma. Physicians should confirm suspected onychomycosis and tinea capitis with a potassium hydroxide preparation or culture. Tinea corporis, tinea cruris, and tinea pedis generally respond to inexpensive topical agents such as terbinafine cream or butenafine cream, but oral antifungal agents may be indicated for extensive disease, failed topical treatment, immunocompromised patients, or severe moccasin-type tinea pedis. Oral terbinafine is first-line therapy for tinea capitis and onychomycosis because of its tolerability, high cure rate, and low cost. However, kerion should be treated with griseofulvin unless Trichophyton has been documented as the pathogen. Failure to treat kerion promptly can lead to scarring and permanent hair loss.


 2014; 14: 90. 

Published online 2014 Jul 11. doi: 10.1186/1471-2415-14-90

A case of fungal keratitis and onychomycosis simultaneously infected by Trichophyton species

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