Those at highest risk of tinea pedis are those with persistently wet feet, diabetes, immunocompromised conditions, or occlusive shoe wear. Untreated tinea pedis may lead to cellulitis in the foot, groin, or hands.
Chronic hyperkeratotic (moccasin-type) tinea pedis typically manifests as patchy diffuse scaling on the soles, medial, and lateral surfaces of the feet with underlying erythema. Vesiculobullous tinea pedis consists of fluid-filled vesicles or bullae with underlying erythema.
Symptoms
Tinea pedis is an infection of the skin on the feet caused by dermatophytes such as Trichophyton rubrum, T mentagrophytes and T interdigitale. These fungi can be acquired by walking barefoot in public areas such as locker rooms and showers. Patients with tinea pedis experience pruritic scales and sizes of hyperkeratosis, often with underlying erythema on the medial and lateral aspects and soles of the feet.
Determining a tinea pedis VA rating involves assessing the severity of this fungal infection and its impact on a veteran’s feet, considering the discomfort, limitations, and potential complications it may cause in daily life and activities.
These fungi produce club-shaped, asexual spores called macroconidia and microconidia. The asexual spores are referred to as mycelial masses. They can cause an inflammatory condition that is sometimes mistaken for ringworm (although the latter typically has a red ring with normal-looking skin in the middle).
Most patients can successfully manage tinea pedis with topical antifungals. However, due to high rates of treatment failure and recurrence, oral itraconazole or terbinafine may be required. Preventive measures include wearing breathable shoes, washing and drying feet, especially between the toes, after exposure to water, and not sharing footwear or socks with others.
Treatment
Veterinarians diagnose tinea pedis on the soles of the feet from clinical examination and by taking skin scrapings and examining them under a microscope. The fungus grows best on moist surfaces, and shoes provide the perfect environment for its growth. Thus, the condition is most common in patients who walk around in socks and shoes and is less frequent among those who go barefoot or wear sandals.
Pustular tinea pedis (dermatophytosis pustulosis) is a more severe variant of the condition that causes fluid-filled blisters on the instep and plantar surfaces of the feet. This disease variation must be considered in the differential diagnosis and ruled out by microscopy and culture using potassium hydroxide or a dermatophyte-specific KOH preparation.
Sometimes, tinea pedis develops into cellulitis, which can be complicated by poor blood flow to the feet. Infections of the interdigital spaces, particularly in those with diabetic foot ulcers or peripheral vascular disease, are at particular risk of developing this complication.
Preventing Recurrences
There are a few things patients can do to prevent tinea pedis. They should practice good foot hygiene by thoroughly washing and drying their feet, especially between the toes. They should also wear rubber sandals when using communal showers or at locations where other people may have walked with bare feet.
They should change their socks daily and wear breathable shoes. They should also encourage family members to follow similar hygiene practices. They should also regularly hose the floors of their shower rooms and swimming pools to decrease the amount of dermatophyte growth on these surfaces.
Tinea pedis, commonly known as athlete’s foot, is a fungal infection that can cause itching, scales, erythema, and erosions of the skin of the soles of the feet. It is a common problem for those who walk barefoot in communal showers and locker rooms, such as at summer camps, college dormitories, public swimming complexes, gyms, sports clubs, or steam rooms.
Rating
A Veteran is rated by comparing their symptoms with the criteria established in the schedule for rating disabilities. The percentage evaluations in the schedule represent, as far as can be determined with reasonable certainty, the average impairment of earning capacity due to the disorder. 38 U.S.C. 1155; 38 C.F.R. 4.1 (2015).
During service, the Veteran was granted service connection for tinea cruris, tinea pedis, genital herpes, and post-inflammatory hypopigmentation on the right thigh and leg, all rated at 10 percent disabling under DC 7899-7806. These disorders are hyphenated because they do not qualify as a single disability under the existing schedular evaluation criteria.
VA proposes to rename DC 7817, “Exfoliative Dermatitis (Erythroderma),” as “Papulosquamous Disorders (Erythroderma),” and amend the description to reflect current medical understanding of this disorder. VA also proposes to clarify that the use of a topical treatment does not constitute systemic therapy. This change will remove the need to invoke SS 4.20, analogous ratings.