Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Skin conditions of the feet — fungal infections, inflammatory dermatoses, and chronic skin diseases — are a distinct and important component of podiatric practice that overlap with dermatology but have foot-specific presentations and implications. Correctly identifying foot skin conditions prevents misdiagnosis, inappropriate treatment, and the missed diagnosis of more serious conditions (subungual melanoma presenting as nail dystrophy; diabetic foot ulcer presenting as a ‘blister’). The three most common non-infectious and fungal skin conditions of the foot each have characteristic morphology, distribution, and treatment.
Tinea Pedis (Athlete’s Foot)
Tinea pedis — superficial dermatophyte infection of the foot skin — is the most common fungal infection in humans, affecting 15–20% of the adult population. Three clinical patterns: interdigital tinea pedis (the most common — macerated, scaling, white or erythematous skin in the toe clefts, particularly the 4th web space; secondary bacterial infection [Pseudomonas] turns the skin green and produces malodor); moccasin-type tinea pedis (diffuse scaling and hyperkeratosis on the plantar surface and medial and lateral borders — the ‘moccasin’ distribution; associated with Trichophyton rubrum; chronic, difficult to treat with topical agents alone; often accompanied by toenail onychomycosis); vesicular tinea pedis (bullous; intensely pruritic vesicles on the instep and arch; acute presentation). Treatment: topical azoles (clotrimazole, miconazole) for uncomplicated cases; terbinafine cream for moccasin-type; oral terbinafine (250mg/day for 2 weeks) for extensive or recurrent infection; always treat the toenails if onychomycosis is present (toenails serve as the reservoir for reinfection).
Contact Dermatitis and Psoriasis
Contact dermatitis of the foot: allergic contact dermatitis (Type IV hypersensitivity reaction) to shoe materials — most commonly chromate (in leather tanning), rubber accelerators (in shoe soles), and adhesives; presents as pruritic erythema, vesicles, and scaling in a pattern corresponding to shoe contact (dorsal foot in sandal dermatitis; periungual in sock dye allergy); patch testing identifies the causative allergen; treatment: allergen avoidance, topical corticosteroids, hypoallergenic footwear. Psoriasis of the foot: psoriasis may present on the plantar foot as palmoplantar psoriasis — thick, silvery scale on an erythematous base; particularly challenging because plantar psoriasis is often seronegative for the psoriatic plaque morphology seen elsewhere; may mimic moccasin tinea pedis (KOH prep and culture distinguish fungal from psoriatic); involvement of the nails (nail pitting, onycholysis, subungual hyperkeratosis) is highly characteristic of psoriasis and distinguishes it from tinea unguium in ambiguous cases; treatment: topical corticosteroids, calcipotriene, tar preparations; systemic therapy (methotrexate, biologics) for recalcitrant cases. Dr. Biernacki at Balance Foot & Ankle evaluates foot skin conditions with KOH microscopy and clinical examination, and coordinates dermatology referral for inflammatory skin diseases affecting the foot. Call (810) 206-1402 at our Bloomfield Hills or Howell office.
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Frequently Asked Questions
When should I see a podiatrist?
See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.
What does a podiatrist treat?
Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.
What can I expect at my first podiatry visit?
Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.