Look to what materials the footwear is made of. Maybe the innersoles or the uppers are causing the problem. Manmade uppers will be more likely to make the feet sweat alot more, Thus agitating the condition. Also personal foot hygiene may be a factor. Paul

This is a serious problem and not one to be taken lightly or with mirth. If the individual is in that much pain the infection is severe and probably longstanding. Other underlying conditions are likely. There are several very potent antifungals that can give resolution within 7-10 days but resistant infections are not unknown. The big problem and one that cannot be understated is of re-infection. Shedding of skin fragments and fungal elements is common. Socks will be contaminated and may remain so after laundering. The same is true for all boots and shoes worn by the individual and though various products are available to manage this their efficacy is low and the best solution is to destroy contaminated footwear and start again. That's not much of a problem for you when thinking about 1 pair of boots, but presents real financial difficulties for patients making this an entirely impossible proposition. Add to this the inevitability that at home carpets too will be heavily contaminated and you begin to see the difficulty. Fungal infections of the feet are now generally easy to treat thanks to several new antifungal agents but recurrence is likely and for the patient the misery is likely to continue. If the infection is so severe and to impair mobility and cause daily pain I woiuld expect that the GP will be dealing with underlying conditions and prescribing oral antifungals. A sick note would be very sensible. If it were me, I would expect one, for around 7-10 days in the first instance! Do consider that investigation may identify some yet more serious underlying problem and in turn that may require time off for further investigation and treatment. What should you do? When the individual is off from work discard the boots. A change of boots without treatment is pointless. Consider the flooring of any communal changing areas and step up the hygiene. Keep it clean and use a wet mop and suitable disinfectant product, not once but on a regular basis. (If anyone wants to read a piece about fungal transfer of the flooring of airports, in the area of the scanner where many will walk one after another over a small area in stocking feet, pm me with an email address - it will make great reading as you sit in the airport at Christmas, trying to squeeze onto a non-BA flight). If antifungals are effective then some resolution would be expected relatively quickly, though if pain is so severe there is likely to be much tissue damage that will take time to resolve. Repeated or long-term antifungal treatments may keep things under control and deal with constant re-infection from contaminated footwear, clothing and furnishings. You can help by destrying old and providing new boots - but only when treatment starts. The quality issue may be a red herring. Nice, of course, to have a good quality pair of boots but the dermatophyte fungi are really not too fussy. Ian