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Mixed toe web infection in Child
Other Resources UpToDate PubMed

Mixed toe web infection in Child

Contributors: Rajini Murthy MD, Susan Burgin MD
Other Resources UpToDate PubMed


A mixed toe web infection is an infection between the toes that is caused by a primary fungal infection and worsened by secondary bacterial superinfection.

The primary event in these infections is damage to the stratum corneum by dermatophytes. This is superseded by bacterial proliferation and secondary infection. The superinfection is commonly caused by the organisms, which are present even on normal skin, such as Staphylococcus aureus, Staphylococcus epidermidis, aerobic diphtheroids, Enterococcus faecalis, Acinetobacter, Klebsiella, Proteus, and Pseudomonas. Pseudomonas is the most commonly identified organism in gram-negative toe web infection, either alone or within a mixed gram-negative infection.

Bacteria and fungi are more likely to grow in warm, moist environments. Therefore, hot weather, excess sweating, athletic / recreational activities, and closed-toe / tight-fitting shoes can lead to mixed toe web infections, which can appear similar to Candida toe web infections, known as erosio interdigitalis blastomycetica.

Diabetes and smoking are predisposing risk factors for the development of mixed toe web infections.

These infections can be disabling, with the threat of cellulitis or septicemia in immunocompromised individuals, if not adequately treated.


B96.89 – Other specified bacterial agents as the cause of diseases classified elsewhere

402933000 – Gram-negative infection of toe web

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Differential Diagnosis & Pitfalls

  • Interdigital tinea pedis – This is the underlying factor that causes a mixed toe web infection. There are 2 types: the interdigital dry type and the interdigital macerated type, which is also called a mixed toe web infection.
  • Pitted keratolysis – Shallow, rounded, 1- to 3-mm pits present on the pressure-bearing areas of the soles; lesions can coalesce to form furrows, and affected areas may become macerated.
  • Atopic dermatitis – Usually favors the first and second web spaces.
  • Candidiasis – The maceration induced by Candida albicans is less severe than that caused by gram-negative bacteria. Associated with poorly controlled diabetes mellitus. Antifungal therapy alone will result in complete remission. The severe form is known as erosion interdigitalis blastomycetica.
  • Psoriasis – Sometimes psoriasis may be limited to the soles or may present in a palmoplantar distribution.
  • Erythrasma – Brown, minimally scaly plaques with sharp borders. Web space erythrasma is typically hyperkeratotic but can be erosive.
Less common:

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Last Reviewed:05/02/2021
Last Updated:06/06/2021
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Patient Information for Mixed toe web infection in Child
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Contributors: Medical staff writer


Fungal infections between the toes (on the toe web) may develop when the feet are exposed to heat, moisture, or tightly fitting footwear. Skin damaged by fungus provides an entry for bacteria that can cause bacterial infection or even superinfection. This combination of fungal and bacterial infection is called a mixed infection.

Who’s At Risk

Athletes and workers with sweaty feet, wet or damp socks, and/or tight-fitting shoes or boots are at risk for fungal and bacterial infection. Going barefoot in public showers and locker rooms can increase risk of athlete's foot and other infections.

Both children and adults can get mixed toe web infection.

Signs & Symptoms

Fungal infection begins with red, itchy, scaly skin. Then skin gets irritated and inflamed. There may be peeling skin, pain, or stinging. Skin or wounds that have been exposed to wetness over time become macerated, and the skin begins to break down.

Be watchful for the infection spreading to areas of the foot surrounding the infected toes.

Self-Care Guidelines

Prevent foot infections by keeping your feet dry, aerated, and clean. Change wet socks and avoid wearing wet shoes. Do not share shoes. Protect yourself from locker room athlete's foot with flip flops or sandals.

If you think you have athlete's foot, treat it with over-the-counter anti-fungal cream.

When to Seek Medical Care

Seek a doctor's care when you have multiple symptoms that fail to respond to ordinary care or treatment for athlete's foot.


Your physician will prescribe a combination of treatments for fungal and bacterial infections and provide you with instructions for the care and cleaning of feet and toes.
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Mixed toe web infection in Child
A medical illustration showing key findings of Mixed toe web infection : Macerated skin, Web spaces of toes, White scaly plaque, Pruritus
Clinical image of Mixed toe web infection - imageId=4195633. Click to open in gallery.  caption: 'Macerated scale in the third and fourth webspaces that extends to the base of the fourth toe, with surrounding hyperkeratotic scale.'
Macerated scale in the third and fourth webspaces that extends to the base of the fourth toe, with surrounding hyperkeratotic scale.
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