Prevalence of Tinea pedis in military personnel: a systematic review and meta-analysis

Abstract

Background

Tinea pedis, commonly known as athlete’s foot, is a fungal infection caused by dermatophytes, affecting the skin of the feet. It is prevalent in various populations, but military personnel are particularly vulnerable due to their unique environmental and behavioral factors. These include living in close quarters, exposure to humid conditions, and wearing tight, non-breathable footwear for prolonged periods. This systematic review and meta-analysis aim to estimate the global prevalence of tinea pedis among military personnel and explore factors contributing to its high occurrence in this population. 

Methods

A comprehensive literature search was conducted in multiple databases, including PubMed, Scopus, and Web of Science, for studies published in English up to 21 March 2025. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies, evaluating aspects such as the selection of participants, comparability, and the assessment of exposure. The prevalence rates were pooled using a random-effects model, and heterogeneity among studies was evaluated. Studies employing various diagnostic methods, including microscopy and fungal culture, were analyzed to identify variations in prevalence estimates. A subgroup analysis was performed based on geographic regions to explore the influence of environmental factors on prevalence. 

Results

A total of 25 studies, involving military personnel from different regions, were included in the analysis. The pooled prevalence of tinea pedis among military personnel was estimated at 17% (95% CI: 12–23%). Subgroup analysis revealed regional variations, with the highest prevalence observed in the Americas and Australia, where hot and humid climates are prevalent. The lowest prevalence was observed in European studies, which may be attributed to milder climates. Studies using both microscopy and fungal culture reported higher prevalence rates (20%) compared to those relying solely on microscopy (9%). 

Conclusion

Tinea pedis remains a significant health concern among military personnel, with a global prevalence of 17%. Military environments, characterized by high physical activity, shared living conditions, and poor foot hygiene practices, exacerbate the risk of fungal infections. Preventive strategies, including improved foot hygiene, better footwear design, and enhanced access to antifungal treatments, are essential to reduce the prevalence of tinea pedis in military settings.

Introduction

Tinea pedis, commonly known as athlete’s foot, is a superficial fungal infection of the skin affecting the feet [1]. It is typically caused by dermatophyte fungi such as Trichophyton rubrum complex and Trichophyton mentagrophytes/interdigitale complex. Tinea pedis often presents with symptoms like itching, scaling, and redness, which can range from mild discomfort to more severe, chronic conditions [2]. As one of the most prevalent fungal infections worldwide, it represents a significant burden on public health, affecting millions of individuals across various climates and regions [3].

Military personnel are particularly vulnerable to tinea pedis due to their unique living and working conditions [4]. Prolonged exposure to moisture from wearing enclosed footwear, such as combat boots, combined with physical activity and the frequent use of shared facilities, such as showers and barracks, creates an environment conducive to fungal growth [5, 6]. The demanding physical and operational nature of military life further amplifies the risk of developing and spreading tinea pedis within this population [7]. Untreated or recurrent cases of tinea pedis can lead to complications, such as secondary bacterial infections, which may impact the overall health, morale, and operational readiness of affected individuals [1].

Despite the known risk factors and the potentially significant impact of tinea pedis on military personnel, there remains a lack of comprehensive data on its prevalence in this group [8]. Existing studies often vary in their methodologies, population samples, and geographic focus, leading to inconsistent prevalence estimates. As a result, there is a need for a systematic review and meta-analysis to synthesize the available data and provide a more accurate estimation of the prevalence of tinea pedis among military personnel. While no previous meta-analysis was available to determine a definitive prevalence range, we searched individual studies and identified that reported prevalence rates varied from approximately 2.4–63.3%.

This study aims to fill this gap by systematically reviewing and analyzing existing research on the prevalence of tinea pedis in military populations. By providing a detailed synthesis of the available evidence, this analysis will inform military healthcare providers and policymakers about the extent of the problem and support the development of targeted prevention and treatment strategies. Additionally, understanding regional variations and associated risk factors can help optimize resource allocation and improve the health and readiness of military personnel.

Method

The study protocol of this review was registered in PROSPERO under the identification code CRD42024601536 [9].

Study design

This study is a systematic review and meta-analysis aimed at estimating the prevalence of tinea pedis among military personnel. The study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a comprehensive and transparent review process [10].

Search strategy

A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and Scopus for English-language studies published from January 2000 to 21 March 2025. Additional sources included grey literature such as unpublished studies, doctoral theses, conference abstracts, and manual searches of reference lists from included studies. The search strategy combined terms related to tinea pedis and military personnel, including: (“tinea pedis” OR “athlete’s foot” OR “foot dermatophytosis”) AND (“military personnel” OR “soldiers” OR “army” OR “naval” OR “air force” OR “military”). Boolean operators were used to refine search results. The PICOs strategy was used as a structured approach to formulate the research question and develop the search strategy, particularly for systematic reviews. For this study, the components were defined as follows:

Components of PICOs

• Population (P): Military personnel, including soldiers, naval personnel, air force personnel, and other members of the armed forces.

• Intervention (I): The focus is on the prevalence of tinea pedis rather than a specific intervention or treatment. Therefore, the traditional concept of “intervention” does not apply.

• Comparator (C): No direct comparisons are included, as this study aims to assess the prevalence of tinea pedis across different studies rather than comparing it with another condition or population.

• Outcome (O): The prevalence of tinea pedis among military personnel.

• Study Design (S): Cross-sectional studies, cohort studies, and case-control studies that report on the prevalence of tinea pedis in military personnel.

In the search phase of this study, two independent reviewers (AS and MB) searched the databases. When there were disagreements regarding the eligibility of specific studies, the reviewers discussed these discrepancies. If a consensus could not be reached through discussion, a third reviewer (OR) was consulted to make the final decision. This process ensured that the study selection was systematic and minimized the risk of bias in the inclusion of studies.

In addition to searching electronic databases, we performed a manual search of the reference lists of all included articles to identify any additional relevant studies that may not have been captured in the initial database search. This process ensured that potentially relevant studies, especially those cited within key articles, were not overlooked. To ensure that no relevant studies were overlooked, we also included a search of Google Scholar.

Eligibility criteria

To enhance clarity, the inclusion and exclusion criteria have been summarized in Table 1 as recommended.

Table 1.

Inclusion and exclusion criteria for studies included in the systematic review and meta-analysis

Inclusion Criteria	Exclusion Criteria
• Studies that report the prevalence of tinea pedis among military personnel.	• Studies focusing on non-military populations or mixed populations without separate data for military personnel.
• Studies conducted in any region or country and published in peer-reviewed journals.	• Case reports, editorials, review articles, and commentaries without primary data.
• Cross-sectional, cohort, and case-control studies with clear diagnostic criteria for tinea pedis.	• Studies lacking sufficient information to calculate the prevalence of tinea pedis.
• Studies published from January 2000 to March 2025 in English or with an available English translation.	• Duplicate publications from the same dataset (in which case, the most comprehensive or recent version was included).
• Studies with a defined military population, including soldiers, naval personnel, air force personnel, and other military branches.

Study selection process

Two independent reviewers (MY and AS) screened the titles and abstracts of all identified studies. Full-text articles were retrieved for studies that met the inclusion criteria or when eligibility was unclear. Discrepancies during the selection process were resolved through discussion or consultation with a third reviewer (MB).

Data extraction

Data extraction was performed independently by two reviewers using a standardized extraction form. The extracted data included the following items:

• Study characteristics: Author, year of publication, country of study, study design.

• Participant characteristics: Age range, gender distribution, military branch (e.g., army, navy).

• Sample size and prevalence data: Total number of participants, number of cases of tinea pedis, and reported prevalence rates.

• Diagnostic criteria and method: Criteria used for diagnosis (e.g., clinical examination, laboratory testing), and the diagnostic methods employed (e.g., microscopy, culture).

• Additional variables: Reported risk factors or conditions associated with tinea pedis, such as use of communal showers or type of footwear.

Disagreements in data extraction were resolved by discussion between the reviewers or by consulting a third reviewer.

Quality assessment

The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS) for cross-sectional and cohort studies [11]. The NOS assesses studies based on three domains: selection of study groups, comparability of groups, and outcome assessment. Studies with a score of 1 to 3 were classified as poor quality, those with a score of 4 to 6 as moderate quality, and studies with a score of 7 to 9 as good quality. Each study was independently evaluated by two reviewers and categorized as low, moderate, or high risk of bias based on their total NOS score. Discrepancies in quality assessments were resolved through discussion or with input from a third reviewer.

Data synthesis and analysis

The DerSimonian-Laird method was used to calculate the pooled prevalence rate and its 95% confidence intervals (CI) utilizing a random-effects model [12]. Meta-analysis was conducted using the R software (Version 4.4.1). Heterogeneity among studies was assessed using the I² statistic [13]. An I² value of 25% was considered low heterogeneity, 50% moderate, and 75% high. Given the anticipated variability in study populations and diagnostic methods, a random-effects model was employed to calculate the pooled prevalence and 95% confidence intervals. Subgroup analyses were conducted based on geographical region (e.g., Asia, Europe, North America), military branch (e.g., army, navy, air force), and diagnostic method (e.g., clinical examination versus laboratory testing) to explore potential sources of heterogeneity. Publication bias was evaluated using Egger’s test. Asymmetry in the funnel plot was interpreted as potential evidence of publication bias, and Egger’s test was used to quantify this bias statistically. Sensitivity analyses were performed to assess the robustness of the pooled prevalence estimates. This included excluding studies with a high risk of bias and reanalyzing the data to observe changes in overall prevalence estimates. We also created a Baujat plot to investigate heterogeneity. Additionally, we conducted a meta-regression analysis considering factors such as sample size, year of publication, and the mean age of participants. A p-value of less than 0.05 was used as the threshold to determine statistical significance for all analyses.

Results

After an initial search in the databases, 1,372 studies were identified. After removing 384 duplicate studies, 988 studies remained. Then, the titles and abstracts were carefully reviewed to exclude studies that did not meet the inclusion criteria. At this stage, 865 studies were excluded, and 123 studies were selected for full-text review. After thoroughly evaluating the full text of these studies and applying the inclusion and exclusion criteria, 94 more studies were excluded, and finally, 29 studies were selected for meta-analysis [7, 14–41]. The study selection process is presented in detail in Fig. 1.

Fig. 1.

PRISMA flow diagram of study selection process

The characteristics of the included studies are presented in Table 2.

Table 2.

The characteristics of the included studies

First Author	Year	Country	Sample	Number	prevalence	Age
Davies, A. J	1952	USA	1050	337	32.1	NA
Doupagne	1957	Belgian Congo	105	39	37.1	NA
Ohm	1968	Norway	304	42	13.8	21
Davis	1972	USA	152	22	15	19
Anand	1980	India	3500	924	26.4	NA
Svejgaard	1986	Denmark	546	23	4.2	20.5
Noguchi	1994	Japan	30	19	63.3	23.5
Noguchi	1995	Japan	74	26	35.1	37
Brocks	1999	Denmark	73	7	21.3	30.5
Ingordo	2000	Italy	410	10	2.4	23
Cohen	2002	Israel	224	106	47.3	NA
Ingordoa	2004	Italy	1024	28	2.7	24
Cohen	2005	Israel	223	109	27.3	19.6
Davin S. Lim	2005	Australia	193	38	20	NA
Djeridane	2007	Algeria	650	49	18.3	43
Sasmaz	2011	Türkiye	188	48	25.5	25.5
Min Bae	2012	Korea	1321	201	15.2	24
Pereira Leite Jr	2013	Brazil	197	39	39.4	34
Alshehabi	2013	Bahrain	183	64	35	43.5
Ahmed Mujahid	2013	Pakistan	350	34	9.71	19.5
Şenel	2014	Türkiye	1148	181	15.8	26.04
Rahimi Dehgolan	2014	Iran	9707	583	6	NA
Zhou	2016	Lebanon	1658	211	13	32
Irfan Anwar	2016	Sudan	542	122	22.5	30.45
Punyawee Ongsr	2018	Thailand	303	54	17.8	19
Wang	2020	China	549	26	4.7	35
Diongue	2020	Senegal	169	11	6.5	47
Olayemi	2021	Nigeria	250	31	12.4	38.3
Kintsurashvili	2021	Georgia	729	340	46.64	34

(NA  Not Available)

Based on the NOS checklist scores, 12 studies had a quality score of 4–6, while 17 studies scored 7–9. Based on the random-effects model, the prevalence of tinea pedis among military personnel was estimated at 17% [95% CI: 12–23] with an I² = 99% (Fig. 2).

Fig. 2.

Forest plot of the prevalence of tinea pedis among military personnel

To ensure the stability and robustness of the results, as well as to assess the trend of changes in prevalence, sensitivity analysis and cumulative analysis were conducted by gradually adding studies. The results were stable in both analyses, and the prevalence of tinea pedis among military personnel was found to be 17% [95% CI: 12–23]. Figure 3 shows the sensitivity analysis, and Fig. 4 presents the cumulative analysis.

Fig. 3.

Sensitivity analysis of prevalence of tinea pedis among military personnel

Fig. 4.

Cumulative analysis of prevalence of tinea pedis among military personnel

To identify outlier studies and examine the cause of heterogeneity in this study, a Baujat analysis was conducted. Four studies: Davies in the USA, Anand in India, Rahimi Dehgolan in Iran, and Kintsurashvili in Georgia had the most significant impact on the overall meta-analysis results. Figure 5 shows the Baujat plot.

Fig. 5.

Baujat plot Identifying Influential studies in this meta-analysis

These 4 studies were excluded from the analysis, and the prevalence was calculated without them, as shown in Fig. 6. Accordingly, a prevalence of 16% [95% CI: 11–22] was observed.

Fig. 6.

Prevalence estimate after exclusion of four studies

To examine the heterogeneity observed among the included studies, subgroup analyses were performed based on continent, sample size, publication year, status of service, diagnostic test, and study quality score, as shown in Table 3.

Table 3.

Subgroup analyses based on study characteristics

Variables	Number of studies	Prevalence [95%CI}	I2	P-value
Continent
America	3	22% [13–34]	93%	0.00
Africa	5	15% [7–27]	96%	0.00
Europe	10	15% [7–30]	99%	0.00
Asia	10	18% [10–30]	99%	0.00
Australia	1	20% [14–26]	-
Sample size
< 500	17	21% [14–30]	96%	0.00
≥ 500	12	13% [7–21]	99%	0.00
Publication year
Before 2000	10	18% [9–33]	96%	0.00
After 2000	19	16% [11–23]	99%	0.00
Status of Service
Employed	23	17% [11–24]	99%	0.00
Conscripts	6	17% [11–32]	97%	0.00
Diagnostic test
Microscopy	9	9% [13–31]	98%	0.00
Microscopy + Fungi culture	20	20% [10–23]	99%	0.00

A subgroup analysis of the prevalence of tinea pedis among military personnel was conducted based on various factors, including continent, sample size, publication year, status of service, diagnostic test, and study quality. Continent-wise, the prevalence was highest in America at 22% (95% CI: 13–34%), based on three studies with substantial heterogeneity (I² = 93%). In Africa, the prevalence was 15% (95% CI: 7–27%) based on five studies (I² = 96%). Similarly, Europe reported a prevalence of 15% (95% CI: 7–30%), but with notable heterogeneity (I² = 99%), based on ten studies. Asia showed a prevalence of 18% (95% CI: 10–30%), also with high heterogeneity (I² = 99%), across ten studies. In Australia, one study reported a prevalence of 20% (95% CI: 14–26%). When stratified by sample size, studies with a sample size of less than 500 reported a higher prevalence of 21% (95% CI: 14–30%) with significant heterogeneity (I² = 96%), compared to studies with a sample size of 500 or more, which had a lower prevalence of 13% (95% CI: 7–21%) and high heterogeneity (I² = 99%). Regarding publication year, studies conducted before 2000 reported a prevalence of 18% (95% CI: 9–33%) with substantial heterogeneity (I² = 96%), while studies published after 2000 showed a slightly lower prevalence of 16% (95% CI: 11–23%) but with higher heterogeneity (I² = 99%). Based on the status of service, the prevalence was similar between employed personnel and conscripts, with both groups showing a prevalence of 17%. For employed personnel, the confidence interval was 11–24% with significant heterogeneity (I² = 99%), while for conscripts, it was 11–32% (I² = 97%). In terms of diagnostic methods, studies using only microscopy reported a prevalence of 9% (95% CI: 13–31%) with high heterogeneity (I² = 98%). However, when both microscopy and fungal culture were used, the prevalence increased to 20% (95% CI: 10–23%) with substantial heterogeneity (I² = 99%).

In this study, we evaluated publication bias by visually examining the funnel plot and performing Egger’s test, which is used to identify small-study effects (Fig. 7). The funnel plot showed asymmetry, but the presence of publication bias was not statistically significant. The Egger’s test for small-study effects yielded a bias coefficient with a P-value of 0.96, indicating no significant bias. Additionally, we applied the Duval and Tweedie non-parametric trim and fill method. The adjusted rate from this method did not differ significantly from the unadjusted pooled prevalence estimates (Prevalence = 17% [95% CI: 12–23]).

Fig. 7.

The publication bias

Discussion

The present systematic review and meta-analysis aimed to estimate the prevalence of tinea pedis among military personnel and explore potential sources of heterogeneity. The pooled prevalence was estimated at 17% [95% CI: 12–23%]. The prevalence of tinea pedis among military personnel can be attributed to several factors, many of which are unique to military settings [4, 25, 39]. Military personnel often live in close quarters, such as barracks, which can lead to increased person-to-person transmission of fungal infections. Shared facilities like showers, locker rooms, and communal bathrooms increase the risk of exposure [42]. Military personnel often engage in physically demanding activities, leading to prolonged periods of sweating, which creates a moist and warm environment around the feet ideal for fungal growth [33, 43]. Military personnel frequently wear tight, heavy boots as part of their uniform, often for extended periods. These boots may not provide adequate ventilation, trapping moisture and heat, which encourages the growth of dermatophytes that cause tinea pedis. In high-intensity training or operational settings, personnel may not have the time or resources to practice optimal foot hygiene, such as washing and thoroughly drying their feet regularly, which can prevent fungal infections [5, 44]. Military activities often result in trauma to the feet, like blisters, cuts, or abrasions. These minor injuries can become entry points for fungal pathogens [45, 46]. Military deployments in tropical or humid regions increase exposure to environmental conditions conducive to fungal growth [4, 47]. This further raises the risk of developing Tinea Pedis. Preventive interventions, like antifungal powders, breathable socks, and protective footwear, may not always be adequately available or used consistently in all military settings [48, 49]. These environmental, behavioral, and systemic factors could explain why military personnel have a higher prevalence of fungal infections like tinea pedis [33].

These findings align with studies such as Toukabri et al. [50], which observed a prevalence of 22.5% for tinea pedis among Tunisian patients. This study highlighted key risk factors, such as the use of occlusive footwear, communal showers, and nail trauma factors similarly prevalent in military environments. Additionally, Henderson et al. [51], emphasized the role of environmental conditions, including high humidity and inadequate hygiene facilities, in fostering the spread of tinea pedis among vulnerable populations like the homeless. Both studies highlight parallels with military settings where communal living and rigorous physical activity under harsh conditions amplify these risks.

The prevalence of tinea pedis among military personnel can be attributed to several factors unique to military settings, such as close quarters, shared facilities, and heavy, non-breathable footwear. The increased risk in military environments mirrors patterns seen in vulnerable populations, as observed in Henderson et al. [51], study of homeless individuals. For instance, the use of shared hygiene facilities, prolonged exposure to moist environments, and lack of preventive resources were noted as key drivers of fungal infections [48].​.

The findings of this meta-analysis highlight notable variations in the prevalence of tinea pedis among military personnel across different continents. The findings of this meta-analysis highlight notable variations in prevalence across continents, with the highest prevalence observed in regions like the Americas and Australia, characterized by hot and humid climates. Similarly, Toukabri et al. [50], identified warm, humid conditions as critical contributors to tinea pedis in Tunisia. The predominance of Trichophytonrubrum as a causative agent in both studies underscores the importance of targeted antifungal treatments. These differences can be attributed to a range of environmental, occupational, and socio-cultural factors unique to each region [52]. The highest prevalence was observed in studies conducted in America, where the climate in many regions, particularly in the southern and tropical areas, is characterized by high humidity and elevated temperatures [52]. Such environmental conditions create a favorable environment for dermatophyte growth, particularly when compounded by the prolonged use of occlusive footwear in military settings. Additionally, the communal use of shared facilities such as showers, barracks, and training equipment in American military bases is a well-documented risk factor for the transmission of tinea pedis. Similarly, in Asia and Africa, the warm and humid climates present in several regions are conducive to the proliferation of tinea pedis causing fungi [51, 53, 54]. These climatic factors, coupled with the demanding nature of military training, result in prolonged periods of sweating and moisture accumulation inside footwear [55, 56]. In Asia, the high population density and crowded living conditions often encountered in military settings may further contribute to the spread of fungal infections [57, 58]. Previous studies have shown that crowded environments and shared living quarters increase the risk of direct and indirect transmission of dermatophytic infections in military personnel [57]. In Europe, the moderate prevalence observed can be partly explained by environmental and operational factors. Although colder regions may not be as conducive to fungal growth, the frequent use of heavy and insulated boots, particularly during winter months, creates an enclosed, humid environment that supports the proliferation of fungi. Moreover, communal facilities and high exposure to wet, muddy conditions during training can increase the risk of fungal infection in European military personnel. In Australia, the prevalence of tinea pedis was also notably high, which may be attributed to the region’s hot climate, particularly in northern areas. Australian military personnel are frequently exposed to prolonged outdoor training and field operations, often in hot and humid conditions, which promote excessive sweating and moisture retention in footwear. Prolonged exposure to such environments has been previously associated with increased rates of tinea pedis [29, 52]. These findings suggest that climatic conditions, operational practices, communal living arrangements, and access to hygiene facilities are critical factors contributing to the prevalence of tinea pedis in military personnel. High humidity and warm temperatures are particularly notable risk factors across continents, promoting fungal proliferation in occlusive footwear [59]. Additionally, shared environments and high physical activity levels increase susceptibility by facilitating direct and indirect contact with infectious spores. Future preventive strategies should consider these risk factors and aim to improve hygiene practices, footwear design, and access to appropriate facilities to mitigate the prevalence of tinea pedis in military settings [39].

The variation in reported prevalence rates of tinea pedis based on diagnostic methods highlights the critical role of accurate and comprehensive diagnostic approaches in assessing the true burden of this condition among military personnel. Studies that employed only microscopy reported a prevalence of 9%, which was notably lower than the prevalence of 20% observed in studies utilizing both microscopy and fungal culture. This study emphasized the importance of comprehensive diagnostic methods, showing underreporting when microscopy alone was used. Balci et al. [60], employed both direct microscopy and fungal cultures, which enabled accurate identification of causative agents, corroborating the need for reliable diagnostic techniques. This discrepancy is likely attributable to the limitations of microscopy alone in accurately identifying dermatophyte infections. Microscopy is known to have lower sensitivity, as it primarily relies on the visualization of fungal elements, which can be challenging, especially in cases with low fungal load or subtle infections [38]. In contrast, the combined use of microscopy and fungal culture provides a more comprehensive and reliable diagnostic assessment, leading to higher reported prevalence rates. Fungal culture is considered the gold standard for diagnosing dermatophyte infections, as it allows for the growth and identification of specific fungal species that may not be detectable through microscopy alone. The higher prevalence observed with the combined diagnostic approach suggests that reliance on microscopy alone may lead to underreporting of tinea pedis cases, thereby underestimating the true burden of this condition in military populations.

Limitations

This systematic review and meta-analysis provide valuable insights into the prevalence of tinea pedis among military personnel, but there are several limitations that must be considered. First, the included studies exhibited considerable heterogeneity, which could be attributed to differences in regional factors such as climate, military environments, and population characteristics. The diversity in diagnostic methods used across studies also contributes to the variability in reported prevalence rates. While the combined use of microscopy and fungal culture provides a more accurate diagnosis, studies relying solely on microscopy may underestimate the true prevalence of Tinea Pedis. Furthermore, the potential for publication bias should be considered, as studies with negative results or small sample sizes may be underrepresented in the literature. Another limitation is the lack of detailed information regarding military-specific variables. Important contextual factors such as the type and intensity of physical training, hygiene and foot care practices, use of communal facilities, and the availability and implementation of preventive measures (e.g., antifungal powders or protective footwear) were poorly reported or entirely absent in many studies.

These factors could influence the prevalence rates but were not consistently reported across the studies reviewed. Additionally, the cross-sectional nature of many studies limits the ability to assess causality or identify trends over time. Future studies that incorporate longitudinal data and control for confounding variables would provide a more comprehensive understanding of the factors contributing to tinea pedis in military settings.

Conclusion

The prevalence of tinea pedis among military personnel is a significant concern, with a pooled prevalence of 17% observed in this meta-analysis. The high prevalence can be attributed to various environmental, behavioral, and systemic factors unique to military settings, including close quarters, shared facilities, heavy non breathable footwear, and high physical activity levels. Regional variations in prevalence, influenced by climate, operational practices, and diagnostic methods, further highlight the complexity of this issue. The findings emphasize the importance of accurate diagnostic methods, such as the combination of microscopy and fungal culture, to accurately assess the burden of tinea pedis. Addressing this issue will require a multifaceted approach that includes improving foot hygiene practices, enhancing the design of military footwear, ensuring adequate access to preventive measures, and considering environmental factors such as climate and living conditions. Future research should focus on more comprehensive studies that explore the role of these factors in greater detail and evaluate the effectiveness of preventive strategies. In particular, longitudinal studies with appropriate control of confounding variables are needed to deepen our understanding of causal risk factors and the long-term effectiveness of interventions in diverse military environments. By addressing the key risk factors identified in this review, military organizations can reduce the prevalence of tinea pedis, ultimately improving the health and operational readiness of military personnel. 

Abbreviations

NOS

Newcastle-Ottawa Scale

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

CI

Confidence intervals

Authors’ contributions

MY, MB and AS designed the study. OR and MB collected the data and performed the data analysis. All authors edited and revised the paper for grammar.All authors read and approved the final paper for publication.

Funding

The authors no funding was received to assist with the preparation of this research.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.