Skepticism on Report of Rash of Yoga Mat Foot Infections

NEW YORK, Aug. 1 -- A dramatic increase in foot infections from unclean yoga mats, reported by a podiatrist last week, remains a mystery to other podiatrists who have seen no such increase.

Significantly, while all the evidence in this brouhaha is anecdotal everyone agrees that research has not confirmed a link between dirty yoga mats and fungal, viral, or bacterial foot infections.

Greg Cohen, D.P.M., of Long Island College Hospital and in private practice in New York City's tony Brooklyn Heights, stirred concern with a report in the New York Times that in the last two years he has seen a "50% spike" in patients with plantar warts and athlete's foot, probably due to bare-foot patients practicing yoga on unclean mats.

"Hard to fathom the fuss," said Martin B. Silverman, D.P.M., who practices in suburban New Rochelle. Not only has Dr. Silverman seen no increase in infections among his many patients, but he said "it's hard to ascribe these things to one set of causes."

Veruca plantaris, for example, can be picked up just about anywhere, especially in warm summer weather. Rashes or cracked skin from hyperhydrosis or improper drying can cause infections between the toes, for example, he said.

Roger Beck, D.P.M., of Tavares, Fla., said he has not seen an increase in tinea pedis (athlete's foot) or for that matter plantar warts. It's hard to link these infections to the yoga mats alone, he said, because bacteria will cause infections wherever there is warmth and moisture, that is, elsewhere in the facility.

Dr. Beck was more concerned about the risk for women who go to pedicure salons where unsterile instruments may be used. Anybody can get a fungal infection if they put their shoes back on after a yoga class because heat and sweat build up, he said. However, taking a shower would solve that problem.

Bacterial infections entering through open sores can cause more serious problems, but yoga practitioners are typically healthy, he added.

Jane Anderson, D.P.M., of Chapel Hill, N.C., despite the reported increase, she has seen no such increase in foot infections linked to unclean yoga mats. Plantar warts, caused by HPV virus specific to the bottom of the foot, and athlete's foot may increase in summer when people are sweatier and when they spend more time in the pool and walking barefoot. So the link isn't clear, Dr. Anderson said, noting that although she was interviewed for the earlier yoga-mat report, her experience was not included.

Finally, a spokesperson for the New York City Department of Health and Mental Hygiene says the agency is unaware of any surge in foot fungal, viral, or bacterial infections due to contaminated yoga mats.

As for Dr. Cohen, when asked why his experience appears to differ, his answer was, "location." The upscale Brooklyn Heights area where he practices, he says, has many new yoga facilities, which may account for the increase in patients who arrive at his office with foot infections.

Mats need to be disinfected with bleach or Lysol (which contains citric acid), although alcohol may not do a good enough job, according some podiatrists. And everyone agrees that that a soap and water wipe can't do the job. One solution, the podiatrists say, is to bring one's own mat, rather than using the facility's mat, although many health clubs stoutly insist that they take adequate hygienic precautions.

Speaking for the New York Health & Racquet Club, a large local chain, group fitness director Maryann Donner said, "I've never had any complaints about infections in the 13 years that I have been director."

The club has a large yoga program, and we provide yoga mats and yoga props in all our clubs, she said, adding that members, as well as instructors, often bring their own personal mats.

The club provides its members with towels that are used in class for poses that involve the face or when needed for added padding for the knees.

The yoga mats are cleaned on a daily basis with disinfectant, and are also inspected and replaced if they fade or peel, she said.

At Crunch Fitness, a health-club chain in major cities, spokeswoman Amy Strathern said the mats are cleaned daily with a disinfectant spray, washed, and hung up to dry. The general manager of each club is supposed to make sure it's done properly. Still, she said, "one-third of the members bring their own mats, although in a city it may be hard to lung your mat around all day."

Finally, it appears to be up to club members to take their own precautions. Yoga mats, aside, "gyms are notorious and infamous for standard foot ailments," said Craig Fritz, speaking for the American Podiatric Medical Association.