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Nail Trauma Paronychia

My patient welcomed in the New Year by doing a midnight 21 mile run through the streets of San Francisco.  It was a clear, crisp night and what a healthy and invigorating way to celebrate New Year's Eve!  The next day, however, her 2nd toe looked like this.  It was throbbing and tender to the touch.  She did not remember any specific trauma.

By the looks of the photo, it is a paronychia, an infection around a fingernail or toenail.  This infection is probably the result of repeated trauma as her foot struck the ground and the top of the nail struck her shoe.  A little bacteria (staphylococcus) was able to take hold in the skin as it broke through the protective cuticle.

Because she is healthy, without diabetes or other immune problems, I advised frequent hot water soaks to increase blood flow and (hopefully) promote natural immune healing.  If the swelling worsens or pus appears, it can be cured by excising it to drain.  Topical antibiotics are of no use and rarely are oral antibiotics needed unless the infection is worsening.


RecessIsOver said…
The leader of a hiking group told us to be aware of our toes: if we could feel the shoe pressing on them, we should stop & retie the shoe. He said he lost a SET of toe nails because of repeated pressure on his toes.
Anonymous said…
What is the yellow discoloration on the other toe?
Interesting post. Looks painful
woodwoman said…
I've lost entire toenails as a runner. I do not like my toenails very long at all - keeping them short seems to help.
Cary McNeal said…
A different kind of toe jam!

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