piedmontcat
Big Toe Injury/Infection 8/29/2009 5:40PM Reply | Return to Index | Report Post
Don't know if I need a podiatrist or to use my incompetent primary care physician for an annoying big toe infection. After months and months of running in soaking wet (sweated out) socks and shoes in this Carolina hot/humid weather, my feet finally suffered from my bacteria-infested shoes/socks. The thing was swollen like a bee stung it for two weeks. I had it numbed and sliced open this past Wednesday night (by physician) around the cuticles; lots of blood, pus, and old/dried out blood shot out like a popped pimple. The next day, I squeezed some more pus/blood out of it. I still have pus/blood leaking out 3 days later and the lacerations will eventually close, but I'm concern that it will come back with a vengeance. I'm taking two different antibiotics to fight off the infection as well. I also plan on getting another pair trainers with a wider toe box to give my toes more wiggle room and minimize the trauma placed on my big toe.
Questions:
1. With the lacerations/drainage and antibiotic combo, will this nail eventually fall off naturally or should I let the physician numb it and tear the whole nail off manually?

2. How long will it take for the nail to fall off naturally?

3. Will this infection continue to hamper my training? There is currently no pain, so can I begin running again now??

4. What else can I do to make sure this thing becomes a thing of the past.

Thanks for all who decide to help a brother out.
Podmed
RE: Big Toe Injury/Infection 8/29/2009 5:58PM - in reply to piedmontcat Reply | Return to Index | Report Post
Okay, you obviously have a problem that has to be treated correctly in order to avoid a much larger problem (i.e. osteomylitis or sepsis). Let me ask you some questions: Did you go to a podiatrist or just a primary care physician? Did this doctor take a culture of the wound and send it to a pathology lab to determine the exact
organism(s) present? Did the doctor take x-rays?

If the doctor took a culture, he can determine the exact microbe in your wound and treat it with the correct antibiotics. If he didn't take a culture, then he is just giving you a broad spectrum antibiotic and hoping your problem will resolve--personally I would be concerned in this case. Additionally, did your doctor take x-rays? An x-ray will show if the microbe has infected your bone (aka osteomylitis), in which case, you have a serious problem and may have to have your toe resected. I would be far more concerned about this rather than just a toe nail falling off.
piedmontcat
RE: Big Toe Injury/Infection 8/29/2009 6:11PM - in reply to Podmed Reply | Return to Index | Report Post
Thanks for the scaring the crap out of me, even though I have no idea what resected or sepsis means. I'll google each term. I do know that he took a culture and had his nurse call me yesterday to let me know 2 different bacterias showed up; he's gonna do some research over the weekend and give me a call early next week to let me know what types. He didn't take any x-rays, but did squeeze around me toe joints and push the end of the toe a lot and watched my response. There were nothing (pain-wise) there and felt very centralized behind the nail, right behind the cuticle.
piedmontcat
RE: Big Toe Injury/Infection 8/29/2009 6:16PM - in reply to piedmontcat Reply | Return to Index | Report Post
Oh yeah...a primary care physician, not a specialist like a podiatrist.
Podmed
RE: Big Toe Injury/Infection 8/29/2009 6:25PM - in reply to piedmontcat Reply | Return to Index | Report Post
So your doctor got the lab results back and needs to do "research" on types of bacteria that were discovered?? I don't mean to pass judgement, but all doctors should know their microbiology well enough to tell you what sort of bacteria you have (i.e. gram +, gram -, aerobic, or anaerobic) and give you the correct antibiotic to target them...like right away. What sort of doctor did you go to??

Sepsis is when the bacteria get into your blood stream and spread throughout the body (i.e your toe infection starts to spread up your leg). Chances are you will be fine and sepsis won't occur because you are taking antibiotics (hopefully the correct ones).

I wasn't trying to scare you with my last post. I just wanted to make you are aware of complications that can occur if you aren't treated correctly. In all seriousness, if your infection doesn't resolve after your supply of antibiotics (so like 7-10 days) I would advise you to find another doctor.
piedmontcat
RE: Big Toe Injury/Infection 8/29/2009 6:30PM - in reply to Podmed Reply | Return to Index | Report Post
Thanks and actually we share the same concerns about this doctor and the complications of infections. I've been very unpleasantly surprised by the incompetence of doctors/healthcare around the Charlotte area and have already started my search for a better doctor. Again, I'm not sure what sort of doctor he is, I just know he works in family practice now. I'm sure Raleigh is in much better shape having UNC, NC-State, and Duke nearby.

I do appreciate your input, nevertheless. What about those other questions I posed? Any thoughts?
Again, thanks for looking out.
Podmed
RE: Big Toe Injury/Infection 8/29/2009 7:14PM - in reply to piedmontcat Reply | Return to Index | Report Post
Well, I'm not sure if I can answer your other questions accuratly, but here's what I've got...

First of all, I'm not sure if your toenail will fall off. You mentioned there were 2 bacteria at the site. If by chance, on of those "bacteria" was in fact a fungus, then you may have to remove the nail to get rid of it completely. This is no biggie, the nail should grow back depending on how they do the procedure. Nevertheless, I don't think that a bacteria infection alone would cause you to lose a nail...but I could be wrong.

As far as running goes, I would say you could start up again. Just make sure you keep the wound SUPER clean and dry. So perhaps you could wrap up your toe and maybe put some water-resist wrap around it if you know your shoes will get soggy. You may have to be a little innovative here.

If you never want this to be an issue again, try hosing down your shoes after every run. Its very easy for microbes from the dirt to attach to the shoes and then get into your blisters or under your toe nail cuticles. Also, you may want to try some Dr. Scholl's foot powders or sprays that you can get at any pharmacy. I think these are marketed to kill bacteria, while making your shoes smell fresh.

I don't want to play doctor here, but let me ask you this...does your toe have a "fruity" odor to it? or did the doctor tell you what bacteria was found?? If it does smell fruity, you probably have a pseudomonas infection. This can be treated easy enough with an antibiotic, but it could have been just as easily treated by dipping your toe in vineger. Now don't start dipping you toe in vineger, because you don't want to interfer with the antibiotics. But if however, you find out pseudomonas is the cause, maybe you could wash down your feet with vineger a couple times a week in the shower to kill the bacteria before you get a problem like this again.

I hope this helps...let me know how it all resolves :)