Patient: Hi there, I was hoping to get some input about something I noticed on my right pinky toe after getting home from work today. When I took off my shoes today after an eight hour shift at work (I am a server at a busy restaurant) I noticed that my pinky toe on my right foot and the area to the right of it (area opposite the ball of my foot on outside) was swollen and had a distinctive blue hue to it. The area is not painful, does not feel cold per-sé and really does not bother me aside from it looking really bad. I did trip and fall on my way home from work today and do remember falling after tripping on my right foot, but I think it was more the inside potion, though it could have been the outside. I was also able to scrape away the blueness on the side of my foot in the shower. Last piece of information, I was wearing cloth blue shoes at the time, not sure if that relates but figured I’d mention it. Attached is a picture of my toe. I did notice a couple of days ago that it looked a bit funky but only noticed the swelling and the color today. Obviously I should see a doctor as soon as possible but should I be running to the ER tomorrow (could it be gangrene) or is it likely just a broken toe?
Doctor: Welcome to Ask The Doctor.We are here to help you our best on this medical platform.I have read your query in det ail and have seen the attached photograph also.As per details, the most likely possibility for your symptoms is a condition called Acute Paronychia that is a condition of nails which is characterized by swelling of the nail folds usually lateral nail folds with redness. It may or may not be painful at all. The most common reasons for Acute Paronychia are Bacterial or Fungal infection. Tight fitting shoes specially for long time in hot humid weather precipitate it very easily.In such cases, I prefer to advise oral antibiotics like Amoxycillin with topical antibiotic cream like Mupirocin 2 % over the affected area. Once the acute infection is settled, we later add topical antifungals like clotrimazole cream and tablet fluconazole is started. Decision for duartion of the treatment is based on the severity of the lesion and effect of the treatment. You should try to keep the area clean and dry and preferably wear open sandals or loose broad shoes from front. You should also get your blood sugars tested as diabetes can also precipitate it.Share my opinion with your doctor before acting upon it.I hope it helps.Stay Healthy
Comments / Follow Ups
Patient: Hi, thanks for the quick response. I think maybe it was related to my fall yesterday as the swelling seems to have gone down. One other question – I do actually have some fluconazole with me for a recurrent sweat rash I get on my back. Is it possible to treat the primary infection with that and/or any OTC mess? Just ask because I’m currently without health insurance.
Doctor: Hello. No I would not advise you any Fluconazole without indications and doctors advise. Excessive sweating is no indication to take Fluconazole.