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An Infected Toe: Ouch!

by Sue Hubbard, M.D.

It’s media office day and I just received an email via our new iPhone App (The Kid’s Doctor) from a parent who has a child with an infected toe.  I suspect that her child might be a ‘toenail’ picker which often leads to a local infection along the edge of the toenail.

This seems to involve the ‘great toe’ more often than other toes, due to the development of an ingrown toenail. I also seen it when a child or parent has cut the toenail too short and the toenail wants to grow down into the skin rather than ‘out’.

Because the edge of the nail has penetrated the skin, and therefore there is a break in the skin, bacteria (remember our feet are dirty) can easily get into the skin and cause a local infection. The term for an infection of the toenail is a paronychia. But, regardless of the fancy term, it causes an infection which is painful.

On occasion if the infection is minimal and you recognize it early you can treat it by using warm water soaks with an antibacterial soap and then applying a topical antibiotic such as Polysporin or a prescription called Mupiricin (many parents may have this from their doctor for a previous skin infection for a child after a bite or something). If the toe is getting more red, inflamed and tender then this will require a visit to your doctor.

When I see a paronychia in the office I typically treat it with not only local care, but with an oral antibiotic that treats skin infections.  If there is a lot of “pus” at the site (some can get really bad before they are seen) then I like to take a culture of the pus to determine which bacteria I am dealing with in order that the appropriate antibiotic may be selected.

It is always preferable to send a culture when possible as you not only identify the bacteria in question, but you also get the antibiotic sensitivities which allows you to select the most appropriate antibiotic for the infection.

Often it seems that a paronychia will become recurrent, which will then require an appt with a foot doctor to remove the offending nail matrix.

Best advice, don’t cut the nail too short and no toenail biting or picking!!  Easier said than done.

That’s your daily dose for today. We’ll chat again soon.

Related Posts on www.kidsdr.com

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