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Paeds podiatry problem

Ok, the Paeds month is coming to its end. But here us a common, curly clinical question. 13 yo girl presents complaining of a sore, red, smelly toe.  It is stopping her from soccer practice – cant Bend it like Beckham any longer….

How do you manage this:

20130425-144723.jpg

Specifically – what do you do with this patients toe :

today?

next week?

and for the longer term?

This is really GP bread n butter stuff. But I know there are heaps of opinions out there – are you passionate about paeds peds?
Casey

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Comments

  1. It’s a bit hard to tell from the picture, but is it a paronychia? If so, I would incise it and get as much pus out as possible. Hold off on antibiotics unless the kid is systemically unwell and review the next day.

    Had one on an oldie the other day -- nothing more satisfying than squeezing out a heap of pus!

  2. Oh and in the longer term… good advice about nail cutting, eg dont cut the nail at an angle at the side, cut straight across or even slightly longer at the sides. Sometimes taping the toe so that the nail fold on that side pulls away from the nail can be helpful until the nail grows out a bit longer. Make sure the shoes aren’t too tight!

    If they are getting recurrent infections or dysfunction despite all of that, talk about wedge resection.

  3. I’d say ungus incarnatus lateralis with partial paronichium.
    Now: I/D
    Next week: partial nail resection
    Later:toe nail clipping advice (straight)
    Cheers

  4. Andy neill says:

    Looks a bit more like herpetic whitlow but I’ve not seen it on a toe. Either that or paronychia but obviously management is different!

  5. DAN SHAN says:

    today: squeeze out the pus ( if there is any), incise the ingrown toenail. Cover the wound with dressing and review the next day.
    next week: check the growing of toenail.
    and for the longer term: educate the patient on right method on toenail trimming.

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