Paronychia

When an ingrown toenail becomes infected, it is referred to as a paronychia. This happens due to the nail literally digging into the skin, causing a breakdown in the soft tissue, which allows bacteria to penetrate the natural skin barrier. The organism that is usually responsible for the infection is a staphylococcus species.

Paronychia will appear as a small, localized area of redness that may spread up the toe. It is generally quite painful, and there is usually a fair amount of pus and drainage from the site. In patients that are immunocompromised, such as diabetics or patients on long-term steroid regimens, a paronychia can advance to a more complicated infection of the soft tissues. These should be dealt with rapidly and aggressively by a doctor.

Treatment for paronychia includes incision and drainage of the infection site, which will help to relieve pain as well as remove much of the infection. A bandage is applied, usually with a topical antibiotic, and oral antibiotics may be used as well. Augmentin is a commonly prescribed oral antibiotic for paronychia, though it may not always be necessary. The bandage may be changed once or twice a day for the first few days, and soaks in a dilute betadine solution may be beneficial as well.

If ingrown toenails and paronychia are a chronic problem, they can be addressed with one of several more permanent procedures. A podiatrist will typically be the type of doctor that deals with this problem. After the infection resolves, a chemical matricectomy may be performed. This procedure involves using a chemical, such as phenol or sodium hydroxide, to permanently remove a portion or the entire nail matrix. The nail and nail matrix may also be surgically removed. Both are relatively minor procedures, and allow for a quick recovery. The recurrence of ingrown toenails after these surgical procedures is extremely low.

Generally speaking, a paronychia is a minor infection, and is treated as such. It is only in the diabetic or otherwise immunocompromised patient that it becomes an area of greater concern. If not dealt with rapidly, a minor infection can become a more serious, even life-threatening infection.

If you are experiencing pain from an ingrown toenail, show it to your doctor. Even if it is not infected, it should be dealt with in an appropriate manner, to relieve pain, prevent regrowth of the ingrown portion of the nail, and prevent a pending infection. With time, many ingrown toenails will ultimately become infected.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

With cold weather approaching, it’s important to learn how to protect yourself from the bite of cold! Whether you know it or not, your skin is the largest bodily organ and comprises 15% of your total body weight! Your skin works to protect your body from a host of environmental assaults, but trauma in the form of hot or cold injury can compromise its protective properties. A cold injury, such as frostbite can cause fluid loss within the skin and increase its breakdown and the likelihood of infection.

Although frostbite is used as a general term to cover all sorts of cold injuries, there are actually different and specific types of cold injury with frostbite being just one of them. The non-freezing types of cold injury are chilblains and immersion injury (trench foot). The freezing types of cold injury are frostnip, superficial frostbite and deep frostbite.

Chillblains

The mildest form of cold injury is called chilblains and is the most commonly experienced. It occurs when bare skin is exposed to temperatures of 33 – 60 Fahrenheit. The typical places for chilblains to occur are the ears, fingers and the tip of your nose. The best way to treat chilblains is prevention: avoiding the cold and protecting prone areas. Make sure to cover yourself adequately before going out! If chilblains do occur, the best way to treat it is via rapid rewarming and the application of moisturizers.

Immersion Injury

Immersion injury is also known as trench foot because in World War I, many soldiers who fought in the trenches experienced this type of cold injury. Unlike other cold injuries that are associated with cold air, immersion injury has to do with cold water. Cold water leads to much rapid heat loss than cold air by about 25-fold! As a result of the water penetrating the skin, trench foot can occur at much higher temperatures than the cold you may associate with frostbite. As a result of prolonged skin exposure to water in cold weather, your foot may look dusky and blue with swelling or blister formation. The best way to treat the affected area is to rewarm and dress the area with dry materials.

Winter time conjures up memories of snow angels, snowball fights and snow men! However, care must be taken to prevent cold injuries as a result of prolonged exposure to the weather. Skin injuries due to the cold are due to ice crystal formation in the tissue. To prevent crystal formation from occurring in the vital tissues of your body such as your brain and heart, blood gets diverted from your extremities (arms and legs) into the core (trunk and head). The process of redirecting blood flow to more vital structures is called arteriolar shunting.

The process of transferring blood to the inner most aspect of your body means that your extremities are more prone to dying off with increased exposure to cold. In essence, your body sacrifices your limbs in order to keep its vital functions going. Without blood keeping the area supplied with oxygen, nutrients and warmth – it is easy to see why areas furthest away from the head and heart are most affected by the cold.

Frostnip

Frostnip is a freezing type of cold injury where reversible ice crystal formation occurs. This is the mildest form of frostbite and the nose, ears and extremities are the most likely areas to encounter it. When frostnip occurs your affected areas will become white and have a decreased sensation. Rapid rewarming in water over the boiling point (104-108) is the best way to rescue those areas from further damage. The reasons for the use of very hot water is to shorten the frozen state, increase the local blood flow to the area and decrease the time cells are exposed to ions in the blood.

Superficial Frostbite

Extended exposure to the elements can turn a condition of frostnip into superficial frostbite! In this case, the cold has penetrated the area of skin and its underlying subcutaneous tissue. There are a variety of signs that indicate superficial frostbite has occurred: itching/burning that is lateral replaced by ache, swelling, cyanosis (blueness), excessive perspiration, and coldness of injured parts that occurs 2-3 weeks after the injury and lasts for many months! The cold did not kill off the nerves in the affected area so there is significant pain.

With winter time upon us, it is important to discuss safety measures and treatment tips if you should encounter a cold injury. Cold injuries can be likened to burn injuries in that the trauma caused to the skin is very similar. In addition, frostbite is graded in stages just like a burn injury.

Deep Frostbite

Deep frostbite is the opposite temperature equivalent to a burn injury. Both burns and deep frostbite have degrees of severity and the greater the degree of burn, the more injury a particular area has sustained.

First degree and second degree cold injuries are actually classified as superficial frostbite whereas third degree and fourth degree injuries are of the deep frostbite category.

First degree frostbite is painful and the affected area looks white with delayed vascular supply to the area. Second degree frostbite leads to big blister formation, burning and tingling sensation, and the area will become hot and dry to touch. After rewarming the area, swelling and burning pain may occur and last for several days. Healing of the areas will occur after 3-4 weeks and pain relievers prescribed by your healthcare professional will help with the pain.

First and second degree frostbite occurs at the level of the skin and subcutaneous tissues. However, third and fourth degree frostbite (deep frostbite) involves skin and may extend to the bone!

Third degree burns are characterized by skin tissue death, blister formation, blue skin and excessive perspiration (hyperhidrosis). Throbbing/shooting pain will occur approximately 2 weeks after the injury due to nerve involvement. The fourth degree burns will involve tendon and bone with similar symptoms.

Despite healing, there will be no blood filling the affected areas with rewarming and as a result auto amputation of the area may occur. Auto amputation is basically complete tissue death and the body’s expulsion of that tissue or part! Treatment of deep frostbite requires physician supervision: rapid rewarming needs to occur and hospital admittance is the usual course of action.

With any cold injury to your lower extremity, it is important to consult with your podiatrist. They know the best way to evaluate the extent of injury and the resulting treatment. They will be able to prescribe you the appropriate medications to relieve your pain and help facilitate a recovery process. Remember that prevention is the best treatment so bundle up when you go outside into the cold this winter season!

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com