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non-healing wound 9 weeks after ingrown toe procedure

by Judy
(Farmer City, Il.)

Almost 9 weeks ago, a podiatrist performed a procedure in her office where she cut out my ingrown toenails on both sides of big toes using phenol. within 3 days, she put me on antibiotic. Said both big toes were infected and also that I had a severe allergic reaction to the phenol. I saw her every week for 7 weeks and she had me on antibiotics 3 times. Left big toe the worst - on left side, large open wound that still hasn't healed!! Started with a New Podiatrist during 7th week. Took me off antibiotic right away, ruled out diabetes also sent me to wound center,for test for foot circulation which I passed with flying colors. Sent a culture to the Lab Dec. 29th. Said he'd call if they found anything - haven't heard a word. Meanwhile, I'm supposed to soak in water with a cap of iodine in it once a day and afterward put iodine on wound to dry it up. Today, Jan. 3rd, my left toe still oozing, and painful. When I ask new podiatrist last Monday why my toe is still so painful, his reply,"It's a Mystery" Any ideas?? I am very frustrated!


RESPONSE

Hi Judy,

This can be a tough one to diagnose from the other side of the internet. The problem with phenol matrixectomies (which I also perform) is that it can be difficult to tell an infection from an allergic reaction to the phenol. This can also be complicated by simply having too much phenol applied during the procedure, which then just creates a severe inflammatory reaction and possible burn.

If the toe worsened appreciably at the three day mark, I would be leaning more towards an infection than allergic reaction, as I would think an allergic reaction would have occurred almost immediately. Applying too much phenol would have also created problems almost immediately.

You do not mention if the original podiatrist performed a culture and sensitivity when she suspected infection. If not, it could be a case of prescribing the wrong antibiotic for the type of infection that you may have.

I am only guessing here, but probably the reason you have not heard from your second podiatrist regarding the culture and sensitivity is nothing more than it occurred during a holiday period. I would suggest you call the doctor on monday for the results.

Now the problem is that nine weeks have passed and you are still having issues. If you had a reaction to the phenol or had a phenol burn from too much phenol being applied, I would like to think by this time you would have been well on your way to being healed.

You have been checked for diabetes and circulation and as you state, passed with flying colors, so that is in your favor. I will also assume there are no other possible health issues that might affect your healing.

At this point in time my biggest concern would be the possibility of a bone infection. The reason I state this is because if your original problem were the result of an infection and it had not been properly treated, the soft tissue infection could have spread to the adjacent bone. This would cause a persistent problem that would not clear up by applying medicine and soaking.

I would suggest you raise this possibility with your podiatrist and let him decide whether or not that is a possibility.

Just to further complicate the problem is the probability that all four sides got infected, which is very slim, unless you did not take care of the toes as you were instructed. Ingrown nail surgery is considered "dirty surgery" meaning you cannot adequately surgically prep the nail area because of the fact that there is no perfect way to surgically scrub the nail area of a toe or even a finger. Although iodine, and I suppose that is actually betadine which is an iodine derivative is great at killing germs and yes, it will dry out weeping wounds, sometimes works against you because it does not create a great wound environment for an open wound to heal.

I would also raise the issue of how the surgical sites were treated initially by your first podiatrist. Phenol kills the root of the nail via a chemical burn. Burns have a tendency to drain a lot. Sometimes the side of the nail is not able to drain due to dry blood and so the drainage backs up and increases the chances of infection, or even just more inflammation. Did your original podiatrist clean out the nail grooves, the sides of the nails, when she saw you weekly to promote drainage?

I am sorry that I cannot give you more definitive advice but as you can see there are varying reasons as to what may be causing your continued problem, however, as I just suggested, ask your podiatrist about the possibility of a bone infection.

Marc Mitnick DPM
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