YANMD-Filter: DIY Toe Surgery?

October 22, 2011 7:20 AM

I have a paronychia on a middle toe. It's not as horrible as the images Google offers, but it hurts a little and has hung around for a few weeks now.

The toe is pink or red when it hurts (which is not always, or terribly much) and there's always a yellow/green crescent beside the nail, with a darker dot in the center. (I think this is pus, and maybe an abcess?)

It doesn't look very deep, and in fact, before I investigated, I was thinking of taking an X-acto knife and poking it, guessing that it was some kind of splinter that had gotten grown over.

The nail, cuticle & hyponichium are sound, and it doesn't look like a fungal infection. Nail is trimmed and not ingrown.

I have crappy insurance: this will cost me $25 (plus antibiotics) to fix, but the next thing that happens to me may cost up to $7,500, so I'd rather not use my last inexpensive doctor visit of the year to fix a minor annoyance, particularly if there's a reasonable chance it'll go away on its own, or that I can fix it myself with a box cutter and some alcohol.

Can I ignore it? (Keeping in mind all the caveats about ER if joint pain, fever, or other signs of infection?) Can I lance it myself? Or is this just something that won't go away without antibiotics?

posted by spacewrench to health & fitness (15 answers total)

I am not a doctor and I have no knowledge of this specific condition. Two things: 1) if the redness spreads I would see the doctor 2) I would treat this at home by soaking it regularly (30 min 4x day) in hot water or cover it with a hot compress. I might add salt to the water for good measure, but that could be a placebo. The hot water soak is a great first line treatment for small inflamed skin ailments and is supported by this page on your condition.
posted by mercredi at 7:30 AM on October 22, 2011

Hot water + antibacterial soap (which I otherwise don't use) usually works for me, though mine is typically very mild. And yes you can home-surgery it, don't ask how I know.
posted by Eyebrows McGee at 7:41 AM on October 22, 2011

there's always a yellow/green crescent beside the nail, with a darker dot in the center. (I think this is pus, and maybe an abcess?

IANAD. I had one of these after really grinding out some cardio over a period of months in ill-fitting sneakers. I had to go to the podiatrist to get the nail shaved away and the abscess cleaned. Recovery time was minimal, a bandaid over the nail at first, applying Bactroban twice daily for a week, and generally keeping the area clean and dry for several weeks. The problem is that this may not heal on its own, and the X-acto knife route risks further infection because there will be areas under the nail that neither oxygen nor antibacterial substances can reach.
posted by Inspector.Gadget at 9:00 AM on October 22, 2011

You should have put Bag Balm on that at the very, very first signs of infection.

I think you should just go to a doctor and get this fixed, why can't you pay cash and not use your name (if that is possible to avoid insurance problems). Do they have low cost clinics in your area? That's where we get things like this done.

I am a back-to-the-lander and have done a lot of doctoring on my own but never when there is already an infection going on.

Just not worth the risk. And down time. And I know someone who died from gangrene from an infected toe (he was 70 though).
posted by cda at 9:33 AM on October 22, 2011

Wow. I didn't even know there's a name for this. [Gross details -->] I obsessively trim my toenails so I get a swollen toe with pus at least once or twice a year. If it doesn't go away after a few days, I usually just take a needle (maybe sterilized) and stick it into the yellowest part and squeeze out whatever fluid is in there. If sticking the needle in hurts, then it's not pus. I think the pain/redness just comes from the pressure of the pus pocket (abscess?). IANAD and I never had splinters in my toe!!!
posted by bread-eater at 9:44 AM on October 22, 2011

Thanks, all. I'll try the hot water thing for a few days and see how it goes.

...soaking it regularly (30 min 4x day)...

Man, if I had the leisure to spend 2 hours a day soaking my foot, I could probably afford better insurance! ;-)
posted by spacewrench at 9:46 AM on October 22, 2011

IANAD, but in my experience with those you can sterilize something small, flat and thin (I used the flathead screwdriver part of a Leatherman), insert it between the nail and your skin in the weird-colored part and pry/lift while squeezing the pus out. I would soak your foot first, and I would not use a needle, Xacto or anything else sharp.
posted by charmedimsure at 11:26 AM on October 22, 2011

PS- doesn't really hurt, makes it feel better pretty much instantly.
posted by charmedimsure at 1:32 PM on October 22, 2011

I didn't know that had a name, either! I get that (mildly) a couple times a year and also go the grossout home toe stabbing route.

The worse I ever had it was on my thumb once, really red and swollen and tender. I was nowhere near a doctor, so I visited the medic tent (Burning Man) and they soaked it, smeared it in Polysporin and wrapped it in gauze. It was much improved by morning and totally fine within 24 hours.
posted by looli at 3:04 PM on October 22, 2011

What with beating my hands up not wearing gloves around the barn, I'm an expert at these darn things. Soak it. Soak. Soak. Soak. HOT water and lots of salt. I alternate plain and Epsom salts. Slather on Neosporin at night, and wrap it so the medication doesn't get smeared off. Leave it to air as much as possible during the day. Or flip that if you have to wear shoes--wrap all day, and air it at night.

I know several people that have committed do-it-yourself home surgery and one who was hospitalized for a major systemic infection, thanks to their poor knife skills. I just do the soaking route, as mine are too darn sore to stick anything in there. If you can't find 15-20 minutes at least twice a day, you're not going to get rid of the thing.

If the above doesn't help within a reasonable period, or if it gets worse, sorry, it's doctor time.
posted by BlueHorse at 7:31 PM on October 22, 2011

"Wow. I didn't even know there's a name for this. [Gross details -->] I obsessively trim my toenails so I get a swollen toe with pus at least once or twice a year. If it doesn't go away after a few days, I usually just take a needle (maybe sterilized) and stick it into the yellowest part and squeeze out whatever fluid is in there. If sticking the needle in hurts, then it's not pus. I think the pain/redness just comes from the pressure of the pus pocket (abscess?). IANAD and I never had splinters in my toe!!!"

Apologies to bread-eater, but there is no part of this comment that is a good idea.

BlueHorse's advice is about as good as you're going to get in this thread. Best practice involves not stabbing a patient's sealed infection unless there is a pressing reason to do so (there often is). You are not trained to recognize those reasons and none of us here have access to your toe to get an idea of what caused the infection, smell the toe, or look at the size, severity, or progression of the infection. AskMetafilter is not an appropriate resource for you, sorry.

That said I am concerned that you will listen to the bulk of the advice in this thread and lance your pustule, I'm going to tell you the very basics of how to do so with the minimal amount of damage. Use a sharp needle, the longer the better because you're going to dip it in the strongest liquor you have access to and then you're going to light it on fire. It will look cool, but be careful with your fingers, and let it cool without letting it touch anything, it won't take long. Then, in the brightly lit and clean room you started this foolish thing in (Bathrooms work great), you are going to make sure you can see as much of the infection as you are going to be able to. You are then going to find the spot on the pustule that is furthest away from the toenail (or sole of the toe depending on location), is on the extreme edge of the pustule, and still has only a thin layer of skin between you and the infection that you are going to pierce like the medical advice ignoring person you might end up being. You will then carefully lance it in the area you found from that side so that you are disturbing the layer of skin above the infection as little as possible. After lancing your pustule you will let it drain naturally and then gently apply sterile gauze (available at your local pharmacy) to the wound to soak up what left by capillary action, having hopefully not disturbed your toe's natural healing process. Once this is done DON'T FUCK WITH YOUR FOOT, at least for a while and don't put on socks unless advised to do so by a doctor, which defeats the point any right? Keep it dry and elevated (the elevated part mostly just helps you not fuck with your foot).

Really the only good advice for this thread is to find some way to see a physician and you have gotten some tips on how to do that, please follow them. Lancing a pustule is not something they even let nurses do, its got to be a physician, and that is for good reasons.
posted by Blasdelb at 10:02 PM on October 22, 2011

I would have advised taking a swig of that liquor, after the deed, but this is your foot and alcohol seriously impairs ones ability to not fuck with ones foot
posted by Blasdelb at 10:04 PM on October 22, 2011

You should have put Bag Balm on that at the very, very first signs of infection.

cda, AFAIK Bag Balm is just lanolin, with no anti-bacterial agents at all, so it's effects on an under-the-nail infection would be nil.

I ABSOLUTELY agree with the rest of your advice about GO SEE A DOCTOR; THIS IS A PERSISTENT INFECTION AND YOU COULD DIE FROM GANGRENE... (not likely, but possible, so take it seriously)
posted by IAmBroom at 10:15 AM on October 23, 2011

Oops, even better advice, from Blasdelb:

AskMetafilter is not an appropriate resource for you, sorry.

tl;dr: SEE A DOCTOR.
posted by IAmBroom at 10:17 AM on October 23, 2011

Update: my toe scarcely bothered me at all yesterday and today, so the closest I got to soaking my foot was washing it carefully in the shower. No pain now, and the yellow/green/gray area is starting to look more like a plain old callus -- the skin appears to be getting harder and thicker. I guess my immune system knocked down the infection (go WBCs!)

Thanks Blasdelb for the very useful advice, which I hope will help the next person who finds this thread. Your technique is how I lance blisters that are in the way (needle, lighter, from the side, and I haven't died of gangrene yet) but I wasn't sure if it was acceptable to do that for other sorts of liquid-filled infections. (Actually, I'm still not sure, and will certainly consult with a medical professional before even considering any sort of self care. It's the only way to be safe.)
posted by spacewrench at 11:24 AM on October 23, 2011 [1 favorite]