The image is of a patient who presented at my rooms recently with a markedly painful left hallux “ingrown toenail” unresponsive to treatment. The patient was referred to me due to her complex medical history; however, she had no history of diabetes, yet had been a long-time smoker.
On assessment, there was indeed an involuted toenail with signs of a mild ingrown toenail. But, on further examination, I had concerns about the colour of the hallux and second toe. The toes were also cold to touch. Quick doppler assessment displayed an absent dorsalis pedis and weak tibial artery.
She will probably require a PNA at some time, but my concerns were that the patient had a significant circulation issue. The patient was referred for an ultrasound investigation and an urgent referral to a vascular surgeon. She had both of these carried out within two days and was indeed diagnosed with three occlusions in her left leg arterial supply. Anticoagulation medication was initiated with a plan for endoscopic vascular surgery.
She phoned me approximately one week later with signs of improvement. The patient was also profusely thankful that I had identified this major issue – cyanotic toe – that would have led to severe ramifications. She also informed me that she had finally quit smoking – success on two fronts.
This a stark reminder to think of all differential diagnoses to ensure nothing is missed.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
Also read:
Gout or degenerative osteoarthrosis/hallux limitus?
Gout deposits (not bunions)
Remember functional anatomy and to x-ray
(This content is intended for healthcare professionals only)