Acute Paronychia with Suspected Ingrown Toenail in a 25-Year-Old Female

Case at a Glance

A 25-year-old female warehouse worker presented with a painful, inflamed great toe with purulent drainage and difficulty ambulating, consistent with acute paronychia secondary to ingrown toenail.

Patient's Story

The patient reported onset of severe toe pain approximately one week prior to presentation. She described the affected toe as 'scary looking' and extremely tender to touch, stating she 'couldn't even gently pat it dry without crying out.' She works in a warehouse environment wearing steel-toe safety footwear in hot conditions. The patient noted continuous drainage alternating between blood, clear fluid, and initially purulent material that would adhere to her socks and form painful scabs requiring removal.

Initial Assessment

Physical examination revealed significant erythema and inflammation of the affected great toe with active drainage. The patient demonstrated an antalgic gait, unable to bear full weight on the affected foot. Occupational history significant for prolonged standing and walking in steel-toe footwear in warm warehouse conditions. Patient denied tobacco use and alcohol consumption. Current medications limited to antihistamines for seasonal allergies. Vital signs: Height 5'5", Weight 126 lbs (9 stone).

The Diagnostic Journey

Based on clinical presentation of localized toe pain, erythema, purulent drainage, and occupational risk factors, initial assessment suggested acute paronychia likely secondary to ingrown toenail. The combination of tight-fitting safety footwear, warm working conditions, and mechanical trauma were identified as contributing factors. Patient was scheduled for definitive evaluation due to severity of symptoms and functional impairment.

Final Diagnosis

Acute paronychia with ingrown toenail of the great toe, complicated by secondary bacterial infection.

Treatment Plan

Immediate management included proper wound care with daily cleansing and dry dressing changes. Patient education provided regarding footwear modifications and proper nail trimming techniques. Oral antibiotic therapy initiated for secondary bacterial infection. Referral for possible minor surgical intervention (partial nail avulsion) if conservative management unsuccessful.

Outcome and Follow-up

Patient scheduled for follow-up evaluation within one week to assess response to conservative treatment. Return precautions provided for signs of spreading infection or systemic symptoms. Occupational modifications recommended including temporary alternative footwear if possible and frequent sock changes to maintain dry environment.