I am 46 years old and diabetic. Two weeks ago I dropped a heavy thing on my toe and now my nail looks weird and now I am having pain in my foot. I want to know whether this is gangrene or a bruise under the toenail? I am currently on Novolog.
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I have seen the photographs. (attachment removed to protect patient identity).
The photograph sent by you shows some ecchymosis over the nail base and the adjoining skin. This is due to the weight that fell on the toe. Many patients come with similar complaints to me and most of them heal without much interventions except in those cases, where there is any fracture of toe bones (phalanges). In your case, the diabetes is what we should be careful, as it can result in infection of the ecchymosis and resultant pain in the toe as well as the foot. I suggest the following medications for you:
1. A course of antibiotics, Cefixime 200 mg twice a day after food for five days to take care of infection if it has risen.
2. Tablet Chymotrypsin-Trypsin, anti-inflammatory to reduce inflammation, edema, and swelling, take twice a day before food for three days and there after depending on the swelling take once a day.
3. Tablet Paracetamol 650 mg twice a day for pain. However, if the pain is very severe take a combination of Aceclofenac 100 mg and Paracetamol 325 mg. In the latter case, take the combination after food and an antacid Ranitidine hydrochloride 150 mg before food.
4. Do not put any tight dressing on the toe or foot and keep it elevated while on the bed.
Please observe for two days following my suggestions and if you feel better then it is good. However, if the pain does not relieve or is worsening, we need to get an x-ray toe and foot done to check for any phalanx fracture. Also, we must do your complete blood count to check for any rise in the cell counts due to infection.
Do take your insulin and other medications for diabetes without fail. If sugars are kept in control then it is less likely that infection will complicate.
I hope this helps.
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