When we last left our story, I'd been to urgent care who'd diagnosed cellulitis with a minorly scary aside about MRSA.
I've been diligently taking my antibiotics and the problem persists. It has gotten somewhat better, but the toe is still quite blood-colored under the nail and although the swelling is down somewhat it's not clearing up. So I decided to keep the appointment today with the podiatrist. I'm glad I did.
The problems are of two sorts - the immediate, which were dealt with today and over the next two weeks - and the longer-term, which we'll start to discuss at the follow-up visit I have in two weeks.
Immediately: the doctor believes that the reason the infection has not responded well to antibiotics is that it's primarily fungal. She sees signs elsewhere on my feet of fungal infection. She'll send a sample off to a lab for analysis but we're going to treat this as a fungal infection for now. MRSA is not a concern here, though there are often bacterial co-infections with fungal. She thinks I've gotten as much use out of antibiotics as I could.
The infection is almost certainly a result of the toenail being damaged by (her phrase) "repeated micro-traumas". That is, I didn't hit the toe once, but rather many times. This is partly due to the toe being longer than others - I have a hammer toe. The situation is likely exacerbated by wearing shoes that are too narrow for me and the fact that the arthritis has badly affected the ball joint of my big toe, causing me to use the second toe for gripping much more than I should. As a result the tip of the toe repeatedly impacts the ground. She tested both feet and while I have several bilateral conditions the right foot doesn't seem to have this problem.
Given the persistent infection and damage to the nail the recommended short-term solution was to remove the nail. That will let us clean out the infection and give space for the new nail to grow in unimpeded. She felt I was likely to lose the nail eventually anyway and the longer the current nail stayed the more likely it was to lead to a deformity of the new nail. So we had SURPRISE MINOR FOOT SURGERY today.
This leads to a long string of things I have to do, like take a shower with my foot in a bag for two weeks, dressing changes, and use of an antifungal spray on feet and in the shoes to try and kill off the spores so we don't get a re-infection.
The surgery itself was quite fast - the longest part was waiting for the novocaine to numb the toe. She used a "freeze" spray to numb the needle sites for injection. That was exciting. I'm told that this sort of thing happens to runners quite often (she asked if I was a runner) which makes me even more convinced that running is a dumb idea. For me, anyway. In theory this will clear up in a couple weeks, the toenail grows back in 3-6 months and that's it for the short-term stuff. The other stuff... well.
During the exam, she dug in and poked me pretty hard in a couple places and I yelped about it. The cause (she says) is that I have nerve impingement in both feet. That is almost certainly due to my arthritis causing joints to stiffen and swell and the likely treatment is shoe inserts. She agreed that the foot arthritis isn't going away and isn't getting better (so no, I'm basically never going to be able to rock climb again comma dammit) but she believes that treatment can significantly lengthen the time I have before we have to consider more serious actions like injections or fusions. I also have extremely tight Achilles tendons which, she says, is likely affecting the normal roll of heel-to-toe gait and may be causing me to strike the ground harder with my toes than I normally would.
Prior to the return visit I'm to go get foot X-rays so we have a baselines measure of how bad the joints are and can plan longer-term care from there. I'll update when I have more info.