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I have been seeing a 35 year old male appx 6 weeks now for treatment of bilateral TNA's of both hallux.

No medical history
Works as a fruit inspector
Pulses biphasic and triphasic.

Both sites have been non-healing with intermittent infections and constant layer of removeable slough.

Two weeks ago he had a week off work and things improved but today they were inflamed and sloughy again as he has been back at work. Obviously this could be a telling factor.

But today was the first time I really saw the Tinea on the plantar surface of both his feet for which he treats with Daktarin spray

I wonder if anybody has any thoughts on the effect of the Tinea on the healing of the TNA's?

Many thanks

Dom

 

Hi Dom

I'm presuming you've checked the work shoes/boots aren't applying pressure to the tna sites.

If they're not then tinea could certainly aggravate the non-healing- nice moist environments under dressings are ideal for tinea, seems to make secondary bacterial infection more likely as well. I've seen this on several patients (including my own pna :eek: )

I'd treat feet with lamisil once including around the dressing sites prior to redress, a load of anti-fungal powder to all shoes and general t/p advice. Something like betadine ointment for around tna as it's also anti-fungal.

If there is no other medical problems, no pressure to the op sites and the infection clears should start to heal fine

Some pictures of op sites would be useful if you have them.

Ian