Two-Toned Toes
Match the diagnosis to the photo by letter
a. Blue toe syndrome
b. Pernio (chilblains)
c. Subungual hematoma
d. Antiphospholipid syndrome
For answers, see next issue; for discussion, go to www.mdedge.com/clinicianreviews/picture
Answers to January “Picture This” (Clinician Reviews. 2018;28[1]:29): 1d, 2c, 3a, 4b
Photos and text for case 1 courtesy of Richard P. Usatine, MD; from Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:551-556.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/
You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com.
Case presentation and photograph for Cases 2, 3, and 4 courtesy of Cutis. Copyright 2017 Frontline Medical Communications Inc.
1. A 22-year-old woman dropped an iron on her toe yesterday. Today, the toe is painful at rest and worse with movement.
Diagnosis: The patient was diagnosed with a subungual hematoma and a possible fracture of the distal phalanx. In this case, the clinician offered to drain the hematoma but did not have access to an electrocautery unit. The patient consented to any procedure that would relieve the pain. An open paperclip, held in a hemostat and heated with a torch, was used to pierce the patient’s nail plate and drain the blood, providing immediate relief. Citing lack of insurance, the patient declined an x-ray, despite the possible fracture. The toe was bandaged, and the patient was instructed to keep it elevated and avoid weight-bearing activity. Her toe healed well, and no radiographs were taken.
,For more information, see “Painful toe.” J Fam Pract. 2011;60(12).
