Special Operations Forces Medical Handbook

5-3

Fungal nail infection,subungual hematoma, foreign body reaction (granuloma)

Plan:
Treatment
Primary: Partial nail avulsion

1. Perform digital block using Xylocaine 1% or Marcaine 0.5% plain (no epinephrine for digits) - see
   Anesthesia: Local/Regional.


2. Use elevator to free nail from bed along border. Also free nail from overlying soft tissue.


3. Use an English nail anvil or nail clipper to remove the offending nail border. Scissors will also work.


4. Use curette to remove infected necrotic tissue or excessive granulation tissue (proud flesh) from the
   nail groove.


5. Dress with Betadine gauze and Kling. Coban or Elastoplast helps hold dressing in place.


6. Elevate foot and apply warm soaks or compresses tid.


7. Antibiotics for 7 days: Dicloxacillin 500mg po qid or Keflex 500mg po qid for broader coverage.
   Erythromycin 500mg po qid for penicillin allergic.


8. Pain control: Motrin 800mg po tid prn pain. Narcotics are not usually necessary.
   Alternative: Remove nail corner with clipper, antibiotics.
   Primitive: Lift side of nail corner and remove with small scissors.

Patient Education
General: Instructions on soaking: add few ounces of Betadine solution to water; remove loose necrotic
tissue or scab covering with washcloth while soaking to promote drainage when infected and speed the
healing process.
Prevention and Hygiene: ALWAYS cut nails straight across.
No Improvement/Deterioration: If recurrent problem, return for definitive procedure.

Follow-up Actions
Return evaluation: At 3-5 days, check for any remaining nail spicules (small, needle-shaped pieces); check
cultures; consider X-ray.
Evacuation/Consultation Criteria: Evacuation not usually necessary. Partial nail avulsion should be
considered in recurrent cases once the infection is resolved. This will destroy the nail matrix and prevent
re-growth. The definitive procedure is not recommended in an operational setting. If problem recurs or fails
to respond, consult podiatrist or dermatologist.

Podiatry: Plantar Warts

CDR Raymond Fritz, MSC, USNR

Introduction: Warts are caused by human papillomavirus viruses and can be found anywhere on the skin
when the virus is introduced through a crack in the skin of a susceptible individual. When located on the sole
of the foot, these warts are called plantar warts. A plantar wart can be found as a single lesion or grouped
together (referred to as a mosaic wart). Most common areas include the ball of the foot and heel, where
increased pressure and irritation is common. Discrete plantar corns are sometimes mistaken for warts. A
wart has tiny dots in the center which are small vascular elements. These dots are often black (dried
blood) due to irritation, when located on the plantar aspect of the foot. Warts are often ignored until they
become painful.

Subjective: Symptoms
Pain, especially if wart is on prominent plantar area; may have tried over-the-counter preparations, other
family or team members may have warts as well.

Objective: Signs
Using Basic Tools: Lesions tender to palpation and squeezing especially if located on weight-bearing area;
callus may form over the wart, increasing pain.