From the Guidelines
A patient with a dark spot under the toenail and foot pain should be evaluated promptly by a healthcare provider to rule out serious conditions such as melanoma or fungal infection, and in the meantime, should rest the affected foot, apply ice, and take over-the-counter pain relievers as needed. The patient's symptoms require professional assessment as the dark spot could potentially be a subungual hematoma (blood collection under the nail), melanoma (skin cancer), or fungal infection 1. While waiting for the appointment, the patient should rest the affected foot, apply ice for 15-20 minutes several times daily to reduce pain and swelling, and take over-the-counter pain relievers like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours if not contraindicated by other health conditions. Some key points to consider in the management of foot problems include:
- Wearing socks/stockings without seams (or with the seams inside out) and changing them daily 1
- Washing feet daily with water temperature below 37 °C and drying them carefully, especially between the toes 1
- Using emollients to lubricate dry skin, but not between the toes 1
- Cutting toenails straight across 1
- Having feet examined regularly by a healthcare provider 1 In terms of footwear, the patient should be advised to wear footwear that accommodates the shape of their feet and fits properly, and to consider extra-depth shoes, custom-made footwear, custom-made insoles, and/or toe orthoses if they have a foot deformity or pre-ulcerative lesion 1. The patient should also be educated on how to check the inside of their shoes for foreign objects and to wear socks made of natural materials that are seamless and preferably light in color.
The healthcare provider will likely examine the nail, possibly using a dermatoscope, and may recommend imaging or biopsy depending on their assessment. Early diagnosis is crucial, especially to rule out melanoma, which though rare, requires prompt treatment. If the pain is severe, spreading, accompanied by fever, or if the spot is changing rapidly in size or color, the patient should seek immediate medical attention.
From the Research
Next Steps for Patient with Dark Spot under Toenail and Foot Pain
The patient's symptoms of foot pain and a dark spot under the toenail may indicate a potential infection or other underlying condition.
- Monitor the spot on the left foot for any signs of infection, such as increased redness, swelling, or discharge.
- Maintain good foot care to prevent further complications.
- The prescription of medical shoes, Apex X520M, size 13.0 Wide, and insoles, size 13.0, may help alleviate foot pain.
Considerations for Potential Infection
If the patient's symptoms worsen or signs of infection develop, further evaluation and treatment may be necessary.
- The patient should be instructed to contact the healthcare provider immediately if any signs of infection occur.
- The healthcare provider may need to reassess the patient and potentially prescribe antibiotic therapy or other treatments.
Relevant Studies
There are no research papers directly relevant to the patient's specific condition of a dark spot under the toenail and foot pain 2, 3, 4, 5, 6. However, studies on prosthetic joint infections and skin disorders in skin of color may provide some general insights into the importance of proper wound management and infection prevention.