Differential Diagnosis for Black Toe Following Toe Nail Removal

• Single most likely diagnosis
  • Dry gangrene: This is the most likely diagnosis due to the interruption of blood supply to the toe, which can occur after toenail removal, especially if the procedure causes damage to the surrounding tissue or if the patient has pre-existing vascular disease.
• Other Likely diagnoses
  • Infection (cellulitis or abscess): Bacterial infection can occur after toenail removal, leading to inflammation and potentially causing the toe to turn black.
  • Traumatic injury: Direct trauma to the toe during the procedure or afterwards can cause bruising or more severe injury leading to black discoloration.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Sepsis: Although less likely, if the black toe is a sign of an underlying infection that has spread systemically, it could lead to sepsis, a life-threatening condition.
  • Embolic event: In rare cases, a black toe could be a sign of an embolic event affecting the blood supply to the toe, which could be a sign of a more serious cardiovascular issue.
• Rare diagnoses
  • Buerger's disease (thromboangiitis obliterans): A rare disease of the arteries and veins in the arms and legs, which could potentially cause black toes due to decreased blood flow.
  • Chilblain: A condition caused by the inflammation of small blood vessels in response to cold temperatures, which could potentially cause discoloration of the toes.
  • Raynaud’s phenomenon: A condition that affects blood flow to the fingers and toes, and sometimes the ears, nose, and lips, which could potentially cause black toes due to vasospasm.