Question
I am a 58 year old female living in a suburb of Houston, Texas.
The problem I am experiencing is pain and swelling in multiple toes on both feet. Some of my toes are red, swollen, and tender.  Some of the affected toes are more red and very sensitive on the very tips, like when you have been walking in a swimming pool and your toes get rubbed raw on the ends. My left foot and affected toes are also a little darker than the right foot and affected toes. It's quite painful to walk.
I went to a podiatrist locally that I have been to before when I broke my left foot 10 years ago.  He took a scraping from the side of one of the affected toes to culture.  The culture didn't grow anything.  He also gave me a steroid ointment and fungal cream which I applied twice a day for two weeks, an antibiotic and a diflucan pill.
The day before I went to him I started using a vaginal cream ,Monistat, because I had the symptoms of a vaginal yeast infection.  Much to my surprise the next morning, the morning of my appointment with the podiatrist, my toes seemed to be improved.  I told him about this when I saw him. Naturally I thought the two were related. My toes got better over the course of a week and so did the symptoms of the vaginal yeast infection.
A few days after I finished the Monistat (7 day variety) the toe symptoms returned and I went back to the Podiatrist.  I also scheduled a visit with my OB GYN doctor. My Podiatrist gave me some different foot cream and another diflucan and I used these with less sucess the second time.  I also saw my OB GYN doctor who told me that I didn't have a yeast infection, just dryness.
I was getting frustrated with the lack of results on treatment of my toes and went to my Primary Care Physician.  I related all the treatment I had previously received. He did a scraping between the base of my toes and said he saw a little fungus so he put me on Lamisil tablets.
So here I sit two weeks later with toes that are still swollen, red and tender.  I can't wear any shoes but flip-flops and that's okay for now because I am on leave from work.  Problem is I will be going back to work soon and will have to at least wear tennis shoes, and that will be quite painful.  

Answer
Hi Joan,

There are many possible causes for the redness swelling and pain in the toes.  It could be fungal but I would explore other areas as well.  An x-ray should be obtained to see if there are any bone or joint changes.  


One area that should not be overlooked is some type of arthritis or autoimmune problem.  Your PCP can run some basic lab tests to see if there are any of these problems.  I would also consider a referral to a rheumatologist.

Also, if you should have labs to check your liver enzymes prior to starting Lamisil.  

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
http://www.thetampapodiatrist.com
http://www.tampacryosurgery.com
http://katzpodiatristtampa.blogspot.com
http://painfoot.blogspot.com
http://twitter.com/TampaPodiatrist
http://www.notoenailfungus.com

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