Apparently, an ingrown toenail can be quite complicated, especially when an NFL contract is involved.  Lawrence Tynes, a placekicker for the Tampa Bay Buccaneers (who knew Tampa had a team?) underwent an ingrown toenail procedure in July and developed an infection a few days later.  After the initial antibiotics failed to cure the infection, a culture obtained from the site confirmed the growth of MRSA, or methicillin resistant staphylococcus aureus, a so-called “superbug”.  So what is this bug, how can it be treated, and what does it have to do with NYC podiatry?

Let’s go back a few decades to the dark, pre-Fleming days of medicine.  Infections of skin and soft tissue, most commonly caused by strains of staph, were a common cause of death.  A foot or ankle infection was treated by amputation- no more foot, no more infection.  After penicillin was discovered by Alexander Fleming (another Scot, like Mr. Tynes, coincidence?) in 1928, a new era of medicine was born, in which infections were treatable, which led to first widespread use of antibiotics on soldiers in the battlefields of World War II.   Then bacteria, through natural selection, quickly developed resistance to penicillin in the early days of antibiotic use, and new antibiotics were developed to combat the new strains of bugs.  The first of these drugs were different forms of penicillin, known as extended spectrum penicillins, including one called methicillin.  Over time, strains of staph resistant to methicillin, known as MRSA, were observed, and are now becoming increasingly more common.

There are two main forms of MRSA seen today, community acquired and hospital acquired.  As reported ad nauseum in the media a large percentage of hospital acquired staph is MRSA, and it is becoming an increasingly greater problem.  Patients who frequent hospitals, such as diabetics, elderly, chronically ill and nursing home patients are far more likely to be infected with more resistant strains of staph.  And while there are antibiotics available for the treatment of MRSA and other superbugs, there is a palpable, and not unwarranted, fear of the day the bugs become resistant to everything we have.  To compound the fear, community acquired MRSA is also more frequently seen, although this form usually presents as abscesses that are drained and often do not need antibiotics.

So what does this mean for us and for Mr. Tynes?  First of all, don’t freak out yet.  There are still many antibiotics for MRSA and other superbugs, and more are in the pipeline.  Also, in my NYC podiatry office, we see many ingrown toenails, most of which do not become infected, and those that generally respond quite well to antibiotics.  Meanwhile, we must all take sensible precautions.  Wash hands frequently with soap and water, which is the simple, proven way to prevent infection.  And to prevent antibiotic resistance, don’t take antibiotics unless there is good evidence of infection and follow up with your doctor after starting medication to ensure the bacteria are responding.

Now kids, if you have an ingrown toenail, or if you’re a placekicker for the NFL, don’t let it go.  It could cost millions of dollars, just slightly less than most copays today.

See you in the office.

Ernest Isaacson

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Ernest L Isaacson DPM PC
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