Potentially Deadly Infection, Once Seen Primarily in Hospitalized Patients, Is Now Linked to Common Foot Conditions in the Community

More Americans are developing drug-resistant staph infections, known as MRSA, from common, relatively minor foot problems such as cuts, cracks in the skin, athlete’s foot and ingrown toenails.

“If you have a cut or a scrape that gets infected and it’s not healing in a timely fashion, don’t hesitate to get it checked out,” said Karl Collins, DPM, FACFAS, a foot and ankle surgeon in St. Louis. Dr. Collins said he’s diagnosed community-associated MRSA infections in patients with athlete’s foot and even a six-year-old who stubbed his toe.

Brandi Johnson, DPM, AACFAS, estimates treating 20 patients for community-associated MRSA in 2008. The Brandon, Fla., foot and ankle surgeon says half of those patients had infected ingrown toenails. Puncture wounds, pedicures and cuts from glass and seashells caused the rest of the infections.

One of Johnson’s patients was a teenage boy. He waited months before seeing a doctor for an infected ingrown toenail. After the boy’s primary care doctor referred him to Johnson, she ran several tests. Results showed a community-associated MRSA infection. Even worse, it had spread to bone in the teen’s big toe. He recovered after six weeks of intravenous antibiotics.

“I’ve had several high schoolers come in with ingrown toenails during the last six months of 2008,” Dr. Johnson said. “Their pediatricians started them on antibiotics and sent them to my office.  Lab results showed they all had MRSA.”

Preventing Infection

Staph bacteria such as MRSA are common. One in three people carry them. The bacteria live on the skin and in the nose and are spread through skin contact. Even minor tears in the skin’s surface open the door to bacteria and infection. Skin conditions such as athlete’s foot, calluses, corns, eczema and psoriasis can create breaks in the skin. Walking barefoot increases the risk of cuts and puncture wounds. Foot and ankle surgeons say simple steps can prevent community-associated MRSA infections:

• Wash and bandage cuts.
• See a doctor within 24 hours for any puncture wound. 
• Never perform “bathroom surgeries” to cut or dig out an ingrown toenail. 
• Keep feet clean and dry to prevent fungal infections such as athlete’s foot.