Whilst, "paronchyia" or "nail bed infection" remains a well recognised condition it can be very difficult to resolve. The assumption is that through boisterous activity probably with his frisbee "Jack" traumatised his toe by catching his claw in the ground. This trauma involving some localised bleeding and inflammation then allows a secondary bacterial infection to take hold within the joint and eventually the bone.

Once a bone infection or "osteomyelitis" becomes established medication alone is unlikely to succeed. Despite initial success with high doses of prolonged antibiotics the bacteria are able to "hide" amongst the diseased bone fragments and soon proliferate when the treatment is stopped.

The other issue of concern is that a specific cancer known as "squamous cell carcinoma of the digit" can often present with very similar clinical symptoms. The only way to effect a complete cure is to remove all the diseased tissue by amputating the toe.

Whilst amputation may sound like a radical approach it has no functional limitations and allows "Jack" to return to what he enjoys doing most as quickly as possible: although we all hope he looks after his remaining toes with more care! Somehow looking at "Jack", his focus will continue to be on that frisbee!