Felon
What is it: A felon is an infection of the fingertip on the palmar pulp side.
How does it present: Patients will present with significant pain, swelling and warmth to this region. There may have been a previous puncture wound noted.
Common exam findings: Exam often reveals a tender swollen distal finger. Sometimes a collection of purulent material may be seen beneath the skin.
Tests and treatment: A felon is a clinical diagnosis, but it must be differentiated from herpetic whitlow that may present similarly, but often has the presence of vesicles on the skin. A felon may progress to osteomyelitis of the distal phalanx, so in specific cases, x-rays or further evaluation with bone scan may be indicated. If the infection has spread to the tendon sheaths, then orthopedic referral is indicated to consider surgical debridement. Treatment for a felon is generally incision and drainage of the infection using a volar or lateral incision along the fingertip. Staphylococcus aureus is the most common causative organism and antibiotics should provide coverage for that.