Type 2 diabetic presents with left hallux subungual discolor | Figure 1

Type 2 diabetic presents with left hallux subungual discoloration. This is a recent finding since the last appointment 2 months ago. Denies any trauma to the toe or surrounding area. No pain on palpation and no signs of disrupted nail plate.

Differential Diagnosis (DDx)

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66 Y/O Male, Type II diabetes. Presented with pain, bad smell and infection 1 week ago (pic 1) from assisted living facility patient had several strokes years prior so does not have memory of how painful and bad it is to tell his nurses. After bactraim and soaking foot in epsom salt we get picture #2 with horrific smell we clean in office with peroxide and sterile #Saline to then get pic #3. Next treatment we are doing 2 IM rocephrin with follow up in 2 days, with nail removal when inflammation goes down. Any other recommendations?

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