Swollen soft tissue underneath nail bed

Over the past four weeks, I've been closely observing my beloved pet's foot, as it's been causing her discomfort. Initially, I attributed it to a possible muscle strain, but as time went on, the situation escalated, prompting me to investigate further. After a more careful examination, I identified the issue lying within her foot, specifically the soft tissue underneath. To get a better view, I gently pulled back the skin, akin to how a cat's claws retract, revealing a concerning sight. There was a notable amount of pus emanating from the medial side of her nail, accompanied by a small, protruding white pulpy tissue. Taking action, I began a regimen of soaking her foot in Epsom salt, aiming to facilitate the breakdown of the pus. Using a sterile swab, I carefully removed the r emaining pus. I scheduled a veterinary visit for the following day. The prescribed treatment plan encompassed antibiotics, notably cefpodoxime, a mild anti-inflammatory, and twice-daily betadine soaks. Although her behavior hasn't shown any signs of alteration—she's still enthusiastic about food, water, and play—I couldn't ignore the lack of progress even after seven days. In fact, the inflammation seemed to intensify. On the tenth day, I revisited the vet, leading to a stronger antibiotic prescription (clavamox) and a continuation of betadine soaks. Despite this, nearly 14 days post the second visit, the inflammation has now managed to breach the nail bed. Regrettably, I've invested close to $1000 in treatments thus far, and my canine companion's condition hasn't improved. The proposed next step involves sedation for cytology, x-rays, and an in-depth foot examination, amounting to another $1000. Understandably, I find myself puzzled by how these interventions might lead to a solution. The concern lingers that we're merely experimenting with various options, rather than considering a referral if the underlying cause eludes their understanding. My confusion extends to the continued administration of antibiotics, as the nature of the infection remains uncertain. Could this be a fungal infection? I apologize for the lengthy discourse, but I've included some images to provide visual context. Your insights, guidance, and expertise would be greatly appreciated

Hi Here are some my thoughts: 1. Continued Veterinary Evaluation: It's understandable that you're concerned about the lack of progress despite multiple treatments. At this point, seeking further evaluation, including cytology, x-rays, and an in-depth examination, is a reasonable step. These tests can help identify any underlying issues that might not be visible through external examination alone. 2. Possible Fungal Infection: Given the persistence of the issue, a fungal infection is indeed a possibility. Fungal infections can be challenging to diagnose and may require specific tests, such as fungal cultures or microscopic examination. Your veterinarian should consider these possibilities during the evaluation. 3. Antibiotics: The administration of antibiotics is often a standard practice when there is an infection, but it's essential to identify the specific pathogen causing the infection to choose the right antibiotic. If your veterinarian suspects a bacterial infection, the change in antibiotics (from cefpodoxime to clavamox) might be based on their assessment of the infection's sensitivity to these antibiotics. However, if a fungal infection is suspected, antibiotics might not be effective.

Hello!  Here are some questions that you might ask your vet in order to aid the decision-making involved in this case:   1) what are the differentials for this case (things that it may be)?  Do they include something like fungal disease, bacterial infection, fracture etc?  Might they include an osteosarcoma? (this may justify chest radiographs)   2) What is the liklihood of their telling the difference between these things from a radiograph?  How confident are they?  If they are not sure, a phone call to the pathologist who handles their samples, radiography specialist or orthopaedic specialist may prove to be useful.  Can this be done relatively quickly?   3) How would these differet things be treated?  Given that finances are a concern, what are the advantages and disadvantages of skipping straight to amputation / biopsy / histopathology and is this a viable option?  4) What is the outlook for each case?   I hope that something here helps with your decision making.