Gram-Negative Toe Web Infection Treatment & Management

Updated: Apr 07, 2023
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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If a diagnosis of sepsis is considered, an internist with advanced knowledge in infectious diseases should be consulted. Possible deep tissue infection should prompt surgical evaluation.



Patients should be educated on the importance of keeping the toe webs dry. After a shower, the feet and the areas between the toes should be thoroughly dried. Wearing an open-toed sandal or shoe can be beneficial. The risk is higher in individuals who participate in water-related activities.



The patient's lifestyle should be modified to help prevent recurrence of the infection. Patients who engage in water-related sports should shower afterwards and ensure that interdigital spaces are thoroughly dried to prevent creating an environment for bacterial growth. Open-toed shoes or sandals are encouraged in warm weather to allow air to circulate, which prevents perspiration between the toes that can lead to overgrowth of bacteria and can cause infection. The use of gauze pledgets between the toes helps prevent occlusion, and the use of astringent soaps reduces the number of gram-negative bacteria.

The use of rubber boots should be avoided.

The feet should be kept dry if possible. Feet that actually become wet at the workplace rather than simply perspire heavily may be at increased risk of this infection.


Long-Term Monitoring

Patients should have a follow-up visit after completing the course of therapy. Culturing may be performed to ensure that the infection has cleared. Occasionally, when the bacterial infection is resolving, a sudden recurrence and reactivation of an underlying fungal infection may occur because the bacteria can no longer suppress the fungal proliferation.