Infections of the ankle joint are rare. They most commonly occur as a result of bacteria being introduced into the ankle joint through puncture wounds or trauma. They also occur with a breakdown of the skin over the ankle as a result of ulcerations or abrasions. Patients with impaired immune systems such as those with AIDS , or other immune diseases, are at an increased risk of infections in the joints, including the ankle. Also, patients with diabetes or those who take cortisone medications have an increased risk for bacterial infections of the joints. Bacterial joint infections are serious and require drainage and antibiotics, usually intravenously.
Nonprescription agents have also been used for treatment of onychomycosis ( Table 4 ) . 31 , 33 – 38 These therapies have been evaluated in only a small number of studies involving few patients. Topical mentholated ointment (Vicks Vaporub) was used in a small study involving 18 patients. 37 After 48 weeks, 28% had mycotic and clinical cure, 56% had partial clearance, and 17% had no improvement. Tea tree oil ( Melaleuca alternifolia ) has been evaluated in two studies. Although one trial was favorable, combined data from both studies did not demonstrate significant benefit. 29 , 36 Snakeroot extract ( Ageratina pichinchensis ) is an antifungal derived from plants of the sunflower family. It was studied in a randomized trial involving 96 patients who applied the extract or ciclopirox for six months to nails with confirmed infections. 33 Mycotic cure occurred in 59% of patients receiving the extract and in 64% of those receiving ciclopirox. Clinical cure occurred in 71% and 81% of patients, respectively. Differences between the two treatments were not statistically significant. A small study showed that a combination of cyanoacrylate, undecylenic acid, and hydroquinone (marketed as Renewed Nail) demonstrated mycotic cure in 78 of 154 participants (50%). 34