GPAtlas🧭 When to suspect
A felon is an acute infection of the closed pulp space of the distal phalanx (the fingertip pad).
• The pulp is divided by tough fibrous septa into many small compartments, so infection raises pressure rapidly inside an unyielding space.
• The pressure produces intense, throbbing pain and risks ischaemic necrosis of the pad and osteomyelitis of the underlying bone.
• The usual organism is Staphylococcus aureus.
• Most follow a minor penetrating injury (splinter, thorn, needle, or a diabetic capillary glucose finger-prick).
The two clinical priorities are simple:
• Recognise and decompress a tense felon (antibiotics alone are often insufficient once pus has formed).
• Do not mistake it for the two conditions it most resembles – acute paronychia (a nail-fold infection) and herpetic whitlow (a viral, vesicular infection that must never be incised).
| Condition | Typical features | Key management difference |
|---|---|---|
| Felon (pulp space) | • Tense, shiny, exquisitely tender fingertip pad • Closed-space throbbing pain |
Antibiotics plus incision & drainage if tense or fluctuant |
| Acute paronychia (nail fold) | • Red, swollen, tender nail fold ± pus • Pulp not primarily involved |
Antibiotics ± drainage of nail-fold pus |
| Herpetic whitlow (HSV) | • Grouped non-purulent vesicles • Prodromal tingling • Pulp typically not tensely swollen |
• Self-limiting • Aciclovir if early – never incise |
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