WHAT WOULD CAUSE A HOLE BETWEEN MY PINKY TOE AND THE NEXT…

That's fine. Tinea Pedis (a fungal infection on the foot and often between the toes) is statistically the most common cause of skin breakdown and fissuring between the fourth and fifth toes, and is also the most common reason why people, especially immune-compromised people like diabetics (and others as listed in my initial post), develop bacterial cellulitis involving the foot. The tinea pedis creates a breakdown in our skin that normally prevents bacteria from entering our system or deeper tissues. These are irrefutable facts.

You asked me what would cause your symptoms, and I listed the most common cause. Are there others? Yes, perhaps ... but there is no way to tell without seeing you and examining you, and performing confirmatory tests, which in some cases may include the KOH prep, cultures, or skin biopsy (less likely). The purpose of my answer was NOT to diagnose you, but rather to provide accurate and useful information that helps you to help yourself.

To quote eMedicine physicians, researchers, and editors as well: 'The interdigital (between the toes) presentation is the most characteristic type of tinea pedis, with erythema, maceration, fissuring, and scaling, most often seen between the fourth and fifth toes.'

Your question was "What would cause ...." and my answer was accurate, succinct, and evidence-based. I also recommended seeing your physician for further confirmatory evaluation and possible testing.

The information I presented to you is based upon my training in Orthopaedic Surgery, under Dr. Curtis Steyers, at the Univeristy of Iowa, one of the top Orthopaedics programmes in the World; and my training at the Mayo Clinic (Rochester, MN) in Internal Medicine Critical Care Medicine, and further post-fellowship education and training at Harvard University in Cambridge, MA. Mayo and Harvard are, and always have been, among the top training programmes in the World in my areas of specialty.

The information presented to you is also in direct agreement with another JustAnswer.com Expert and senior Mentor, as well as the authors and editors, a who's who in Dermatology and Dermatopathology, of the eMedicine topic dealing with Tina Pedis, including:

Authors:

• Courtney M Robbins, MD, Resident Physician, Department of Dermatology, University of Alabama at Birmingham.
• Boni E Elewski, MD, Professor, Department of Dermatology, University of Alabama at Birmingham.

Editors:

• Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle.
• Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
• Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
• Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
• William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine -- Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

Good luck with your Podiatry appointment. I hope this information helps you to be able to discuss your healtth concerns with more confidence and a sense of being more well educated in your own health than prior to coming to JustAnswer.com .... again, we're not here to diagnose you or become your Internet Physician, but to provide information for you to help yourself. It seems you are doing that nicely.

Kindest Regards,
***** *****, MD