II. Pathophysiology
- See Sweaty Tennis Shoe Syndrome
- Foreign body Puncture Wound
- Bottom of foot (plantar) affected in 50% of cases
- Other common sites: Knees, Arms and hands
- Puncture causes
- Nails (account for 90% of cases)
- Other common causes: wood, metal, plastic and glass
III. Causes of Infection
- Soft tissue infections
-
Osteomyelitis (or Osteochondritis)
- Pseudomonas Osteochondritis (90% of cases)
IV. Risk factors for complication (especially infection)
- Depth of wound (most important factor)
- Retained Foreign Body
- Presentation beyond 24 hours
V. Complications
- Osteomyelitis (1-2% of punctures in children)
- Severe soft tissue infection (6-10% of punctures)
- Tattoing of skin by debris (dirt, lead, ink)
- Neurovascular compromise (rare)
VI. Radiology
-
Foot xray
- Consider to identify Retained Foreign Body
- Glass and metal are radio-opaque
-
Ultrasound or Computed Tomography
- Indicated for Radiolucent Foreign Body (e.g. wood)
VII. Management: General
- Administer Tetanus prophylaxis (tetanus Vaccine)
- Clean wound
- Clean external wound edges
- Irrigate, debride and explore larger wound sites
- Under Local Anesthesia or regional Nerve Block
- Clean jagged wound edges
- Remove introduced foreign bodies if possible
- Consider orthopedic removal under fluoroscopy
- Important foot structures threatened
- Foreign body causes pain
- Potential for allergic response
- Avoid harmful procedures or that do not improve outcome
- Avoid high pressure irrigation
- Avoid deep probing
- Avoid extensive debridement or coring
VIII. Management: Antibiotics
- Indications
- Infected wound entry site
- Presentation more than 24 hours after puncture
- Cases in which antibiotics are not usually indicated
- Presentation within 24 hours of infection
- Prophylaxis of pseudomonas infection is not indicated
-
Staphylococcus or Streptococcus Coverage
- Oral antibiotic for Localized Cellulitis
- Cephalexin (Keflex)
- Amoxicillin-Clavulanic acid (Augmentin)
- Dicloxacillin
- Erythromycin
- Parenteral antibiotics for severe infection
- Cefazolin (Ancef)
- Ampicillin-Sulbactam (Unasyn)
- Timentin
- Piperacillin
- Oral antibiotic for Localized Cellulitis
- Pseudomonas aeruginosa coverage
- Local infection: Sweaty Tennis Shoe Syndrome
- Osteomyelitis: Pseudomonas Osteochonditis
IX. Follow-up
- Consider re-examination in 48 hours
X. References
- Gilbert (2002) Sanford Guide, p. 2
- Baldwin (1999) Pediatr Rev 20(1):21-3 [PubMed]
- Wedmore (2000) Emerg Med Clin North Am 18(1):85-113 [PubMed]
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Related Studies (from Trip Database) Open in New Window
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 312609001, 11639007 |
| LNC | LA19027-4 |
| English | Puncture wound, puncture wound, puncture wound (physical finding), wound puncture, prick, pricks, puncture wounds, punctures, puncture wound (diagnosis), Prick, Puncture, Puncture wound - injury, Puncture (morphologic abnormality), Puncture wound - injury (disorder), Puncture, NOS, Puncture Wound |
| Dutch | punctiewonde |
| French | Lésion par ponction |
| German | Punktwunde |
| Italian | Ferita da puntura |
| Portuguese | Ferida por punção |
| Spanish | Herida punzante, herida punzante, herida punzante - lesión (trastorno), herida punzante - lesión, herida punzante -lesión (trastorno), herida punzante -lesión, pinchazo, punción (anomalÃa morfológica), punción |
| Japanese | 穿刺創, ｾ�ｼｿｳ |
| Czech | Bodná rána |
| Hungarian | Szúrt seb |
