II. Pathophysiology
- See Sweaty Tennis Shoe Syndrome
- Foreign body Puncture Wound
- Bottom of foot (plantar) affected in 50% of cases
- See Sweaty Tennis Shoe Syndrome (infection with Pseudomonas Aeruginosa)
- Other common sites: Knees, Arms and hands
- Bottom of foot (plantar) affected in 50% of cases
- Puncture causes
- Nails (account for 90% of cases)
- Other common causes: wood, metal, plastic and glass
III. Causes of Infection
- Soft tissue infections
- Staphylococcus
- Streptococcus
- Pseudomonas Aeruginosa (Sweaty Tennis Shoe Syndrome)
- Mixed flora (toothpick Puncture Wound)
-
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 Plantar Puncture Wounds 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 soft tissue Ultrasound for foreign body localization
- 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 Puncture Wound
- Prophylaxis of Pseudomonas infection is not indicated
-
Staphylococcus or Streptococcus Coverage
- Oral Antibiotic for Localized Cellulitis
- Cephalexin (Keflex)
- Amoxicillin-Clavulanic acid (Augmentin)
- Dicloxacillin
- Erythromycin
- ParenteralAntibiotics 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
- (2019) Sanford Guide, accessed on IOS 2/17/2020
- Baldwin (1999) Pediatr Rev 20(1):21-3 [PubMed]
- Rubin (2010) J Foot Ankle Surg 49(5):421-5 [PubMed]
- Wedmore (2000) Emerg Med Clin North Am 18(1):85-113 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| 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 (anomalía morfológica), punción |
| Japanese | 穿刺創, ｾﾝｼｿｳ |
| Czech | Bodná rána |
| Hungarian | Szúrt seb |
Ontology: Puncture wound of foot (C0273410)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 17288006 |
| English | foot puncture wound, foot puncture wounds, Puncture wound of foot, puncture wound of foot (diagnosis), puncture wound foot, puncture wound of foot, Nail bind, Pricked foot, Puncture wound of foot (disorder) |
| Spanish | herida punzante del pie (trastorno), herida punzante del pie |
Ontology: Puncture wound of sole of foot (C0561415)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 283543003 |
| English | Puncture wound of sole of foot, Puncture wound of sole of foot (disorder) |
| Spanish | herida penetrante en la planta del pie (trastorno), herida penetrante en la planta del pie |
