II. Pathophysiology
- Puncture through Rubber soled shoe
- Classic example is sweaty tennis shoe
III. Complications
- Osteomyelitis (osteochondritis)
IV. Symptoms
- Persistant symptoms >4 days post-Plantar Puncture Wound
V. Signs
- Metatarsal neck to distal toes most often affected
VI. Labs: Evaluation for Osteochondritis
- Complete Blood Count (CBC)
- Erythrocyte Sedimentation Rate (ESR)
VII. Radiology: Evaluation for Osteochondritis
VIII. Differential Diagnosis of Osteochondritis from puncture
- Pseudomonas Osteochondritis (90% of cases)
- Beta-hemolytic Streptococcus
- Klebsiella
- Serratia marcescens
- Bacteroides Melaningogenicus
- Escherichia coli
- Proteus mirabilis
- Staphylococcus aureus
- Salmonella typhi
IX. Management: Antibiotics
- Prophylaxis of Pseudomonas infection is not indicated
- Suspected Sweaty Tennis Shoe Syndrome
- Ciprofloxacin (avoid under age 16 years)
- Pseudomonas Osteomyelitis (Osteochondritis) coverage