Introduction: Penetrating injuries of the foot
are very common. We present our diagnostic approach and therapeutic management in
these patients.
Patients and Methods:
Our study population consisted 63 patients (mean age 38 years, range 8-63)
who were treated for penetrating foot injuries and found to have a foreign body.
Each patient underwent x-ray and foot sonography. 45/63 patients suffered
injuries that penetrated through shoes (metal nail 39/45, wood 6/45). 18/63
patients were barefoot (metal nail 10/18, glass 5/18, wood 2/18, seashell
1/18).
Results: Presence of a foreign body (FB) in
the soft tissues of the foot was detected by initial sonography in 47/63; in an
additional 11/63 patients FB was discovered in follow-up sonography; in 5/63
patients the FB was not discovered by imaging, but was found during surgical
exploration. All patients underwent surgery including meticulous debridement
and removal of FB. Complete healing was observed in 62/63 (98%),
although 6/63 (9%) required secondary debridement. One diabetic patient developed
chronic osteomyelitis of the second metatarsal and required repeated surgical
interventions.
Conclusions: Penetrating injury of the foot is a
challenging clinical problem, and a good outcome demands a systematic approach.
Radiography and sonography are mainstays for discovering a FB, but sonography is
operator dependent; thus a high index of suspicion must be maintained when sonography
is negative and there is no clinical improvement despite appropriate systemic
and local treatment. In our experience, repeated sonography and even surgical
exploration in such circumstances are likely to reveal the presence of a FB.
Injuries through a shoe rather than a bare foot may result in local infection
secondary to the penetrating object and also complications related to the
additional presence of penetrating fiber, rubber or leather foreign body.
