INTRODUCTION

Puncture wounds to the plantar surface of the foot are seemingly innocuous and common injuries but have the potential for serious complications.

EPIDEMIOLOGY

Puncture wounds of the foot are a common problem encountered by the acute care physician. One study showed that plantar puncture wounds constitute 7.4% of lower extremity trauma seen in the emergency department or office setting. In another series, puncture wounds made up 0.8% of all pediatric emergency department visits. These estimates may be deceivingly low as many puncture wounds are self-treated and present once complications have arisen. There is a seasonal variation, with the highest occurrence in incidence seen in the warm months from May through October when children go barefoot and people engage in more outdoor activities. The vast majority of these are caused by nails (98%). Of the remaining cases, a wide variety of other objects have been described including wood, toothpicks, glass, plastic, rock, bones, coral, straw, bullets, wire, and sewing needles. Infection risk is increased in patients with wounds to the forefoot, in patients wearing shoes when the injury occurred, and in patients with diabetes.

EVALUATION

The complication rate of plantar puncture wounds is dependent on multiple factors that must be considered when determining management. See Table 28.1.

CLINICAL FEATURES

Plantar puncture wound infection may present with the five classic signs of inflammation: rubor (erythema), tumor (swelling), dolor (pain), calor (warmth), and functio laesa (loss of function) (Table 28.2).