Abstract
Purpose: Nail punctures of the foot initially appear deceptively mild. Most reported series relate to injuries in children mostly complicated by pseudomonas infection. The study aimed at reviewing our experience of managing plantar puncture injuries.
Methods and Patients: The medical charts of 350 patients treated and followed between 1995 and 2000 were reviewed. Data collected included wound classification according to Alson, wound location, management, isolated pathogens, and complications.
Results: 151 patients had superficial wounds (Alson I) treated with oral antibiotics. Of the 199 patients who were admitted (Alson II– IV), 74% were construction workers, average age was 24.5 years, 35% presented within 24 hours after injury, 68% of wounds were located at forefoot (23% and 21% at first and second MTPJs areas respectively), 21% were in midfoot, and 11% in hindfoot. 44% were treated with intravenous antibiotics, 30% had plantar incision and drainage, 14% had plantar and dorsal incision and drainage, and in 12% arthrotomy or bone debridement were also needed. Different pathogens were isolated mainly staphylococcus (36%). Retained foreign bodies were identified in 14 cases. Septic arthritis and osteomyelitis developed in 11% and 4% of cases respectively.
Conclusions: Adult and children puncture injuries seem to behave differently, including risk for complications, and bacteriology. Clinical vigilance and early treatment are crucial. Forefoot injuries occur at the heel-off stage of the stance phase, and the nail is pushed with a high ground reaction force. The injury is therefore deeper, usually involving an MTPJ space and consequently more liable to complications.
The abstracts were prepared by Orah Naor, IOA Co-ordinator and Secretary. Correspondence should be addressed to Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
