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.

Purpose: The injury occurs when a child passenger sits behind or in front of the rider; his leg gets caught in the rotating wheel’s spokes, and crushed against the frame. The study aimed at reviewing our experience in managing this common injury.

Patients and Methods: Between 2000–2005, 43 children were treated following bicycle spoke injury. All cases were thoroughly reviewed.

Results: Mean age was 5.1 years (range 1–15). Twenty-seven were up to 5 years. Thirty-seven were males, and 7 were females. The right leg was injured in 30 children, and the left in 13. Twenty one were seated behind the rider, and 6 in front of him. Most children were injured in the afternoon and between April and September. Twenty six injured the antero-medial aspect of the ankle and lateral calcaneal region. Twenty nine children had deep abrasions, 11 had abrasion with skin defect, and 3 had laceration. All children had edema and ecchymosis. Eighteen children had fractures. Greenstick fracture of the distal and fibula with anterior and varus angulation was observed in 6 cases. Hospital stay ranged 2–12 days. All fractures were treated non-operatively and healed uneventfully. Soft tissue injuries healed well largely by secondary intention within up to 9 weeks.

Conclusions: Bicycle spoke injury may lead to considerable morbidity and prolonged healing time. The mechanism of injury and management are discussed. The injury may be initially underestimated due to deceptively mild appearance. The prognosis is determined mainly by soft-tissue damage. Preventive measures include ergonomic changes like installing special carriers and spoke-guards.