Introduction: Penetrating injuries of the foot are very common. Although apparently straightforward, inappropriate approach and treatment can lead to complications and unsatisfactory results. We present our diagnostic and therapeutic approach using an outcomes approach, clinical results and complication rate.

Patients & Methods: Between 2001 and 2003, 63 patients (57 M and 6 F; mean age- 38, range 8 to 63; follow-up: mean 2.5Y range of follow-up 2–4 years) were treated for penetrating foot injury. Each patient had a routine x-ray and foot sonography. The most common injuries were those that penetrated shoes (45/63 pts) – nails (39/45) and wood pieces (6/45), – or bare feet (18/63 Pts) – nails (10/18), glass (5/18), wood pieces (2/18) and even seashells (1/18). The medical files of all these patients were searched for the relevant parameters.

Results: The presence of a foreign body inside the foot tissues was detected in 58/63 Pts (92%) and they were operated upon by meticulous debridement and removal of FB. In the remaining 5 Pts we could not trace any FB and they were treated initially by IV antibiotics. In these 53 Pts (91%) penetrating foreign bodies were detected by sonography, most of them on arrival. Only 5% of the cases could be diagnosed initially by x-ray. The false negative rate of sonography was 19% (11/58 pts). In 6 of these 11 pts, the presence of FB was detected only by a second sonography. In the remaining 5 pts, foreign bodies were not detected even in the second sonography, but found only during surgery. Complete healing was observed in 62/63 (98%) of patients, although 6 /63 (9%) underwent secondary debridement. One patient (diabetic) developed chronic osteomyelitis of the second metatarsal bone and needed repeated surgical interventions.

Conclusions: In order to avoid complications and poor clinical outcome, penetrating injuries of the foot must be approached in an orderly and appropriate manner. The main purpose is to confirm the presence of a foreign body. Plain x-rays and sonography should be used in order to identify or rule out the presence of FB. Sonography is a good diagnostic technique, but it is operator dependent; thus a high index of suspicion must be maintained when the imaging study is negative and there is no clinical improvement despite appropriate systemic and local treatment. In our experience, repeated sonography and sometimes surgical exploration in such circumstances are likely to reveal the presence of a FB. It should be emphasized that injury 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 fiber, rubber or leather foreign body. Excellent results are observed following meticulous debride-ment combined with systemic antibiotics.