Contracture of the Third Toe as a Delayed Presentation of a Foreign Body in the Foot

Abstract

Foreign body retention in the foot after a penetrating injury is an unusual occurrence with varied presentation. A degree of suspicion needs to be present in situations where there is an inexplicable swelling, sinus, abscess, or tenderness. The authors present a case with a contracture of the third toe that had been caused by plantar fascial fibrosis secondary to retention of a rubber foreign body in the foot. This case report highlights the fact that an ultrasound to rule out retention of the foreign body might be a judicious investigation if common causes of toe contracture are excluded. It may also have therapeutic implications.

Intraoperative Ultrasound Guidance for the Removal of Nonmetallic Foreign Body from the Foot

“…Puncture wounds to the plantar surface of the foot are typically reported in individuals who are walking barefoot in their homes 3,4 or in underdeveloped countries. 5 Because of its porous consistency and organic nature, wood is an excellent medium for microorganisms and, if retained, may lead to cellulitis, abscess, or fistula formation as well as synovitis or osteomyelitis. 6 When the wood initially enters the body it may be predominately filled with air; however, over time, its porous nature allows it to absorb surrounding fluids, thus increasing its attenuation.…”

“…The multiple attempts to debride and the misdiagnosis, respectively, characterize the failure of early detection. 5 Such a delay in diagnosis is what may lead to recurrent cellulitis and ultimately to potential of osteomyelitis. 9 As with our second case, it is not uncommon for the delayed presentation to lead to an initial physical examination that mimics a soft tissue malignancy.…”

Orthopedic approach to foreign body injuries

“…In these circumstances, the open wound is sutured in most cases; however, the patient's complaints continue related to the type of the remaining foreign body [14]. The foreign body, which could not be detected, may lead to problems such as infection, chronic pain, stinging, swelling, loss of function, and contractures [15].…”

Therapeutic Dermoscopy to Facilitate Detection and Extraction of Foreign Bodies

“…1 Despite the seemingly benign character of an injury caused by stepping on a thorn or an unrecognized sliver of glass finding its way deep into the thick epidermal layer of the plantar skin, such events may lead to hospitalization, surgery, or even long-term complications such as tumors, contractures, infections, and chronic ulcers. [2][3][4][5][6] If ignored, imaging may be needed to locate the penetrating object. 7,8 It is assumed that clinicians would welcome a technique enabling prompt diagnosis and removal of most foreign bodies before the onset of difficult-to-treat complications.…”