OrthoDx: Foreign Body in Toe

Slideshow

  • Figure 1. Anteroposterior view of the foot showing a foreign object.

  • Figure 2. Oblique view of the foot.

  • Figure 3. Lateral view of the foot.

A 25-year-old man presents with right foot pain after stepping on a pencil tip 1 week ago. The pencil tip pierced his second toe in a plantar to dorsal direction.  He had erythema 2 days later and was placed on doxycycline; the erythema and pain have improved. The patient presents with concerns about the retained foreign body, which he believes is the graphite tip of the pencil. Radiographs of the second toe confirm what appears to be a pencil tip lodged in the soft tissues of the medial second toe (Figures 1, 2, and 3).

Retained foreign bodies are frequently seen in the medical setting and can lead to allergic, inflammatory, and infectious complications. As in this case, pencil puncture wounds often cause retained graphite from the pencil core. The vast majority (80%) of foreign...

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Retained foreign bodies are frequently seen in the medical setting and can lead to allergic, inflammatory, and infectious complications. As in this case, pencil puncture wounds often cause retained graphite from the pencil core.

The vast majority (80%) of foreign bodies can be seen on radiographs, however low- density objects such as wood may be more difficult to see. Computed tomography (CT) offers improved visualization of wood, while magnetic resonance imaging (MRI) is less ideal for identifying wood objects but better at viewing surrounding inflammation and fluid, if present. Ultrasonography offers the best study to view wood foreign bodies but visualization is operator dependent and unlikely to be seen with inexperienced hands.1,2

Nonorganic foreign bodies often pose no problems and can be left in place without fear of migration. Organic foreign bodies such as wood or plant material are more likely to cause a reaction and require removal. Foreign bodies that cause pain with weight-bearing, are located in a joint, or cause a chronic sinus wound should be removed. This often requires anesthesia in the operating room setting to explore the soft tissues. It is challenging to make sure all foreign body material is removed during surgical excision. Wounds typically heal well if all foreign body material is removed successfully.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.

References

1. Halaas, GW. Management of foreign bodies in the skin. Am Fam Physician. 2007;76(5):683-688.  

2. Sidharthan S, Mbako AN. Pitfalls in diagnosis and problems in extraction of retained wooden foreign bodies in the foot. Foot Ankle Surg. 2010;16(2):e18-e20. doi:10.1016/j.fas.2009.04.006

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