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Discussion in 'General Issues and Discussion Forum' started by conp, Aug 5, 2009.

  1. conp

    conp Active Member

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    Hi Guys,

    A dentist that I play squash with just returned from a trip to Thailand and eagerly awaited my response to his personal 'foot' story.

    The day before he left for Thailand (2 weeks ago), he was walking barefoot in his house when he felt excruciating pain under the 'ball' of his right foot. He immediately inspected the site and noticed a puncture wound under his 2nd MPJ. He could not determine the cause of this puncture wound so he proceeded to clean and dress the area.

    He arrived in Thailand however the pain was still niggling and so he decided to get some antibiotics (of course over-the-counter in Thailand). He thought it was getting better until some extra walking caused him considerable discomfort. So he mustered up the courage and went to a doctor. The doctor poked around the site for a while and suggested that it 'looked ok'. My fellow dentist normally calm and collected was becoming slightly frustrated as his wife and teenage boys suggested he was a bit 'soft'!

    Never any signs of swelling or cellulitis and so at this stage of the story my bet was a piece of glass (as they are difficult to see).

    Last night after taking off his socks he noticed something between the 4th and 5th digits. I have attached 2 low quality photos that he sent me.

    The first photo shows a 20mm fine nail (not the toenail variety but the ones you use the hammer with) EXITING the foot interdigitally between 4th and 5th and if you look closely enough you will see the entry point under the area of 2 MPJ.

    I have never seen anything migrate that far inside the foot!!

    My friend got the response he wanted from me only after I asked whether he had a tetanus shot recently.

    More importantly he holds this nail in his wallet now as a constant reminder to his family that he indeed can never be called 'soft' again.

    Photos are from his iPhone and are low quality.

    Anyone else heard of this before?


    Attached Files:

  2. drsarbes

    drsarbes Well-Known Member

    Hey Con:
    Thanks for sharing that and for taking the time to upload the pics.
    Great story.
    Surprisingly, I have a similar story!
    A few years ago I had an identical acute onset of pain in the medial-plantar area of the first metahead. I was just walking in my home in stocking feet. I could see nothing there! It was not the constant pain as in your friends case, but it did hurt.
    I had pain on and off for several months. It would hurt, then not hurt. I examined the area myself several times but could never see any thing.
    About 6 months later I was in Las Vegas with 3 friends on a golf - guy long weekend and my foot, after golfing 36 holes, was killing me. I had my buddy, an orthopedic surgeon, look at it but he couldn't see anything wrong. The next day, in the middle of another round of golf, it was so painful I had to take my shoe off in the golf cart. It was then that I saw a very small black piece of something sticking out of my foot. I pulled it out and discovered a very think diameter piece of wire about 3/4 of an inch long!!!!!!
    It didn't help my golf game!

  3. W J Liggins

    W J Liggins Well-Known Member

    Serve you right for asking an orthopod! What do they know about feet!

    All the best

  4. shiralee

    shiralee Member

    I treated a woman for heel pain over about an 8 month period, with orthoses. They were successful initially, then every few months she'd be back with the heel pain returning, but just a little bit different than before, so I'd tweak the orthotics and she's go away happy. Eventually she developed a lesion on the heel that she saw he GP about and it turned out to be a piece of glass that had finally made it's way to the outside! She did remember standing on a piece of glass about a year previously, but couldn't remember where it entered the foot. Not exactly the same as the nail, but I was still amazed at the time!

  5. tricia

    tricia Welcome New Poster

    A client of mine had one of the first implannon style contraceptive devices inserted into her arm. Nowadays, these consist of one pin. Back in the eighties, they were using five differrent pins. When she went to get the removed a couple of years later the GP could only find three of them. Subsequent x-ray haven't located them.
    Everytime she comes to our practise she insists we check her feet and legs to see can we find them.
  6. m.tshi

    m.tshi Welcome New Poster

    A lady that i work with stood on a pins about 4 months ago, also still experincing pain on the ball of the foot after her GP told her there was nothing on the area. made app to see me in the next wk, so this will me chek if anything is left behind as she still feels pain in the area
  7. George Brandy

    George Brandy Active Member

    The best one I have personally treated was in my very early days of practice. An old fashioned yard brush bristle gone in plantarly, came out dorsally I/D. It was so long ago I can't even remember which ID space. A good 21/2" long bristle came out with a gentle pull with forceps.

    The one thing that I remember clearly is how unimpressed the patient was.

    Now working in the heart of aircraft industry it is titanium swarf -small needle like shards that can go from foot into my finger like a dart! I am saving them up to make a pair of earings for the better half!

  8. gaittec

    gaittec Active Member

    I had a Diabetic try to heal a plantar ulcer for three years before his DPM found a carpet tack in his foot from going barefoot in a hotel room. My receptionist's diabetic mother had a needle in her heel (found by ankle xray) for several years with no complications. She never had it removed and took it to the grave.
  9. efuller

    efuller MVP

    In podiatry school someone brought in a couple of x-rays taken about a year apart the first one was for when the patient stepped on a needle. it was around the metatarsal heads and pointed proximally. The second film had the same needle under the calcaneus. The second film was taken for some other reason and she was not having symptoms in her heel. I wonder how much pain she would have been from the scar from the attempt at a removal.


    Eric Fuller
  10. toughspiders

    toughspiders Active Member

    I attended to a patient, after treatment i noticed a small open lesion a few inches proximal to medial malleolus. I noticed it had something sticking out of it....looked like a suture. I askeed him about op in that area. Said he had none other than a fem bypass. Consequently, this suture was preventing the wound from healing...so....being the investigative (like to pick) pods that we are. I pulled it....i pulled it...i pullled it....it was over 3 inches long and the non-disposable type!!!

    As you can imagine i fired him back to his GP, to check where it was from and also to see if there was anything else where it shouldnt be!!
  11. Lee

    Lee Active Member

    Had a similar case myself, except the patient had a small, non-healing ulcer at the plantar aspect of her cuboid at the entry point of the needle (and PVD). I gave her an ankle block and attempted removal in clinic, but after 30 mins of fishing I went home empty handed and frustrated. Ended up taking her to theatre to remove the needle under x-ray guidance via a lateral incision. The needle had migrated dorsally, but relatively superficially. The wound healed up within a week and the patient was very happy.

    I also saw a diabetic guy for a 1st IPJ cheilectomy & fusion to his left foot. When I saw him back for a final review with a healed wound, I checked his right hallux out as I noticed 2 small black marks on it - one on the top, one on the bottom. After a bit of persuasion, I removed the 2 inch bristle off a wire brush that was totally impailing his hallux - very cool. Oh, and by the way, I didn't do his pre-op work up to surgery.

    And finally, a teacher friend of mine mentioned he had a painful corn on the bottom of his heel. After the standard chop, I pulled out a one inch dog hair from his heel.
  12. Trudi

    Trudi Member

    I had a diabetic years ago come in with a thumb tack still in his foot between two Met heads. He said he was wondering what the clicking noise was in his tiled kitchen the last couple of days !! Funnily enough the clicking noise always stopped when he stood still to listen ??!!

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