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Foot punctures

Discussion of medical or rescue topics related to climbing and mountaineering.
 

Re: Foot punctures

Postby Tonka » Wed May 16, 2012 8:45 pm

I had a good buddy on my vollyball team cut his planters last summer on a piece of glass in the lake. The big issue he ended up having was as it healed everything on the outside seemed fine and he could comfortably walk so after a few weeks he rejoined the team. The very first time he went up at the net and came down he dropped to the ground in horrible pain. He says pain on a level he had never felt before. The PF takes a long time to heal so really take it easy. His was a cut not a puncture so hopefuly you'll heal faster but he could not do anything athletic for the rest of the summer outside of walking.
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Re: Foot punctures

Postby Clark_Griswold » Wed May 16, 2012 11:38 pm

Going to Flag for an appt. with an orthopedist tomorrow. This "wait and see" approach some people have is great you aren't the one with the injury. +redness and swelling, + increased pain, looks like an infection.
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Re: Foot punctures

Postby e-doc » Fri May 18, 2012 11:21 am

Sierra Ledge Rat wrote:Cored: cutting a conical shaped hole in the bottom of your foot up through the puncture tract, i.e., cutting out the core of the wound tract.

I would have been very aggressive: coring the wound, placing your leg/foot in a splint, crutches with no weight bearing, antibiotics, etc.

Are you mad?

A simple puncture should heal rapidly. You don't need to throw antibiotics at every wound.
After a few days you likely only have point tenderness but the chance of infection; Pseudomonas, Staph, Strep or other is low. This is provided free of charge from someone who has a medical license. (BTW, I didn't get to all the posts, I got swimmy headed reading everything.) Cheers.
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Re: Foot punctures

Postby MoapaPk » Fri May 18, 2012 5:20 pm

Amputation of the foot may be effective. The foot with the puncture, that is.
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Re: Foot punctures

Postby Clark_Griswold » Fri May 18, 2012 6:22 pm

Well, I went to an orthopod in Flag. When I woke up yesterday, things had improved greatly and I might have considered not going, except with the isolation out here, I wanted a medical opinion that would ease my mind. Not so much about infection, as the overall appearance of the foot had improved to the extent where I doubted this, but on the condition of the fascia. He told me that the infection would have been rapid and extreme, and there simply would have been no doubt if I had developed one. At +48 hours, 2 days ago, the inflammation and pain were simply normal healing, and the overall firmness of the site and adjacent area were nothing much to be concerned with. A radio-graph left him with no impression that the fascia had been punctured. More than likely, a serious infection would have occurred if that had been the case. I am able to bare weight on the foot, and am beginning to walk normally.

I think the short answer to my OP question, is that provided there is no infection, expect 2 to 3 days of non-weight bearing capability, localized pain and swelling, with moderate redness and warmth, and a total recovery of around 7 days to 10 days. I suspect that if the fascia was damaged, it would be more painful at this time and recovery would be substantially longer.
Last edited by Clark_Griswold on Sun May 20, 2012 4:49 pm, edited 1 time in total.
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Re: Foot punctures

Postby SeanReedy » Fri May 18, 2012 6:47 pm

Well, I hope the verdict is that Lionel gets to go on the big hike or at least can get back to hiking soon.

My uncle, the doc/hospitalist in Tuscon (previously in Silver City), also cautions against overuse of antibiotics. My sister in law, the local vet, takes her kids to an old traditional doc who seems to prescribe antibiotics to them often for stuff my kids tough through without prescription medication. Sometimes it seems to me like some folks place an overemphasis on attempting to remove minor suffering from the human condition...Not that any of that really means much coming from someone who is not a doctor.

While not as often as some have described, I too have allowed some hard to remove splinters to puss their way out. Also, I suffered a small surface cut on the bottom of the arch of my foot while walking barefoot at some hot springs Monday. I have simply tried to keep the area clean and put some A+D ointment or antibiotic ointment on it every once in awhile. There is still a lot of point tenderness today. Fortunately/unfortunately, I think it is just a painful area to injure and Lionel's injury sounds much worse than mine. Surely it is less painful than watching this Vegas video while recovering from foot amputation (assuming & hoping there was no serious infection).



Edit: Lionel, glad to hear the good news! At least you'll have a detailed story to think back on and laugh about on your next big hike!
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Re: Foot punctures

Postby MoapaPk » Fri May 18, 2012 8:01 pm

I have a friend who got the broken tip of an agave leaf -- a sharp spike 2-3 cm log -- stuck in his shin in 2009. Perversely, this was a trip down Moapa Peak, while on the cliffs, so we really couldn't just stop. He got down the cliffs, but the muscle action in that time worked the spine deeper into his leg. I tried for about 10 minutes to fish the spine out with sterile tweezers, but I could see that the process was painful, so I stopped and just bandaged the wound. We still had about 2 miles to get back to the car, all on rough terrain, and the spine worked in further. He went to the doc that eve, and the doc just gave him antibiotics. There is still a hard lump there, but the spine seems to have been resorbed by the body -- for the most part (the silica is probably still there).
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Re: Foot punctures

Postby RayMondo » Fri May 18, 2012 11:00 pm

Punctured my foot right through my boot and into the ground with a garden fork, when I was a kid. There was less awareness in those days. Didn't cause me any problems and hardly hurt. Lucky, maybe. Though, seeing as the puncture was top down (clean side), and the dirt cleaned off the fork when I pulled it back through the boot, maybe no dirt or bugs entered.
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Re: Foot punctures

Postby Clark_Griswold » Sat May 19, 2012 5:03 pm

Yeah, mine was up from the bottom, and through a shoe which was both sweaty, so bacteria like Pseudomonas can be an issue, and shoe was filled with sand and other trail dirt. Still, it isn't giving me any reason to suspect it is now infected, and I hope to be back to normal by Monday. Either way, it is the waiting that is the worst part. Where is Larry to post one of his videos? Maybe Tom Petty and the Waiting is appropriate here?
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Re: Foot punctures

Postby Tonka » Sat May 19, 2012 6:19 pm

MoapaPk wrote:I have a friend who got the broken tip of an agave leaf -- a sharp spike 2-3 cm log -- stuck in his shin in 2009. Perversely, this was a trip down Moapa Peak, while on the cliffs, so we really couldn't just stop. He got down the cliffs, but the muscle action in that time worked the spine deeper into his leg. I tried for about 10 minutes to fish the spine out with sterile tweezers, but I could see that the process was painful, so I stopped and just bandaged the wound. We still had about 2 miles to get back to the car, all on rough terrain, and the spine worked in further. He went to the doc that eve, and the doc just gave him antibiotics. There is still a hard lump there, but the spine seems to have been resorbed by the body -- for the most part (the silica is probably still there).

I had an ex girlfriend lodge a bass fishing lure into my leg and I'm sure glad the doc didn't take this approach :)
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Re: Foot punctures

Postby MoapaPk » Sun May 20, 2012 12:03 am

Tonka wrote: I had an ex girlfriend lodge a bass fishing lure into my leg and I'm sure glad the doc didn't take this approach :)


That's why you should never go fishing with ex-girlfriends; they are just waiting for a chance to get even.
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Re: Foot punctures

Postby Sierra Ledge Rat » Sat May 26, 2012 5:28 pm

I just performed another core on another plantar puncture, opened it up and drained some pus, pulled out a small foreign body that wasn't on the x-ray.

I should've just prescribed some antibiotics instead.
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Re: Foot punctures

Postby Clark_Griswold » Sat May 26, 2012 5:36 pm

What was the foreign body? Mine seems to be healing, but not as hoped. It was getting better, but then the other day the plug of material sort of fell out. It bled a little, and I probed it a little. It bled a little more, but is healing. I am surprised how slow the skin is closing. No infection though, but it is a little firm at the site and painful to press on, and can be painful to walk on. I expect this is probably normal with healing. It isn't get worse, just progressing slowly. When I saw the orthopod, he seemed reassuring it was fine.
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Re: Foot punctures

Postby Sierra Ledge Rat » Sun May 27, 2012 2:11 pm

Lionel wrote:What was the foreign body?


Looked like flecks of wood.
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Re: Foot punctures

Postby Clark_Griswold » Thu Jun 14, 2012 2:03 am

So I thought I would provide an update, since I asked how long the healing process might take and there never was a clear answer. I am just now getting to 95% recovery, and the puncture is not completely healed. As recently as two weekends ago, I was able to probe beneath the skin and found a small hole. I don't know if it has filled with tissue, as I haven't probed again. The skin formed a tight ring around the hole, but it was very easy to go beneath that area. I am OK to walk on it, and was alright for a moderate hike 2 weeks ago. I am planning on a slightly hard hike this weekend, but have not been able to go to Colorado to do some mountains as I planned on doing over my longer weekends since mid-May. Fortunately, the weather and timing of the long weekends didn't work out, so that wasn't a huge problem. Still, I have done basically nothing since the event, and that ends up being a little depressing. I can't imagine breaking a leg or having something which requires months of convalescence. Now I just jinxed myself.
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