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Foot punctures

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Foot punctures

Postby Clark_Griswold » Tue May 15, 2012 3:30 pm

Yesterday, while out on a minimal hike to keep in shape for what was to be my main event this coming Saturday, a point cedar know went clean through my shoe and entered my foot to a depth of 1/2 and inch, or 2 CM. Any idea how fast recovery time is for an injury like this, provided it does not become infected. A naturalistic doc :roll: refused to prescribe an antibiotic, but I read a few studies that state a recommendation for antibiotics in foot punctures when an athletic shoe (such as I wore) is involved to prevent Pseudomonas infections. Given the depth and nature of the injure, I'm really disappointed. Either way, without infection, what sort of a recovery time am I looking at?
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Re: Foot punctures

Postby MoapaPk » Tue May 15, 2012 3:42 pm

It may be tough to look at the bottom of your foot... but if you see red streaks radiating out from the puncture site, get antibiotics right away.
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Re: Foot punctures

Postby ExcitableBoy » Tue May 15, 2012 4:28 pm

Puncture wounds like the one you describe are particularly dangerous due to other organisms in addition to Pseudomonas spp. The anerobic soil bacteria, Clostridium tetani, can infect deep puncture wounds where anerobic conditions deep in the wound allow it to grow. This bacteria synthesizes endotoxins and causes a disease called tetanus. If you have not had a tetanus vaccination within the last 10 years you should get one. The vaccination is pretty safe, whereas antibiotics can have serious side effects and should not be taken unless a positive culture indicates a bacteria infection is present. The culture should also indicate the least harmful antibiotic that the bacteris is susceptible to. Also, if you haven't done so yet, the wound should be irrigated with sterile saline using a syringe. This can be effectice at washing out any bacteria and obviating the need for antibiotics. As for recovery time, it is impossible to say. If after a week you are not feeling better I would see a podatrist.
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Re: Foot punctures

Postby ExcitableBoy » Tue May 15, 2012 7:24 pm

I agree with twoshuzz. Unless your health problems are diet related, naturopaths are not going to be super helpful. On the flip side my daughter had a number of health problems that no western doc could puzzle out. A trip to a naturopath determined she was lactose intolerant as well as allergic to some very common foods. A simple change in her diet eliminated all her problems.

Also, naturopaths are weary of antibiotics for good reason, some of them have very serious side effects. I have permanent nerve damage in the entire left side of my body due to a bad reaction to an antibiotic. Most western docs do not consider potential side effects of the drugs they prescribe. A palliative care doc prescribed a ketamine creme for my burns. (Yes, the date rape drug). I asked him if it was safe to use on open, raw skin and he said no problem. I asked the pharmacist the same question and she said "Good G-D, no! I need to call your doc to set him straight!".
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Re: Foot punctures

Postby philoparts » Wed May 16, 2012 12:32 am

I'll agree with the last few posts about seeing a real doc. Tetanus shot, thorough cleaning, watch for signs of infection.....yep, pretty much whats been said already. You may also consider instead of just a Tetanus shot getting your TDAP.

http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-td-tdap.pdf

Pertussis (whooping cough) is at almost epidemic proportions in several states right now, and even though adults may not show any symptoms or their symptoms aren't severe, it is easy to pass on to infants and children where it tends to be a much more severe infection, such as pneumonia. Easy to just get 3 for 1 shot and cost is pretty much the same.
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Re: Foot punctures

Postby Sierra Ledge Rat » Wed May 16, 2012 2:41 pm

Lionel wrote:...A naturalistic doc :roll: refused to prescribe an antibiotic...


One word:

M-A-L-P-R-A-C-T-I-C-E

When your foot gets infected, you have an air-tight malpractice lawsuit.
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Re: Foot punctures

Postby ExcitableBoy » Wed May 16, 2012 3:09 pm

Sierra Ledge Rat wrote:
Lionel wrote:...A naturalistic doc :roll: refused to prescribe an antibiotic...


One word:

M-A-L-P-R-A-C-T-I-C-E

When your foot gets infected, you have an air-tight malpractice lawsuit.


Naturopaths cannot prescribe drugs. No malpractice suit there.

Also, there is no small claims court for medical malpractice. No lawyer will take a case on contingency unless you die, lose a limb, or are otherwise horribly and irrevesibly fucked up. I burst a disk at work. Because it was an on the job injury I went to a 'special' doctor that deals with on the job injuries. These are doctors who are so bad they can't get work even as military or prison docs. The reason for this is L&I pays so little and requires a lot of paperwork. He misdiagnosed me with a muscle pull. The disk became infected and eight torturous months later I had to have two surgies and a 6 week hospital stay to replace two infected vertebrae. The team of four orthopedic surgeons each said it was the largest surgery they had scrubbed in on. My vertebrae were the consistency of "cottage cheese" from the osteomylitis. I was plenty fucked up, but because I had an extrodinarily skillful surgeon I made a good recovery (the L&I doc released me from his care, said I was faking a back injury to scam drugs and time off work so I was able to get a private practice doc. He even misread the MRI, the same MRI the surgeon looked at for 5 seconds and told me I need emergency surgery otherwise I would die). I still have nerve problems and cannot have kids, but returned to running ultra marathons and climbing big hard mountains. No lawyer would take my case, my outcome was simply too good to get a large judgment or settlement.
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Re: Foot punctures

Postby Clark_Griswold » Wed May 16, 2012 6:27 pm

I appreciate the thoughtful response, however, I did not go to a Naturopath. Where I live they don't exist, or not as such. That was why I sarcastically put the rolling eye thing there. I went to where I work, initially just hoping to have one of the docs (either MD or Do) inspect the foot to make sure no debris or splinters were imbedded. Not expecting to be told I needed to be concerned with Pseudomonas, I planned to irrigate the wound and dress it with some bacitracin (basically all that happened). It was only after I talked with my boss and he told me about the need for antibiotics due to the shoe being involved in the puncture, that I decided to be officially seen. The MD refused oral antibiotics on the grounds of my youth and relative health. Having checked into an ER (for something I would never do in the real world, but for 100 miles in any direct, that is all there is) and now expecting to pay a lot of money as a result (they won't take the insurance they offer their own employees) I was really angry I bothered to check in. However, life is like that.

Following up with my boss, who consulted our Medical director, there are two schools of thought on this type of wound and infection. 1) Prescribe antibiotics all the time. and 2) wait and see, and then treat accordingly. Reason being, due to the avascular nature of the subcutaneous fascia, antibiotics will not effectively penetrate that tissue and a latent infection can then result in a bad cellulitis, once the wound has healed on the outside and the medication ceases. If an infection does occur, it needs to be treated surgically, debrided, and antibiotics used to control the infection at that time. This would be very bad. Obviously.

I really hope I have no infection and it looks like that may be the case ( infection free). Inflammation is coming down, and I can palpate gently around the puncture where yesterday it was severely painful. I never had more than moderate inflammation at the site, no streaking, and no drainage other than some serous-sanginous fluid of scant amount. At the time of the puncture, and after removing the stick and taking off my shoe and sock, I brushed away some fatty tissue that was removed from the wound with the stick. There were some pieces of fat that were hanging out, and after irrigation, I reinserted these into the wound. BTW, if you ever have tissue hanging out of a wound and think you want to remove it rather than reinsert it, don't pull on it. It hurts in a really bad way. The wound has closed on it's own.

The main issue today is that I can not really bare weight on the foot, and I walk on the outside of it. Provided I have no infection, I am now primarily concerned with the level of damage I did to my plantar fascia. If it is minimal, I may be fine by the weekend as the puncture heals. If I scraped or punctured the fascia, I don't know how long that will take to heal. I really have no way to determine this, other than to travel to a real town and potentially have an MRI done. That is, if an appointment can be made. It may be moot anyway, as there may be no real difference other than knowing it will take 4 to 6 (or more) weeks to heal vs 4 to 6 days of recovery.

I would like to know if anyone has had a similar injury, and if so, what recovery time was like. Infection aside, the complex nature of the foot and the level of wear it is subjected to can really complicate things. Apparently, one small accident can be disastrous, where a similar injury a mere foot (no pun intended) up the leg would be relatively benign and could be a lot less involved from a convalescence point of view.

Oh, and I am sure I had a Tdap in October when I began working, but it was never charted, so when I was being seen, it was advised I get one. I agreed, since even if I was sure I had one, not charted means it was never done. Anyway, I clearly must have had one, as I had some of the symptoms of a minor reaction to a Tdap when two immunizations are given too close together. I woke up yesterday with the loudest ringing in my ears I have ever had. It was loud and bizarre, and would not go away for about 10 minutes. At least I won't get tetanus.
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Re: Foot punctures

Postby Sierra Ledge Rat » Wed May 16, 2012 6:57 pm

I have never seen a plantar puncture wound that didn't get infected. At the very least the wound should have been "cored" to enable it to drain and to prevent it from closing up.

Pain and inability to bear weight, in excess of what can normally be expected for such an injury, is an early sign of infection.
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Re: Foot punctures

Postby Clark_Griswold » Wed May 16, 2012 7:05 pm

At 44 hours post injury, shouldn't things be visibly worse, if an infection is developing. Overall, appearance is improving. When I write "bare weight", I mean stand on the foot normally. With my flat feet, this tends to result in more medial stretching of structures than a normal foot would encounter.

When you say "cored", what do you mean? It was irrigated with 20 ml of sterile saline and a catheter which was inserted into the puncture, but nothing more was done internally. I was annoyed I had to ask the doc to have this done. This person seemed to want my body to do everything. Which was shocking. Her response to my concern over foreign objects such as sand or splinters being in the wound was, "the best thing is for your body to pustulate those out". Really?! The best thing is to develop an infection and not to clean the wound to allow for a rapid, non-infectious recovery?
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Re: Foot punctures

Postby Sierra Ledge Rat » Wed May 16, 2012 7:41 pm

Without seeing you, I can't say. You have to decide if you're healing at the expected rate.

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.
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Re: Foot punctures

Postby MoapaPk » Wed May 16, 2012 8:15 pm

"the best thing is for your body to pustulate those out". Really?! The best thing is to develop an infection and not to clean the wound to allow for a rapid, non-infectious recovery?


A splinter can pustulate out without a severe infection setting in. I've had big pieces of cactus spines that have been in me for weeks to months, then suddenly popped out (you can imagine the rest of the stuff that comes out). But once I had a spine wound that got infected, and within 2 days I had red streaks radiating out from the site. The doc immediately gave me antibiotics. The streaks cleared up within a day, and eventually the spine popped out in the normal way.

On average, I have had at least one large spine/splinter per month for 10 years-- the foreign objects either came out by pustulation, or via sharp knife and tweezers. Only that one got badly infected; that spine punched up through the side of my boot, probably taking a lot of skin flora with it.
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